Goals for Today Learn how to create gender inclusive forms, notes and evaluations

1. GENDER INCLUSIVE DOCUMENTATION AND CLINICAL SERVICES FOR TRANSGENDER AND GENDER EXPANSIVE INDIVIDUALS (UNITED STATES) Social Work Helper Digital Conference March 19th 2019 Nadia Swanson, LMSW

2. Goals for Today • Learn how to create gender inclusive forms, notes and evaluations • Implement Gender Inclusive clinical interviewing skills • Create a deeper understanding of the intersectional needs of the transgender and gender expansive community

3. Mission 1.To empower families of TGNC youth by providing evidence-based and affirmative clinical services, community support and professional training. 2.To create gender justice for all families by providing education and support to all of the systems interacting with children, youth and families.

4. Services since 2010: •Support group for parents of gender expansive children (up to 14) •Play group for TGNC children (4 to 14) •Spanish-speaking parent support group •Parent Group (14 and up) and teen space (14–18) •Sibling Group •Family therapy and parental coaching •Child assessment and referrals for on-going child therapy •School training, work with DOE, ACS and other larger systems •520 families served since 2010. •13,250 teachers/educators/social workers and professionals trained since 2010

6. What Is Gender?

10. Why Work on Gender Inclusivity?

11. Gender diverse youth are often the target of discrimination & harassment, leading to lower rates of success in school, poorer health outcomes & more

12. All people are impacted by gender socialization & gender-based biases. All children, regardless of sexual orientation and gender identity, report greater success in school and better mental health outcomes when they are in a positive school and home climate.

13. Why Work on Gender Inclusivity A 2017 GLSEN study concluded: •87% of TGNC students hear transphobic comments from other students at least daily or weekly •42% of TGNC students are referred to by the wrong name and/or pronouns •46% of TGNC students are forced to use the wrong bathroom or locker room •More TGNC students reported hostile or violent experiences than in years past However, schools w/ inclusive policies have been found to: •Increase safety, leading to more TGNC students staying in school •Increase in accessibility to the proper restrooms & locker rooms •Decrease in hostile remarks from other students & teachers

14. Avg. Age a transgender youth in NY State becomes homeless for the first time is 13.5 -TSER

16. National Transgender Discrimination Survey: Access to Affirming Services 19% of trans people reported being refused medical care due to their transgender or gender non-conforming status, with even higher numbers among people of color in the survey. Fifty-three percent (53%) of respondents reported being verbally harassed or disrespected in a place of public accommodation, including public spaces, government agencies and social service/mental health facilities

18. Experiences of Black and Latinx TGNC People Negative health, social & life outcomes increase for people of color: -TGNC individuals are 2x as likely to live in poverty, but TGNC individuals of color are 3x as likely -Nearly half of Black & Latinx TGNC individuals have attempted suicide by adulthood -Similarly, nearly 40% of black & Latinx TGNC youth have experienced homelessness at some point -Family & school acceptance has shown dramatically improved outcomes for all TGNC youth Data gathered by the National Transgender Discrimination Survey, 2016

19. Data by GLSEN

20. Gender & Childhood Development

22. Transgender Children Most young people explore gender expression during throughout their development. This does not mean all of them are transgender…but some are. Transgender Youth are assessed on three primary criterion: -Insistence -Persistence -Consistence

23. Supporting TGNC and Gender Expansive Clients

25. Client Just Came Out As Trans…. •Affirm & celebrate their identity - ask them what name & pronouns they use / will be using going forward. •Acknowledge the strength it took to come out - thank them for trusting you with this information. •Inquire - Does their family know? Do they want them to know? How can you support the youth and their family? •Examine existing policies - What steps have already been taken? Ask the clients specifically what they need to be supported in your program and outside places they go. •Are there any safety concerns? Collaborate to address. •There may not always be immediate answers - this is an ongoing, open conversation. • For more support in schools, consult DOE guidelines

26. Things to Consider… •Cisgender staff/ trans client power dynamics •Don’t be afraid to admit you don’t know something, be honest but do the work. Don’t expect the person to be your teacher •Be aware of gatekeeping •Be aware of internal bias- we all have some. They are taught through our society, and individual cultures. It is an on-going process to unlearn. •Social workers do not need to know clients’ entire history of SOGI or details about their bodies in order to provide support •Consideration of the student’s history in therapy (and historical/generational pathologization of trans identities) •Distress ≠ Pathology -> Trauma-informed care

27. Things to Consider… Be aware of your role within your program and work to develop rapport with the clients you work with. (Don’t move too fast; developing rapport may take time.) Foster a safe and supportive environment where clients can explore their identities; this is crucial. Understand that some clients are expressing themselves in ways that reflect who they are for the first time.

