Tuesday, March 12, 2019 | 1:25 – 2:15 p.m. LACC, 507 The UCLA Trans Wellness Team: Building Trans Affirming Services in College Counseling and Student Health Centers Tuesday, March 12, 2019 | 1:25 – 2:15 p.m. LACC, 507

Today’s Workshop Introduction of presenters and overview of the institution (5 minutes) Presentation of a model for building an interdisciplinary trans team on campus (10 minutes) Recommendations and discussion of perceived and actual barriers to this work (10 minutes) Problem solving activity to address barriers specific to each campus (20 minutes)

Today’s Presenters Counseling and Psychological Services Saeromi Kim, PhD, she/her/hers, Assistant Clinical Director Arthur Ashe Student Health and Wellness Center Kate Mulligan, MA, she/her/hers, Clinical Coordinator Monique Vaillancourt, NP, she/her/hers, Transgender Health Clinician Sam Elias, MD, he/him/his, Interim Medical Director (not present) Transgender UCLA Pride (TransUP) Student Organization Kai Huang, he/him, they/them, Undergraduate Student Representative

Definitions and Misconceptions Language Gender diversity No typical gender narrative Research is growing, many unknowns We can leave slide as is and just talk or refer to notes during the presentation Transgender is an umbrella term used to describe people whose gender identity, one’s inner sense of being male, female, or other, differs from the sex assigned to them at birth.  Gender-nonconforming people are people whose gender expression, the outward communication of gender through behavior or appearance, differs from expectations associated with the sex assigned to them at birth or sex they are perceived to be.  It’s complicated - fluid, language does not do it justice WPATH – only recently began to address nonbinary people’s needs Language is fluid -what no longer feels inclusive, what is problematic: MTF, etc (just one or two examples)

UCLA Quick Facts Public research institution in Los Angeles, California Student population: 45,000 31,000 undergraduate 14,000 graduate Affiliated medical system UCSHIP Student Health Insurance (Anthem Blue Cross) The Top 10 Trans-Friendly Colleges and Universities, Campus Pride Examples of progress Examples of non progress Kai – examples of progress and non-progress under fact about UCLA being LGBTQ friendly – these are in your notes for yourself Affiliated medical system: UCLA Health (four hospitals on two campuses and more than 170 community clinics in southern California UCSHIP- 28,653 students enrolled in UCSHIP for fall 2018 (many students utilize the UCSHIP benefit) - Transgender medical benefits added 2009/2010 policy year

Transgender Medicine Demographics 75 active students, February 2019 100 total students since program formalization in 2016 60% traditional undergraduates 40% transfers, returning students, and graduate students Age range 17-44 Equal distribution among non-binary people, trans women, and trans men Age range detail: 50% are 18-22, 45% are 23-35, and 5% over 35

Trans Wellness Team Goals Increase care coordination and communication among medical, mental health, and case management providers Provide case consultations for CAPS clinical staff Share updates about trans resources on campus and collaborate with students and campus partners Provide relevant, aggregate feedback re: trans students’ needs to campus partners

First gender identity support group offered at CAPS Timeline 2018-2019 Trans Wellness team expands to include more campus partners, student reps, UCLA Gender Health 2017-2018 Trans Wellness team starts meeting monthly to discuss work flow, staff development opportunities, clinical case consultations Summer 2017 Trans Care continuing education for CAPS and Ashe providers and Trans Allyship Training for campus partners 2016-2017 Ashe Student Health Center begins hormone replacement therapy (HRT) services 2012-2016 Students referred out for most medical transition needs, letters provided 2011-2012 First gender identity support group offered at CAPS the gender therapy group has been essential in communicating needs and making visible what is missing in our systems, setting the course for the creation of this committee.

Trans Wellness Team Members Ashe Student Health Center Student Representatives Monique Vaillancourt, Primary Care Provider Kai Huang, Undergraduate Student Sam Elias, Interim Medical Director Esther Nikbin, PhD Student Kate Mulligan, Clinical Coordinator Elvire Van Spall, Insurance Assistant Researcher/Community Advocate (and UCLA student)   Counseling and Psychological Services (CAPS) Sid Jordan, PhD Student Saeromi Kim, Assistant Clinical Director LGBT Campus Resource Center Tina Williams, Senior Clinical Coordinator Megan van der Toorn, Assistant Director Dee Chappelear, Staff Psychologist Andy Cofino, Director Jade Garneau-Fournier, Staff Psychologist Steve Sager, Staff Psychiatrist UCLA Gender Health Program Amy Weimer, Co-Director Christopher Mann, Care Coordinator

Trans Wellness Team Network

Ongoing Projects In effect: Hormone replacement therapy protocol Case consultations Case management Collaborations and referral network In process: Changes in electronic medical record Training staff Quality assessments for referrals Clinician and student guides In effect: Also, supporting other campus/environmental efforts like gender neutral bathrooms and preferred name on student ID, some campus systems In process: EMR changes: direct online scheduling for trans appointments at SHS, ability to list preferred name/pronoun/gender identity, eliminate legal name from messaging Staff training on gender neutral pronouns /use of preferred names/creating safe space. Review and update of forms/fliers/educational materials

