1. 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

2. 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)

3. 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

4. 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)

5. 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

6. 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

7. 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

8. First gender identity support group offered at CAPS
Timeline
Trans Wellness team expands to include more campus partners, student reps, UCLA Gender Health
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
Ashe Student Health Center begins hormone replacement therapy (HRT) services
Students referred out for most medical transition needs, letters provided
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.

9. 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

10. Trans Wellness Team Network

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. Resources and References
Center for excellence in Transgender Health:
WPATH:
Williams Institute: issues/
Fenway Institute:
Active Minds:
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

21. Contact information
Saeromi Kim, PhD
Assistant Clinical Director
UCLA Counseling and Psychological Services
John Wooden Center West
Los Angeles, CA 90095
Monique Vaillancourt, NP
Transgender Health Clinician
UCLA Arthur Ashe Student Health and Wellness Center
221 Westwood Plaza
Kate Mulligan, MA
Clinical Coordinator

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