Social Work and Health Care Practice with Transgender and Nonbinary Individuals and Communities

Voices for Equity, Inclusion, and Resilience

Shanna K. Kattari, M. Killian Kinney, Leonardo Kattari, N. Eugene Walls, Shanna K. Kattari, M. Killian Kinney, Leonardo Kattari, N. Eugene Walls

• Publisher: Routledge
• Year: 2020
• ISBN:
  9780429811289
• Edition: 1
• Topic: Derecho
• Subtopic: Derechos civiles en la legislación

This book examines issues across the lifespan of transgender and nonbinary individuals whilst synthesizing conceptual work, empirical evidence, pedagogical content, educational experiences, and the voices of transgender and nonbinary individuals. It highlights the resilience and resistance of transgender and nonbinary individuals and communities to challenge narratives relying on one-dimensional perspectives of risk and tragic lives.

While there is currently unprecedented visibility and increasing support, members of these communities still face shockingly high rates of violence, victimization, unemployment, discrimination, and family rejection. Significant need for services and support coupled with social, clinical, and medical service systems ill-equipped to provide culturally responsive care illustrates the critical need for quality education and training of educators, practitioners, and service providers in best practices of working with members of the transgender and nonbinary community.

Organized into six sections:

• Health
• Areas of Practice
• Coming Out and Family
• Relationships and Sexuality
• Communities
• Multiply Marginalized Identities and Populations,

this book offers a current, comprehensive, and intersectional guide for students, practitioners, and researchers across a variety of professions, including social work, psychology, public policy, and health care.

Introduction Part 1

Introduction to social work and health care with transgender and nonbinary individuals and communities

Shanna K. Kattari, M. Killian Kinney, Leonardo Kattari, and N. Eugene Walls

Rationale behind this book

Transgender and nonbinary (TNB) children, youth, adults, and communities face invisibility and invalidation of their gender in numerous domains of their lives, from intake forms to bathrooms to well-intended binary-focused policies, as well as through individual and systemic violence. While there is currently unprecedented visibility and increasing levels of support and acceptance for TNB children, youth, and adults, and high levels of resistance and resilience from TNB individuals and groups, members of this population still face shockingly high rates of violence, victimization, unemployment, discrimination, and family rejection. Similarly, navigating a transphobic culture leaves many TNB individuals feeling hopeless, struggling with suicidality and self-harm impulses, and often reluctant to seek even basic health care or legal protection because of fears and anxiety about the possibility of ridicule, shaming, or outright refusal of services. They may feel wholly erased or, conversely, hyper-visible and on display. Yet, despite interpersonal and societal challenges, members of this population embody an incredible resistance and resilience to so many challenges, and their resourcefulness in not only surviving but also thriving in a society that does not always affirm their identities and existence is magnificent.

Creation of this book

The intentional creation of this book in response to all of this was twofold. First, many gaps in the literature exist regarding health and wellbeing among TNB individuals and communities that are needed for improved practice, education, and research. While there have been books on counseling TNB clients, or social work practice with all lesbian, gay, bisexual, transgender, queer, intersex, asexual, and two-spirit (LGBTQIA2S+) individuals, or working specifically with TNB youth, to our knowledge, there has not been an edited volume that explores social work and related health care when it comes to this population. As both members of the TNB population and those who work with these individuals and communities regularly, we are often called upon to educate social workers, human service professionals, and health care providers. Having a volume to offer these professionals and educators as well as students being trained in these fields helped drive our intentions around this creation.

The need for the book as a tool for educators and service providers is further underscored by the reality that the major associations of mental health and health care providers currently embrace the need for culturally responsive approaches to service provision as well as the importance of educating future and current practitioners on effectively serving TNB individuals and communities. For example, the National Association of Social Workers’ (2017) policy statement on TNB individuals and communities enumerates the importance of training future social workers, the need for the professional development of existing practitioners, the support for antidiscrimination policies, and the need for advocacy in public policy. The American Psychological Association (2015) has guidelines on affirmative practice with TNB individuals, which includes the need for the training of future psychologists to work competently with members of the TNB community. The American Medical Association (2017) extensively outlines general policies, physician-centered policies, and patient-centered policies underscoring support for comprehensive education and competent service delivery for TNB patients. Similar policies and guidelines can be found from the American Counseling Association (2009), the American Academy of Pediatrics (see Raffery et al., 2018), and the American Psychiatric Association (2018), among others.