Medical Provider Role Hormone replacement therapy, both initiation and continuation Surgical referrals Preoperative physical exams Referrals for electrolysis/laser hair removal and vocal therapy Referrals for fertility preservation Age appropriate primary care services Completion of surgery letters and forms for name changes at state/national level HRT: estradiol/androgen blockers/testosterone/progestins Surgical referrals: mastectomy/augmentation/tracheal shave/facial feminization/laryngeal surgery/metoidioplasty/phalloplasty/vaginoplasty/orchiectomy, Primary care: Immunizations/STI screening/pregnancy prevention/PrEP/screening for metabolic illness, Screening for depression/anxiety/PTSD/substance use/violence/self harm/eating disorders

Mental Health Provider Role Exploration of gender identity Explore diversity of gender identities and expression Options available for alleviating gender dysphoria Coming out, social transition, coping with minority stress General mental health issues (not necessarily related to gender identity) Access to medical and legal procedures, other campus referrals Advocacy Preoperative assessments Diagnosis of gender dysphoria Capacity to make informed consent Assessing for specific criteria (e.g., length of hormone therapy) Overall psychosocial functioning and support Health literacy (awareness of risks, aftercare required, impact on fertility) Capacity for self-care Support support structure Housing and Transportation Presence of co-existing behavioral health concerns does not prevent someone from pursuing gender affirming procedures as long as conditions can be well-managed Impact of minority stress

Case Manager Role Help students minimize the impact of illness, injury, and emotional distress on their academic careers through coordination of services from campus and community resources Campus Resources Medical Care Community/Advocacy Counseling center Assist with referrals to specialists and surgeons Locate and maintain community resources, ex: electrolysis providers Disability office (CAE) Financial aid & economic crisis response team Navigate insurance benefits Assist with legal name change letters LGBT center Help generate and organize surgery letters Housing & residential life Advocate for students in difficult situations, ex: misgendered students Student legal services

Student Representative Role and Perspective Campus Life: Challenges and areas of progress Support systems: Transgender UCLA Pride student org (TransUP), UCLA LGBT CRC, CAPS groups, other LGBTQ student orgs, etc. Student role: Challenge of representing diversity of views Challenge of inclusivity: trans community - have people who do not engage because they don’t feel they need it, don’t feel safe, or they haven’t been able to make those connections, or are shy, scared, busy, etc. Recommendations Kai –please feel free to edit

Essential Questions Are services accessible? Are spaces safe and welcoming? Are you building and assessing competence in trans care? Are you collaborating with students and community members? Are you working with an interdisciplinary team to address overall wellbeing? Are providers experienced in trauma informed care? Comfortable Competent Accessible Staff training Forms Waiting areas Bathrooms Gender Identity data Terminology Information access Needs Assessments

Recommendations Assess campus resources Smaller places – assess community resources Remote places – online resources Seek out and engage in ongoing learning about best practices Involve students early Formal student representation on team Seek student perspectives on actual student practices like information gathering and social networking Strategize and find avenues for advocacy Who can you ask, what to ask for? Identify staff who are interested in becoming experts in this area of care and provide ongoing professional development Kai – student perspective –see what he sent. Add or just narrate? – dynamic field

Recommendations, summary If you are a medical or mental health provider Advocate for and invest in professional development: WPATH, UCSF Trans health Connect with campus, local or regional providers for consultations Advocate for a seat at (or create!) a campus wide committee on trans wellness If you are in leadership and/or higher administration Support relationships – LGBT centers, CAPS, Health Centers Increase support for direct providers – medical management, referrals, insurance verification and education Support funding for ongoing professional development Student affairs staff would look very similar so did not include: partner with CAPS and health centers, advocate for funding and prof dvlpt, help build an interdisciplinary team, help connect with students, listen to providers who have important information about the most vulnerable populations

Small Group Activity Group by size or type of institutions, professional roles, stage of implementation Identify and problem solve challenges Identify gaps in services, gaps in knowledge Q&A

Resources and References Center for excellence in Transgender Health:http://transhealth.ucsf.edu/trans?page=guidelines-clinic-environment WPATH: http://www.wpath.org Williams Institute: https://williamsinstitute.law.ucla.edu/category/research/transgender- issues/ Fenway Institute: http://fenwayhealth.org/care/medical/transgender-health/ Active Minds: http://www.activeminds.org/transgender-college-student-mental-health Chang, S. C., Singh, A. A., & dickey, l. m. (2018). A clinician's guide to gender-affirming care: Working with transgender and gender nonconforming clients. Oakland, CA: Context Press. Oswalt, S.B.; Lederer, A.M. Beyond Depression and Suicide: The Mental Health of Transgender College Students. Soc. Sci. 2017, 6, 20. Stolzenberg, E.B., Hughes, B. (2017) The Experiences of Incoming Transgender College Students: New Data on Gender Identity, Association of American Colleges and Universities

Contact information Saeromi Kim, PhD Assistant Clinical Director UCLA Counseling and Psychological Services John Wooden Center West Los Angeles, CA 90095 skim@caps.ucla.edu 310-825-0768 Monique Vaillancourt, NP Transgender Health Clinician UCLA Arthur Ashe Student Health and Wellness Center 221 Westwood Plaza MVaillancourt@ashe.ucla.edu 310-825-4073 Kate Mulligan, MA Clinical Coordinator kmulligan@ashe.ucla.edu 310-206-7171

See you next year in Austin, Texas! Thank you! See you next year in Austin, Texas!