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Patient-Centered Care: Providing Safe Spaces in Behavioral Health Settings

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Pediatric Gender Identity

Abstract

Behavioral health clinicians have a unique opportunity to create safe, affirming, patient-centered spaces that can provide hope to transgender patients experiencing mental health challenges. Through a developing case study, this chapter explores what it means to create a safe therapeutic space and asserts that clinicians can do the following toward creating such spaces: take patients at their word; allow that patients may feel ambivalence about certain aspects of transitioning; honor the fact that patients’ stories do not fit one particular mold; embrace diagnostic complexity and uncertainty; and foster future orientation for each patient. This chapter explores each of these components in depth.

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References

  1. Perez-Pena R, Smith M, Saul S. University of Chicago strikes back against campus political correctness. New York Times [Internet]. 2016 [cited 2019Mar5]. Available from: https://www.nytimes.com/2016/08/27/us/university-of-chicago-strikes-back-against-campus-political-correctness.html.

  2. Jaschik S. Chicago professors fire back. Inside Higher Ed [Internet]. 2016 [cited 5 Mar 2019]. Available from: https://www.insidehighered.com/news/2016/09/14/u-chicago-professors-issue-letter-safe-spaces-and-trigger-warnings.

  3. Ho K. Tackling the term: what is a safe space? [Internet]. Harvard Political Review. 2017 [cited 5 Mar 2019]. Available from: http://harvardpolitics.com/harvard/what-is-a-safe-space/.

  4. Klein A, Golub SA. Family rejection as a predictor of suicide attempts and substance misuse among transgender and gender nonconforming adults. LGBT Health. 2016;3(3):193–9.

    Article  Google Scholar 

  5. Ryan C, Huebner D, Diaz RM, Sanchez J. Family rejection as a predictor of negative health outcomes in white and latino lesbian, gay, and bisexual young adults. Pediatrics. 2009;123(1):346–52.

    Article  Google Scholar 

  6. Olson KR, Durwood L, McLaughlin KA. Mental health of transgender children who are supported in their identities. Pediatrics. 2016;137(3):e20153223.

    Article  Google Scholar 

  7. Ryan C, Russell ST, Huebner D, Diaz R, Sanchez J. Family acceptance in adolescence and the health of LGBT young adults. J Child Adolesc Psychiatr Nurs. 2010;23(4):205–13.

    Article  Google Scholar 

  8. Russell ST, Ryan C, Toomey RB, Diaz RM, Sanchez J. Lesbian, gay, bisexual, and transgender adolescent school victimization: implications for young adult health and adjustment. J Sch Health. 2011;81(5):223–30.

    Article  Google Scholar 

  9. Sterzing PR, Ratliff GA, Gartner RE, Mcgeough BL, Johnson KC. Social ecological correlates of polyvictimization among a national sample of transgender, genderqueer, and cisgender sexual minority adolescents. Child Abuse Negl. 2017;67:1–12.

    Article  Google Scholar 

  10. Kosciw JG, Greytak EA, Giga NM, Villenas C, Danischewski DJ. The 2015 National school climate survey: the experiences of lesbian, gay, bisexual, transgender, and queer youth in our nation’s schools [Internet]. GLSEN. 2016 [cited 5 Mar 2019]. Available from: https://files.eric.ed.gov/fulltext/ED574780.pdf.

  11. Out in the Open. Education sector responses to violence based on sexual orientation and gender identity/expression. Paris: United Nations Educational, Scientific and Cultural Organization; 2016.

    Google Scholar 

  12. Hatzenbuehler ML, Pachankis JE. Stigma and minority stress as social determinants of health among lesbian, gay, bisexual, and transgender youth. Pediatr Clin N Am. 2016;63(6):985–97.

    Article  Google Scholar 

  13. Pearlin LI, Schieman S, Fazio EM, Meersman SC. Stress, health, and the life course: some conceptual perspectives. J Health Soc Behav. 2005;46(2):205–19.

    Article  Google Scholar 

  14. Hendricks ML, Testa RJ. A conceptual framework for clinical work with transgender and gender nonconforming clients: an adaptation of the minority stress model. Prof Psychol Res Pract. 2012;43(5):460–7.

    Article  Google Scholar 

  15. Human Rights Campaign. Violence against the transgender community in 2017 [Internet]. Human Rights Campaign. 2019 [cited 5 Mar 2019]. Available from: https://www.hrc.org/resources/violence-against-the-transgender-community-in-2017.

  16. Rood BA, Reisner SL, Puckett JA, Surace FI, Berman AK, Pantalone DW. Internalized transphobia: exploring perceptions of social messages in transgender and gender-nonconforming adults. Int J Transgend. 2017;18(4):411–26.

    Article  Google Scholar 

  17. Nimmon L, Stenfors-Hayes T. The “handling” of power in the physician-patient encounter: perceptions from experienced physicians. BMC Med Educ. 2016;16(1):114.