Secondly, paralleling the fairly recent support for TNB individuals and communities from professional organizations outlined above, research too has become more common. Wanta and Unger (2017) reviewed all publications in the Medline database (from 1950 to mid-2016), documenting a clear trend of an increasing number of “trans-centric” articles. The body of scholarship has grown to the point where an increasing number of systematic reviews or other types of summary articles have been published, including reviews focused on mental health and gender dysphoria (Dhejne et al., 2016), gender identity in childhood (Perry et al., 2019), health care in primary care settings (Hashemi et al., 2018), cervical cancer screening (Gatos, 2017), incarceration (Glezer et al., 2013), and self-injury among children and young people (Mann et al., 2018). While increasing the knowledge about TNB individuals and communities is a welcome development, the trend is problematic in the lack of TNB authors of this scholarship, the medicalization and pathologizing of TNB individuals, and the absence of the voice of front line practitioners.

The absence of TNB authors in the literature about TNB communities is strikingly apparent. Given that peer-reviewed and professional literature are most often written by those who have access to the Academy and to medical education, it is no surprise that the very discrimination and erasure discussed earlier have prevented many TNB individuals from accessing PhDs, MDs, and other degrees that often result in conducting research and writing about TNB communities. While many research teams are now moving towards including community advisory boards in their research to ensure the voices of TNB individuals are helping guide the research enterprise, these community members are still rarely included in the resulting publications. As such, much of the research and development of best practices about this population are not written by members of the population, reinforcing the marginalization they experience, and running the risk of research that further pathologizes TNB individuals.

There have been increasingly more TNB activists, practitioners, academics, and researchers becoming visible in the past few years, and whose work we wanted to highlight. As editors of this volume, we have been committed to centering TNB voices by co-editing and co-authoring all components of this book and embodying these very tenets of empowerment, resilience, and unique experiences of intersectional identities; every chapter is co-authored by one or more TNB individuals, ensuring their voices are at the heart of this book. Brown and Strega (2005) describe research from the margins as research by, for, and with those who have been marginalized, moving those in the margins from “subject” and “object” to “author”, along with the power and validity which that role entails. It is our deepest hope that this book is seen as research from the margins, and encourages others to center the voices of the marginalized, even if they do not have advanced degrees or academic positions. Recognizing individuals as experts in their own experiences is crucial to fostering equity and justice.

Relatedly, much of the research, especially in social work, is conducted by individuals in the Academy, some who have been away from their practices for decades. While this may have been how it is always done, this leaves out the voices of practitioners who are “on the front lines” in understanding practice and implementation, as well as community members, students who are bridging the community and the Academy, activists, and others. We wanted to make sure this was not just another tome from the Academy, telling practitioners what to do without actually knowing what needs might exist. As such, while many of the authors in this text are tenure-track academics, there are also clinical professors, social work practitioners, midwives, physicians, activists, PhD students, MSW students, higher education administrators, research collaborators, and community members co-authoring these chapters.

Empowerment, resilience, and intersectionality

With consideration for the predominant focus of TNB literature on inequity and pathology, this book and the chapters within were created with an empowerment framework to uplift this community, emphasizing the resilience and successes already celebrated by this population. We have chosen to incorporate and highlight the incredible resourcefulness and resistance of TNB individuals and communities to challenge narratives of educators and practitioners that rely primarily on a one-dimensional perspective of risk and tragic lives. Illustrating ways in which TNB individuals successfully and effectively navigate a world that pathologizes and devalues their existence, connect to create thriving communities and relationships, and organize to find a political voice provides a counter-narrative of empowerment, and identifies potential avenues for further fostering hopefulness, power, and health.

So much of what is written about TNB people comes solely from a risk perspective: concerns about depression, anxiety, and suicidality, experiences of homelessness and murders, and experiences of discrimination. While these are all real barriers facing this population, they do not define the population. Instead of focusing only on how many TNB individuals were denied health care, we wanted to focus on ways health care professionals can create affirming interactions with their TNB patients. Beyond those dismal mental health numbers, we wanted to encourage mental health spaces to be inclusive of TNB individuals, and help them to figure out what they most want and need in their lives, rather than center solely on preventing self-harm and suicide. Changing systems requires discussion of how to empower TNB individuals to move towards leadership positions, to engage TNB communities in community-driven and engaged research, and to organize at all levels across numerous populations, including young people. This book is written with empowerment in mind, providing best practice suggestions that center on the incredible resilience of members of TNB communities, and move towards strategies for empowerment rather than just coping.

Throughout this book, you will learn how to address many of the existing gaps in services, access, and inclusion. Below are some basic best practice guidelines that will be further enumerated in the following chapters. Because the TNB community is so diverse, and each individual’s experiences vary based on intersections of numerous social identities and physical locations, best practices should be thought of as a general blueprint for the work rather than as hard and fast rules. Considerations and adaptations will almost always be necessary for each individual or community. Given this, we encourage you to center the following guidelines.

