Monthly Archives: October 2017

A Fate Worse than Death? Being Transgender in Long-term Care

Serious transgender couple standing together

 

By Mark Brennan-Ing, PhD (Senior Research Scientist, Brookdale Center for Healthy Aging)

 

“I would kill myself.” This is what a 70 year-old transgender woman told me recently when I asked what she would do if she needed long-term care. While this sounds dramatic, it is a common sentiment among older transgender and gender nonconforming (TGNC) adults (Witten, 2014). Many TGNC older adults do not have family caregivers available to meet their needs for assistance in later life, having been rejected and ostracized by their families of origin according to a study by Grant and colleagues (2011), and long-term care services may be their only option.

 

Plans for concealing gender identities, suicide and euthanasia are one way for older TGNC adults to cope with the fears of entering long-term care (Bockting & Coleman, 2007; Ippolito & Witten, 2014). The National Senior Citizens Law Center (2011) reports that TGNC older adults, regardless of the degree of gender transitioning, are at risk for abuse, mistreatment, or violence in institutionalized settings, especially those needing assistance with activities of daily living such as showering, dressing, and toileting.

 

Accessing medically competent care may also be a problem for older TGNC adults in long-term care. Geriatric care for TGNC older adults requires special considerations. Due to potential drug interactions, contraindications, and polypharmacy, TGNC older adults using hormone therapy concurrent with other medications may require close monitoring (Grant et al., 2011; SAGE & NCTE, 2012; Witten & Eyler, 2015). Sometimes these problems may require stopping hormone therapy, which may be especially traumatic for those who have transitioned later in life and not yet achieved their goals for masculinizing or feminizing their appearance.

 

Since private rooms in long-term care facilities are not covered by insurance, older TGNC adults may be assigned shared rooms based on their birth sex instead of their gender identities, which is problematic for the TGNC person as well as their roommate. The Department of Veterans Affairs (2013) has issued a directive that rooms for TGNC veterans are assigned based upon self-identified gender without regard to physical presentation or surgical history. This policy should be a requirement in all long-term care facilities.

 

The Nursing Home Reform Act and the Fair Housing Act prohibit TGNC discrimination and mistreatment in long-term care. The Affordable Care Act (ACA) also prohibits discrimination on the basis of gender identity by health care organizations (NCTE, 2015), but this legal protection is at risk following the 2016 election with promises by those in power to repeal the ACA. If ACA repeal is successful, older TGNC people will lose safeguards around denial of services, access to facilities like restrooms that conform to their gender identities, isolation, deprivation, and harassment by staff.

 

For long-term care providers, there are a number of resources available for continuing education to better serve their TGNC clients. These include the National Resource Center on LGBT Aging, which offers a variety of in-person and on-line training options (http://www.lgbtagingcenter.org/training/index.cfm). Providers working with veterans can review training and education options in the VA system at http://www.patientcare.va.gov/LGBT/index.asp . And TRANSLINE provides on-line consultation for medical providers (http://project-health.org/transline/ ).

 

Sadly, we may soon witness a rollback of protections for TGNC individuals in long-term care. Therefore it is imperative that the TGNC community and their allies work harder than ever to insure that policies, legislation, and training programs are in place to guarantee that older TGNC people are treated with the dignity and respect they deserve in long-term care and other clinical settings.

 

Portions of this blog were drawn from “Providing competent and affirming services for transgender and gender nonconforming older adults” (Porter, Brennan-Ing et al., 2016), and “Guidelines for psychological practice with transgender and gender nonconforming people (American Psychological Association, 2015).

 

References:

American Psychological Association (2015). Guidelines for psychological practice with transgender and gender nonconforming people. American Psychologist, 70(9), 832-864. http://dx.doi.org/10.1037/a0039906 .

Bockting, W. O., & Coleman, E. (2007). Developmental stages of the transgender coming‐out process. In R. Ettner, S. Monstrey, & A. Eyler (Eds.), Principles of transgender medicine and surgery (pp. 185‐208). New York, NY: Haworth.

Department of Veterans Affairs (VA; 2013). Providing health care for transgender and intersex veterans (VHA Directive 2013–003). Retrieved from http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2863

Grant, J. M., Mottet, L. A., Tanis, J., Harrison, J., Herman, J. L., & Kiesling, M. (2011). Injustice at every turn: A report of the national transgender discrimination survey. Washington, DC: National Center for Transgender Equality & National Gay and Lesbian Task Force. Retrieved from http://endtransdiscrimination.org/PDFs/NTDS_Report.pdf

Ippolito, J., & Witten, T. M. (2014). Aging. In L. Erickson-Schroth (Ed.), Trans bodies, trans selves: A resource for the transgender community (pp. 476-497). New York, NY: Oxford University Press.

National Center for Transgender Equality (2015). Know your rights: Healthcare. Retrieved from http://www.transequality.org/know-your-rights/healthcare

National Senior Citizens Law Center (2011). LGBT Older Adults in Long-Term Care Facilities: Stories from the Field.  Washington, DC: National Senior Citizens Law Center.