28. Things to Consider… Not all transgender people have the ability to present physically how they feel mentally or spiritually. A person presenting as physically “male” may use she/her pronouns and ask to be called by a name other than what is stated on their identification. Don’t make assumptions Trans people may change their name and/or personal gender pronouns (PGP). It is important that staff acknowledge the change and enforce the use of the correct name and PGP. Don’t ask a trans person what their “real name” is or what their “gov name” (i.e., government, or original legal name) was.

29. Things to Consider… Don’t assume a trans client is in therapy because of their gender identity or because of their transition. Don’t ask questions about their transition (hormones, surgeries, etc.) just because you are curious − wait for them to share with you (they may not). Don’t assume you know their “transition journey” − everyone’s process is different. Don’t ask them how their family reacted− wait for them to tell you (they may not)

30. Things to Consider… Learn about healthcare, legal rights, social supports, and concrete services for trans people, and how others services interact with trans clients. Keep learning about trans clients and the issues they face….socially, culturally, economically. Include the trans people in your programs in creating policies and services that actually will serve them Update all forms to be inclusive and open to self identification Don’t let discomfort about discussing TGNC topics stop you from listening and responding accurately. The clients have done the work; we must do the work ourselves in order to provide accurate information.

31. Forms and Documentation

32. Personal Demographics EXAMPLE: Race/Ethnicity (Mark all that apply): • Black/African American • Native American/Alaskan Native/Indigenous • Middle Eastern/North African • Hispanic/Latinx/Spanish • East Asian • South and South East Asian • White • Mixed • Native Hawaiian/Pacific Islander • Self Identify___________ • I don’t know Gender(Mark all that apply): • Transgender Woman/Girl/Femme • Transgender Man/Boy/Masc • Cisgender Woman/Girl • Cisgender Man/Boy • Gender Non-Conforming • Non-Binary • Genderqueer • A-Gender • Self Identify___________ • I don’t know Sexual Orientation(Mark all that apply): • Bisexual • Lesbian • Gay • Straight/Heterosexual • Queer • Self Identify__________ • I don’t know Legal Name___________________________ Chosen Name_________________________ Pronouns (Mark all that apply): • She/Her/Hers • He/Him/His • They/Them/Theirs • No Pronouns- Use my name • Self Identify__________ • I don’t know

33. Psychosocials and other Clinical Narratives Tanya Rivera (Gov.Name: Gabriel Rivera) is a 36 year old latina transgender woman who lives in New York City… **Always refer to clients by their chosen name even if they have not gone through a legal name change** When their legal/government names need to be used, have a conversation with the client ahead of time and they will understand why and it will affirm that you see them for who they are.

34. Engaging Families & Caregivers

35. Cisgender Caregiver Experiences Grief: Loss of internalized (cisgender) story of child. HelplessnessandFears: Protectiveness & rigidity. LossofCisgenderPrivilege: to minority status with feelings of failure, shame, stigma (mediated by race, class and religion). Marital,Familial,Culturaland Religious Conflicts: Loyalty conflicts, reliance on and emotional debt toward extended family and community. Rejection as a Misplaced Attempt at Protection

36. Steps for Engaging Cis Caregivers 1.Understand & validate parental experiences (their grief, fears, etc.) 2.Help reducing isolation by providing a community of peers 3.Allow space for complex feelings 4.Reframe negative experience into a positive narrative 5.Interpret parental rejection as a misplaced desire to protect/shield their children from perceived danger 6.Respect parental authority while preventing neglect & abuse (and help them understand the difference) 7.Normalize & universalize other communities while promoting cultural humility & responsiveness

37. Awareness Connection Community

38. Questions? Thank you! Nadia Swanson, LMSW nswanson@ackerman.org