1. Acknowledge the variance of experience. No two TNB persons will have the same experiences. While this book provides research and literature on a multitude of topics that give us a glimpse into the experiences of TNB people, this evidence should be used as a starting point and a broad generalization. We cannot approach our human services and health care practice with TNB people with a “one size fits all” strategy.
2. Stay educated and informed. It is our responsibility as human service professionals to stay up to date on the rapidly changing landscape of our clients’ lived experiences. Gender identity and the policies and practices that influence the lives of TNB people change quickly. Do not expect TNB clients to educate you or even, at times, know themselves how policies and best practices have changed. Keep learning, keep growing, and challenge yourself to stay as informed as possible.
3. Be respectful and avoid assumptions. A theme that winds its way through many of the chapters and that parallels the best practice of acknowledging variance of experience, this theme encourages us to avoid making assumptions about a client’s experience, identities, and even the words they use to describe themselves. When appropriate, ask for more information about how an individual may identify their gender, the pronouns they use, how they define their relationships and/or sexuality, and what family means to them. When asking clarifying questions, confirm with yourself first what your intent is in asking these questions. Is this relevant to your provider/client relationship, or is this a curiosity you have for personal gain? If you’re not sure if asking a direct question is appropriate, stay attuned to the words and terminology a client is using and mirror it back to them. Do not assume that all terms have the same meaning to different people. For example, one client may use the term gender diverse to describe themselves; however, another client may find that term offensive.
4. Meet individuals where they are. For some TNB people, their gender identity may be incredibly salient to their current situation and experiences. For others, they may not need support around their gender identity. If a client is not explicitly stating their need for information, resources, and support around their gender identity, proceed with caution on how you bring it up and incorporate it, if you do so at all. For example, if a client wants to discuss feeling depressed and relates it back to a recent relationship breakup, follow their lead. That should be the primary focus of your work with them. Find a balance between how gender identity may be influencing other aspects of their life if a client is not specifically bringing it up. This is especially important to consider for folks who may be questioning their gender identity.
5. Show up. There are lots of ways to show up and engage with communities. Showing up for TNB individuals is something we can do in our agencies and organizations, as well as in our interaction with external providers and organizations. We can champion efforts to change our organizational policies, update forms, and challenge anti-TNB microaggressions and explicit transphobia. Furthermore, we can do this with other agencies and organizations by working with our colleagues, joining boards, committees, and commissions, and changing how we show up and engage in meetings as facilitators or attendees. We can support TNB-focused organizations by supporting their work through in-kind and financial contributions and through building TNB leadership pipelines to bring TNB voices where they may not currently exist.
6. Use an intersectional lens. All authors in this volume were asked to be particularly intentional about writing with an intersectional lens in mind. In recognizing, for example, the disproportionately high rates of violence against transgender people of color, especially transgender women of color, a lens of intersectionality must be used (Crenshaw, 1990). Intersectionality is a theory grounded in Black feminist thought that looks at the intersection of race and gender (as well as other identities) to explore how the crossroads of multiple marginalized identities may be related to differential experiences of discrimination, victimization, and other challenging outcomes. It is crucial to use an intersectional lens when exploring the experiences of TNB individuals and communities; this concept helps to disrupt the assumption about members of this population, both who they are and what it looks like to be transgender or nonbinary.

Positionality statement of editors

We recognize the value of transparency regarding positionality, particularly around TNB populations who have been largely studied and written about by cisgender researchers. Positionality and worldview can impact one’s work and can include race, gender, sexuality, disability status, social class, religious/spiritual beliefs, political values, and more (Sikes, 2004; Wellington et al., 2005). With an increasing number of TNB researchers, practitioners, and community leaders, the editors prioritized TNB inclusion with the intention of centering the perspectives, experiences, and voices of TNB individuals and communities. The structure of this edited volume was designed with TNB community members involved at all stages, along with consensus-building among the four editors, and integrating input from the 66 authors included herein. Further, the diversity of the authors’ experience enriches this text with backgrounds, including artists, community organizers and activists, practitioners, researchers, and professors.

With consideration of positionality in relation to identity, the editorial team is comprised of one queer nonbinary individual, one queer trans man, one queer cisgender woman, and one gay cisgender man. Both of the cisgender editors are currently tenure-track academics (one tenured), while the trans and nonbinary editors are doctoral students. All of us have experiences with mental health challenges, one of us is disabled and experiences chronic illness/chronic pain, and two of us are neurodiverse. Additionally, all of us are White, with varying ethn...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Contents
• List of tables
• List of contributors
• Acknowledgements
• Glossary
• Introduction Part 1 Introduction to social work and health care with transgender and nonbinary individuals and communities
• Introduction Part 2 Place, joy, and self in trans and nonbinary justice
• Part 1 Health
• Part 2 Areas of practice
• Part 3 Coming out and family
• Part 4 Relationships and sexuality
• Part 5 Communities
• Part 6 Multiply marginalized identities and populations
• Index