Porter, K. E., Brennan-Ing, M., Chang, S. C., dickey, l. m., Singh, A. A., Bower, K. L., & Witten, T. M. (2016). Providing competent and affirming services for transgender and gender nonconforming older adults. Clinical Gerontologist. http://dx.doi.org/10.1080/07317115.2016.1203383

Services and Advocacy for GLBT Elders (SAGE) & National Center for Transgender Equality (NCTE; 2012). Improving the lives of transgender older adults. New York, NY: Authors. Retrieved from http://transequality.org/Resources/TransAgingPolicyReportFull.pdf

Witten, T.M. (2014). End of life, chronic illness and trans-identities. J. Social Work in End-of-Life and Palliative Care, 10(1), 1-26. doi:10.1080/15524256.2013.988864

Witten, T.M. & Eyler, A.E. (2015). Care of aging transgender and gender non-conforming patients. In. R. Ettner, S. Monstrey and A.E. Eyler (Eds.), Principles of transgender medicine and surgery. New York, NY: Routledge Press.

 

Biography:

Mark Brennan-Ing, PhD is the Senior Research Scientist, Brookdale Center for Healthy Aging at Hunter College, City University of New York. He was the 2016 Chair of the APA Committee on Sexual Orientation and Gender Diversity.

 


Filed under: Aging, Health Disparities, LGBT Issues Tagged: health disparities, health equity, LGBT, long-term care, older adults, transgender

3 Essential Tips to Help All Kids to Embrace Their Race and Ethnicity

blog-planting-seeds-res-blog

This is the fourth in a series of blog posts that the American Psychological Association (APA) will publish regarding racial/ethnic socialization practices, programs, and approaches. APA is putting together a clearinghouse of resources to help parents/caregivers to protect youth of color and themselves from the psychological damage of discrimination and racism. For more information regarding APA’s new initiative and to provide feedback as we continue to engage in this series, please visit: www.apa.org/pi/res

 

By Chelsea Derlan, PhD (Asst. Professor of Developmental Psychology, Arizona State University)

 

In their daily lives, children receive many direct and subtle messages involving their racial-ethnic background from others:

 

“But how can he be your dad? You don’t match.”

 

“You should put on sunscreen because you don’t want to get too dark.”

 

“I always thought Black people couldn’t swim. You act White though, maybe that’s it.”

 

Although we cannot control every interaction our child has with others, what we can do is build up positive messages that influence the effect these interactions have on them. For example, what if we had engaged in racial-ethnic socialization (RES) that involved the following messages:

 

“You are such a perfect mix of mine and your fathers’ cultures.”

 

“You have beautiful brown skin. I love how you get darker in the sun.”

 

“Your ancestors are Black kings and queens. You can do anything you put your mind to.”

The RES we provide can have profound effects on our children’s well-being. Here are a few tips:

 

1. RES is important for all children.

It is important that we talk about race-ethnicity with children – all children. A recent ethnic-racial identity intervention study provided an opportunity for teenagers to explore their culture and develop a clearer sense of what their ethnicity-race meant to them. Participating had positive effects on youth from all racial-ethnic backgrounds.

As caregivers, we can set up similar opportunities by providing a space for our children to ask questions, process, and learn. Given our unique histories and everyday realities, we will want to tailor messages based on our children’s specific culture and experiences. For example, we might choose to prepare children for bias they may encounter, highlight stories of their ancestors, or build pride in their appearance. For ideas and activities, check out 25 mini-films for exploring race-ethnicity.

 

2. It is never too early to start.

Caregivers often wonder when it is the right time to begin RES. The answer is that it is never too early to start. Research tells us that by kindergarten, many children already know what their race-ethnicity is, and use race-ethnicity as a way to understand themselves and others. We know that when caregivers engage in RES it has positive effects on children’s academics, behavior, and language skills.

An important thing to keep in mind is to craft messages so they make sense to children based on their age and level of understanding. Very young children tend to focus on the parts of culture that they can see, such as skin tone and hair. For example, with Black children, you might start with books or videos that highlight how all hair is good hair, skin comes in lots of wonderful shades, or that feature Black boys and Black girls as main characters. Sometimes it is easiest to simply start talking, and other times it is helpful to read a book or watch a video, and then build a conversation afterwards.

 

3. Don’t give up!

Despite our most dedicated efforts, there will be times when children question and/or disagree with our teachings.

I came across an article in which a mother wrote about a time when her daughter said: “Mommy, I don’t want to be Black like you.” After talking to her daughter she realized that

“… it wasn’t that my daughter didn’t want to be Black, she was simply struggling to deal with her perception and understanding of who she is. Realistically, I know how the world will view her, and I can’t shield her from it. What I can do is make sure she knows who she is, that she is loved, and that she loves herself, fully.”

Although times like these can be discouraging, we can’t give up. We have to listen, and remember that the ways our children are understanding and interpreting their experiences may not always match our own.

