Using telehealth to improve access to gender-affirming care for BIPOC and rural gender diverse youth

PROJECT SUMMARY This proposal aims to improve the care of specific populations included in the special emphasis notice (NOT- HS-21-014) to advance health equity by increasing health services research involving transgender and gender diverse youth, youth who identify as Black, Indigenous, or People of Color (BIPOC), and youth living in rural communities. Gender diverse youth (GDY) who identify BIPOC, as well as those living in rural communities, are more likely to experience depression and anxiety than their peers.1-5 Additionally, BIPOC and rural GDY are disproportionately underrepresented in pediatric gender clinics,6-8 limiting their access to pediatric gender- affirming care, which has been shown to improve mental health outcomes.9,10 One proposed solution for improving access to gender-affirming care, which is currently provided in large academic medical centers, is facilitating its delivery in the community setting. Prior research suggests both GDY and community pediatric providers are interested in community-based care delivery models, especially those that incorporate technology-based support from gender specialists;11,12 however, additional stakeholder-engaged research is needed to ensure interventions meet the needs of GDY and their families. Given few providers have received training in this area13-15 and most lack opportunities to consult with transgender specialists, telehealth modalities like telemedicine and electronic consultation show great potential in facilitating the provision of community-based gender-affirming care. Unfortunately, little is known about whether existing models provide necessary psychosocial support to GDY and their families. In this K08 proposal, Dr. Sequeira will build on her existing research with GDY, their families, and community pediatric providers to: 1) identify existing barriers BIPOC and rural GDY experience to receiving gender-affirming care and explore design and implementation considerations for facilitating access to care via telehealth, 2) develop a Technology-based Enhanced Gender Support (TEGS) platform to facilitate comprehensive gender-affirming care provision in the community pediatric setting, and 3) conduct a pilot study to determine the feasibility and acceptability of TEGS platform use in the community setting. In addition, this K08 award will provide the necessary skills and preliminary data to inform the development and submission of a future R01 proposal to conduct a randomized trial to evaluate the efficacy of TEGS platform use on GDY’s mental health and perceived care needs as well as community provider knowledge and behavior.