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Identify, Engage, Understand: Supporting Transgender Youth in an Inpatient Psychiatric Hospital

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Abstract

Transgender adolescents may require for inpatient psychiatric care, and have unique healthcare needs and can face barriers to quality care. This study sought to address limited understanding of the inpatient experience of transgender adolescents. This study uses qualitative methods to gain insight into the experience of transgender adolescents and psychiatric care providers on an adolescent inpatient psychiatric unit in the northeast United States. Semi-structured interviews were conducted with patients (9 total, ages 13–17) and unit care providers (18 total). These interviews were recorded, transcribed, and analyzed using inductive thematic analysis. Patients and providers generally reported a supportive inpatient environment. Factors that contributed to this environment were efforts by care providers to respect patients regardless of gender identity, to use patient’s preferred identifiers, and to acknowledge mistakes in identifier use. Barriers to consistently supportive interactions were also identified, including a lack of consistent identification of a patient’s transgender identity in a supportive manner during the admission intake, challenges associated with the presence of birth-assigned name and gender within the care system (e.g. in the electronic medical record, identifying wristbands, attendance rosters), and a lack of formal training of care providers in transgender cultural competency. Interviews also provided insight into how providers grapple with understanding the complexities of gender identity. Findings suggest that gender-affirming approaches by providers are experienced as supportive and respectful by transgender adolescent patients, while also identifying barriers to consistently supportive interactions that can be addressed to optimize care.

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Authors and Affiliations

  1. Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, 06511, USA

    William Acosta & Zheala Qayyum

  2. Division of Child & Adolescent Psychiatry, Massachusetts General Hospital, 25 Parkman Street, WAC 812, Boston, MA, 02114, USA

    Jack L. Turban

  3. Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University and Butler Hospital, 345 Blackstone Boulevard, Providence, RI, 02860, USA

    Gerrit Ian van Schalkwyk

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  1. William Acosta
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Correspondence to Gerrit Ian van Schalkwyk.

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Conflict of Interest

Authors Turban and van Schalkwyk are currently co-editing a textbook on pediatric gender identity for Springer.

Informed Consent

Informed assent was obtained from all patient participants, explaining study procedures and the voluntary nature of their participation. Patients who agreed to participate were then asked for permission to contact their legal guardian for informed consent. Informed consent was also obtained from care providers who participated voluntarily.

Ethical Approval

All procedures performed were in accordance with ethical standards of the institutional research committee of the participating hospital system. Approval was obtained from the Institutional Review Board prior to study initiation.

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Acosta, W., Qayyum, Z., Turban, J.L. et al. Identify, Engage, Understand: Supporting Transgender Youth in an Inpatient Psychiatric Hospital. Psychiatr Q 90, 601–612 (2019). https://doi.org/10.1007/s11126-019-09653-0

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