 

RES is a process that involves many lessons over time. As children have different experiences, new things will pop up. Our goal is to create a support system so they know there is someone they can go to who will talk and/or listen. It is about planting those positive seeds for them that they can water when they need to. It is an opportunity for us to show our children love and compassion, to help them understand themselves, and to prepare for a better tomorrow with our children today!

 

Learn more:

Start healthy conversations about race/ethnicity with your kids today. Download APA’s RESilience Parent Tip Tool

 

Biography:

 

Chelsea Derlan, PhD, is an assistant professor of developmental psychology at Arizona State University. Broadly, her work examines how risk factors (e.g., discrimination) and resilience factors (e.g., cultural socialization) inform ethnic-racial minority youths’ positive psychological, academic, and health outcomes. Guided by cultural ecological models, she considers the role of family, school, and other key contexts. Her research is focused in two main areas:

(a) assessing what young children understand and feel about their culture (i.e., ethnic-racial identification), and how this plays a role in development, and

(b) examining the interplay between individual and contextual factors as they inform adolescents’ ethnic-racial identity and adjustment.

 

Image source: iStockPhoto.com


Filed under: Children and Youth, Culture, Ethnicity and Race Tagged: children's mental health, ethnic identity, ethnicity, parenting, race, racial and ethnic socialization, racial identity, resilience, stereotypes, stereotyping

What is One Simple Thing You Can Do to Prevent Gun Violence at School? Say Something

 

 

By Julia Mancini (Intern, APA Office on Children, Youth and Families)

 

It is crucial for schools to be supportive environments for youth learning and growth. Too often, they become places of violence and fear. Nationwide, it has been found that 6% of children do not go to school at least once a month because they fear for their own safety at or on their way to school1. This shows that this place that should foster healthy development can be a source of traumatic experiences. Further, violent and toxic school environments are all too common and hinder educational, social and personal development. School should be a place where children can express themselves and be comfortable reaching their maximum potential.

On December 14th, 2012, 20 first graders and 6 educators were shot and killed at the Sandy Hook Elementary School in Newtown, Connecticut. This tragedy has been central to many of the conversations surrounding gun violence in schools and hits close to home for many.

Research has shown that when it comes to violence, suicide and threats, most are known by at least one other individual before the incident takes place.

 

Imagine how much tragedy could be averted if these individuals said something?

Say Something Week raises much needed awareness and educates the community, students, and educators through media events, advertising, public proclamations, contests, and school awards. It provides the confidence and tools to create a safer and healthier school environment. It is important to create positive dialogue around school safety in order to be proactive against community violence and fear.

Say Something Week empowers children to help others and prevent tragedies. They are taught to ‘Say Something’ to a trusted adult to prevent a friend from harming themselves or others. This programing has the potential to save lives in the communities it reaches. Though it is a daunting task to ensure that no student ever has to go to school in fear, campaigns such as Say Something Week can work with schools and youth programs to maximize their safety, learning, and potential.

 

What is Say Something Week?

While there is no simple solution to this problem, Striving to Prevent Youth Violence Everywhere (STRYVE) and Sandy Hook Promise are partnering to implement the Second Annual Say Something Week.

STRYVE is a multi-sector consortium of organizations that work nationally to support local youth violence prevention efforts in states and communities. Sandy Hook Promise (SHP) is a national, nonprofit organization based in Newtown, Connecticut. They are led by several family members whose loved ones were killed in the tragic mass shooting. SHP is focused on preventing gun violence (and other forms of violence and victimization) before it happens by educating and mobilizing youth and adults on mental health and wellness programs that identify, intervene and help at-risk individuals. Their goal is to honor all victims of gun violence by turning their tragedy into a moment of transformation.

 

How can you be a part of this?

Consider joining Sandy Hook Promise, the American Psychological Association, and thousands of other school and youth organizations for the second annual Say Something Week from October 16-20th.  To sign up, visit: http://www.sandyhookpromise.org/saysomethingweek

 

References:

1 School Violence: Data and Statistics . (2017, August 22). Retrieved October 10, 2017, from https://www.cdc.gov/violenceprevention/youthviolence/schoolviolence/data_stats.html

 

Biography:

Julia Mancini is currently a junior Psychology and Criminal Justice double major at George Washington University. Julia has a particular interest in children and families and is excited to be interning with the Children, Youth and Families office this fall. Julia has been involved with behavioral genetic research through The Boston University Twin Project. She also worked as a Clinical Research Intern at Safe Shores, DC’s Children’s Advocacy Center, investigating disparities in PTSD presentations among minority youth. This past summer Julia interned for the Child Protection Unit in the District Attorney’s office in her home state of Massachusetts. She also had the opportunity to work internationally with a non-profit in Cochabamba, Bolivia that provides psychological, legal, and social services to child survivors of sexual violence.


Filed under: Children and Youth, Violence Tagged: #STRYVE, children's mental health, gun violence, gun violence prevention, Say Something Week, school safety, school shootings, suicide prevention, teen suicide, youth violence