    Article  Google Scholar 

  18. Parens E. Taking people at their word [Internet]. Bioethics Forum. The Hastings Center. 2006 [cited 5 Mar 2019]. Available from: https://www.thehastingscenter.org/taking-people-at-their-word/.

  19. Littman L. Rapid-onset gender dysphoria in adolescents and young adults: a study of parental reports. PLoS One. 2018;13(8):e0202330.

    Article  Google Scholar 

  20. Meier C, Harris J, American Psychological Association. Fact sheet: gender diversity and transgender identity in children. Washington, DC: American Psychological Association; 2013.

    Google Scholar 

  21. Cochran BN, Stewart AJ, Ginzler JA, Cauce AM. Challenges faced by homeless sexual minorities: comparison of gay, lesbian, bisexual, and transgender homeless adolescents with their heterosexual counterparts. Am J Public Health. 2002;92(5):773–7.

    Article  Google Scholar 

  22. Keuroghlian AS, Shtasel D, Bassuk EL. Out on the street: a public health and policy agenda for lesbian, gay, bisexual, and transgender youth who are homeless. Am J Orthopsychiatry. 2014;84(1):66–72.

    Article  Google Scholar 

  23. Grossman AH, Daugelli AR. Transgender youth and life-threatening Behaviors. Suicide Life Threat Behav. 2007;37(5):527–37.

    Article  Google Scholar 

  24. Spack NP, Edwards-Leeper L, Feldman HA, Leibowitz S, Mandel F, Diamond DA, et al. Children and adolescents with gender identity disorder referred to a pediatric medical center. Pediatrics. 2012;129(3):418–25.

    Article  Google Scholar 

  25. Olson J, Schrager SM, Belzer M, Simons LK, Clark LF. Baseline physiologic and psychosocial characteristics of transgender youth seeking care for gender dysphoria. J Adolesc Health. 2015;57(4):374–80.

    Article  Google Scholar 

  26. Reisner SL, Vetters R, Leclerc M, Zaslow S, Wolfrum S, Shumer D, et al. Mental health of transgender youth in care at an adolescent urban community health center: a matched retrospective cohort study. J Adolesc Health. 2015;56(3):274–9.

    Article  Google Scholar 

  27. Kaltiala-Heino R, Sumia M, Työläjärvi M, Lindberg N. Two years of gender identity service for minors: overrepresentation of natal girls with severe problems in adolescent development. Child Adolesc Psychiatry Ment Health. 2015;9(1):9.

    Article  Google Scholar 

  28. Holt V, Skagerberg E, Dunsford M. Young people with features of gender dysphoria: demographics and associated difficulties. Clin Child Psychol Psychiatry. 2014;21(1):108–18.

    Article  Google Scholar 

  29. Peterson CM, Matthews A, Copps-Smith E, Conard LA. Suicidality, self-harm, and body dissatisfaction in transgender adolescents and emerging adults with gender dysphoria. Suicide Life Threat Behav. 2016;47(4):475–82.

    Article  Google Scholar 

  30. Eisenberg ME, Gower AL, Mcmorris BJ, Rider GN, Shea G, Coleman E. Risk and protective factors in the lives of transgender/gender nonconforming adolescents. J Adolesc Health. 2017;61(4):521–6.

    Article  Google Scholar 

  31. The Lighthouse Project [Internet]. The Columbia lighthouse project. 2019 [cited 5 Mar 2019]. Available from: http://cssrs.columbia.edu/.

  32. Suicide Prevention Resource Center. Suicide assessment five-step evaluation and triage for mental health professionals [Internet]. Available from: https://www.integration.samhsa.gov/images/res/SAFE_T.pdf.

  33. Pattillo M. Gender dysphoria study faces criticism. Brown Daily Herald [Internet]. 2018 [cited 5 Mar 2019]. Available from: http://www.browndailyherald.com/2018/09/04/gender-dysphoria-study-meets-criticism/.

  34. It Gets Better. Available from: https://itgetsbetter.org/about/.

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Author information

Authors and Affiliations

  1. Adult Gender and Sexuality Behavioral Health Program at Lifespan, Providence, RI, USA

    Alison M. Jost & Agnieszka Janicka

Authors
  1. Alison M. Jost
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  2. Agnieszka Janicka
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Editor information

Editors and Affiliations

  1. Department of Pediatrics, Brown University, Providence, RI, USA

    Michelle Forcier

  2. Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA

    Gerrit Van Schalkwyk

  3. Division of Child & Adolescent Psychiatry, Massachusetts General Hospital, Boston, MA, USA

    Jack L. Turban

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Jost, A.M., Janicka, A. (2020). Patient-Centered Care: Providing Safe Spaces in Behavioral Health Settings. In: Forcier, M., Van Schalkwyk, G., Turban, J. (eds) Pediatric Gender Identity. Springer, Cham. https://doi.org/10.1007/978-3-030-38909-3_7

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  • DOI: https://doi.org/10.1007/978-3-030-38909-3_7

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-38908-6

  • Online ISBN: 978-3-030-38909-3

  • eBook Packages: MedicineMedicine (R0)

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