“Becoming Visible” Workshop Educates Clinicians on Transgender Patient Care

transgender patient careRachel Legend
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Transgender health needs prompt culturally-sensitive medical training

By: Jenna Spinelle/TRT Reporter—

SOUTH ATTLEBORO Mass.—Rachel Legend has spent her career advocating for the LGBTQ community across the country, collaborating with celebrities, and winning awards in the process.

Currently the CEO of Arbour-Fuller Hospital in South Attleboro, Legend is using her education and advocacy experience to provide training for doctors, nurses, and other clinical staff through a workshop called “Becoming Visible.”

Legend most recently presented “Becoming Visible” early June in Dedham, Mass. as part of a larger training on providing culturally sensitive treatment to LGBTQ patients, with a special focus on suicide prevention and substance abuse. The workshop drew about 125 attendees and also included a keynote address from Ashby Dodge, clinical director of The Trevor Project.

“We are seeing more and more transgender patients and that is where we have some of the most clinical need for training,” Legend said. “We wanted to focus on the soup to nuts experience … everything from a warm handoff in the ER to use of pronouns and sharing best practices with community partners.”

Arbour-Fuller treats adults with general psychiatric or intellectual disabilities, as well as adolescents with psychiatric issues. One of the challenges Legend and her colleagues continue to see is the restrictive gender binary terms mandated by the Centers for Disease Control (CDC) Division of Health Informatics and Surveillance.

The CDC requires that all patients be classified as male or female, which leaves providers with the difficult choice of staying true to their patients’ wishes or satisfying requirements that are tied to federal funding and insurance company payment.

Legend said there is no easy solution to this problem, nor is one likely to appear any time soon in the current political climate. With that in mind, she said it’s more important than ever for providers to find creative solutions like creating separate, more inclusive, forms for internal use while maintaining the binary gender system where needed.

“Our community is incredibly resilient and incredibly strong and I hate to be the bearer of bad news but the onus for change sits in federal government. [I] don’t think anything is going to change in the current administration,” Legend said. “We can certainly lobby, but I spend much more time talking about what we can do in facilities to work within the framework we have now.”

Another struggle Legend and her colleagues face is that things could change at any minute given the uncertainty about the future of the Affordable Care Act and what the new proposed American Health Care Act may mean for trans patients.

She realizes that there’s no one size fits all solution for all clinics and, in her workshops, encourages practitioners to share ideas and develop something that works for their unique circumstances. Ideally, she said, each practice would have its own checklist culled from a collective set of ideas shared among facilities.

“What needs to happen at my facility is not what needs to happen at someone else’s facility,” Legend said. “What does the paperwork look like? Are our receptionists trained? If someone’s name on their insurance card doesn’t match what they sign in the office, how do we work with that? The answers to those questions will vary from practice to practice but we can share ideas to help each other along the way.”

Before she moved to New England, Legend spent 15 years as an anti-bullying advocate in California. She received an award from the Human Rights Campaign (HRC), along with singer KD Lang and former Speaker of the House Nancy Pelosi, for working with youth in California. She’s also a recipient of Rhode Island College’s Annual Diversity Award.

Melissa Holcomb, Arbour-Fuller’s clinical director, has seen the “Becoming Visible” presentation and said Legend takes participants outside of the comfort zone and encourages interaction without being too over the top.

“Rachel has a way of doing a training [that gets] everyone involved without putting people on the spot,” Holcomb said. “Sometimes people are shocked to hear some of the things she says and the data she pulls out, but they leave feeling like they learned a great deal and can put it to use in their practice.”

Another topic Legend discusses during “Becoming Visible” is bathrooms at clinical facilities. Following the bathroom rights battles in North Carolina and other states, she says the tendency among treatment centers is to create individual rooms and bathrooms for transgender patients.

However, as history has proven, separate is not always equal and what can seem like a good intention can come across as a restrictive measure rather than an inclusionary one, she said.

“We have patients who clash for any number reasons and this is one of them, but single rooms and restroom are not the answer,” Legend said. “Rather, we work with our patients every day in our facilities to come up with solutions that will work for everyone. At the end of the day, folks should be allowed to use the restroom of the gender with which they identify.”

While issues related to reporting and bathroom access will take time to correct,” Legend said one easy thing everyone can do right now is be diligent about asking which pronouns patients prefer.

“The smallest act of social justice we can do is we can ask them what their pronoun is,” Legend said. “That small act really allows you to have a conversation about why we’re doing this. It’s going to matter for the trans patient and allows teaching moments for others.”

This point has definitely stuck with Holcomb since she first heard Legend’s presentation.

“I am very conscious and hear her voice in my head being conscious of how I ask questions and asking people which pronouns they prefer,” Holcomb said. “We are making sure we’re clinically sensitive and asking questions in a way that doesn’t make anyone feel embarrassed.”

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