Affirming Care Alberta
About the Affirming Care Alberta Project
The ultimate aim of the Affirming Care Alberta Project is to remove the barriers trans and gender diverse people face when accessing health care services in Alberta. By partnering directly with several of the governing associations for health professionals, we can ensure trans and gender diverse Albertans have access to a health care system that is respectful, affirming and safe.
Trans and gender diverse patients with explicitly affirming health care providers tend to perceive their general health as better overall. We also want Alberta’s health care providers to feel confident and knowledgeable in regards to the needs of trans and gender diverse patients. Health professionals have expressed the desire to offer a more affirming practice. Our hope is that in collaborating directly with professional associations across the medical field, we can ensure affirming care is the standard across the province.
Affirming care is linked to improvements in well-being and quality of life and decreases in depression and anxiety scores. However, our researchers in conjunction with MacEwan University conducted a preliminary study that identified opportunities for delivering affirming care to Albertan youth. Of the current trans and non-binary youth in Alberta:
40% expressed that the current criteria for gender affirming care was often redundant, outdated, and prohibitive
48% found that health services were not inclusive (i.e. not culturally confident, affirming, or transphobic or homophobic)
72% noted that the initial wait-list to access GA care and the waits between follow-up visits or the next referral source were very long and depressing
In order to address these opportunities, it is important to better understand affirming care and why it is essential to QTHC’s vision for all queer and trans community members to have equitable opportunity to experience positive health and well-being.
What is Affirming Care?
Improving affirming care for 2S/LGBTQIA+ Albertans includes access to interventions designed to support and affirm an individual’s gender identity. Whether a single intervention or a combination of interventions is called for, affirmative care is specific to an individual’s needs. These interventions may be categorized as:
Social: ie. external validation of gender or support from family
Psychological: ie. gender counselling
Behavioural: ie. gender presentation
Medical: ie. hormonal treatment or surgery
Who Seeks Affirming Care?
Although we typically associate affirming care with transgender and gender-diverse (TGD) individuals, affirming care is accessed by cisgender individuals as well. Expression and affirmation of self may be influenced by culture, gender or health. Some examples showing the broad range of individuals exhibiting affirming care include:
Gender diverse individuals wearing makeup and jewellery/clothes to present as feminine or non-binary
Gender non-binary person who might have been born female wearing more traditionally masculine clothes
Transgender, gender-diverse and cisgender individuals who elect to undergo plastic surgery to remove or enhance physical features
Cisgender males who take injections of testosterone or cisgender females using hormone replacements during menopause
Indigenous or African male/non-binary people with longer hairstyles that are representative of a diverse group of cultural and gender identities
Indigenous individuals who use tattoos to culturally represent aspects of identity
Why Affirming Care?
The QTHC’s focus is improving affirming care for TGD individuals, but why is that so important? Although every person’s gender journey is unique, some trans or gender-diverse individuals may experience gender dysphoria. Gender dysphoria stems from the incongruence between gender assignment and gender identity — or what gender others perceive them as versus what gender that person really is.
Research shows that TGD people often experience or live in fear of experiencing stigma and prejudice in addition to discrimination, harassment, abuse and violence resulting in social, economic and legal marginalisation, poor mental and physical health and even death. This process has been characterised as a stigma-sickness slope leading to long-term health implications, especially in youth. TGD youth are significantly more likely to suffer emotional distress and depression, bullying and other forms of violence and to harm themselves or attempt suicide.
When to Implement Affirming Care?
Individuals may seek affirming care throughout any stage of their lives.
Childhood: social transitioning may serve a protective function for some prepubescent children and foster positive mental health and well-being
Adolescence: treatment interventions may include any combination of puberty suppression, gender-affirming hormones and surgeries
Adulthood: treatment will vary based on the individual
During childhood, gender may evolve over time and is not necessarily static. In adolescence, identity begins to solidify so family and practitioners should facilitate the exploration and expression of gender openly and respectfully.
Given the lifelong implications of medical treatment and the young age at which treatments may be started, adolescents, their parents and care providers should be informed about the nature of the evidence base. Decisions to move forward with medical and surgical treatments should be made carefully, according to the best practice guidelines.
The TGD adult population is heterogeneous and will vary according to their clinical need, biological, psychological, social situations and access to health care. An individual’s gender identity is an internal identification and experience. The role of the assessor is to assess for the presence of gender incongruence and to identify any co-existing mental health concerns, to offer information about available affirming care options, to support the TGD person in considering the effects and risks of said options, and to assess if the TGD person has the capacity to understand the treatment being offered and if the treatment is likely to be of benefit (WPATH 8).
Where is Affirming Care Validated?
There are many instances where individuals may seek affirming care, meaning there are many places physicians, nurses and pharmacists may be involved, such as for:
Consultations
Prescriptions
Check-ups
Surgeries, including surgical consultations, follow-ups or wound care
Medical, social or psychological support or advice
These interactions might happen in the:
Community
Hospital
Clinic
Pharmacy
Affirming Care Alberta Project: The How
Research: Includes community member consultation, stakeholder focus groups, literature review and survey analysis to determine what patients and providers each need.
Best Practice Guidelines: Developing guidelines to aid doctors, nurses and pharmacists in offering affirming care, detailing appropriate terminology and language, recommendations for inclusive intake forms, anti-discrimination policies, and how to foster affirming interactions with patients.
Training Toolkits: In addition to an evaluation process to determine the effectiveness of the project overall, the final deliverable of the Affirming Care Alberta Project will be a series of professional development training modules, including:
An introductory module serving as a crash course for understanding transgender and gender diverse individuals
A rural trans healthcare module exploring more specific trans healthcare needs based on the findings from our rural focus groups.
A series of three profession-specific training modules that answer questions raised by advisory boards of doctors, nurses, and pharmacists.
Conclusion
We’ve explored affirming care and the aims of our project, but it’s important to summarise why this project is so vital to the trans and gender diverse population: affirming care saves lives.
Community members shared that they are more likely to disclose health information to providers they’ve had a positive experience with, demonstrating that affirming care builds trust.
Additionally, partnering with professional associations and providing online training that is custom fit to our community within Alberta means healthcare providers like you have a strong set of guiding documents to lean on that are relevant to your practice.
Affirming care is preventative care.