EquiCare Toolkit

Abstract: In October 2022, the World Professional Association for Transgender Health published updated international guidelines (Version 8) regarding Standards of Care for medical interventions for transgender and nonbinary (TNB) people. We encourage providers to use The Companionship Model when they are required to write referral letters for patients and clients. This model includes information regarding obtaining informed consent on the procedures from the client, collaborating with the client in navigating institutional gatekeeping, and utilizing the clinician’s knowledge and resources to increase the client’s access to critical resources. Clinicians are encouraged to use four actions to process gatekeeping with clients: validate (V), ask (A), share (S), and engage (E). The referral letter session includes the clinician validating (V) the client’s assumptions, reactions, and normative mistrust of gatekeeping processes, asking (A) for the client’s reactions to the letter-writing process, sharing (S) the clinician’s critical understanding of the letter-writing session, and engaging (E) the client as a collaborative decision-maker in writing the letter. To illustrate The Companionship Model, we provide two case examples of clients from a community clinic. By using this model, we invite clinicians to shift their typical role from assessor to companion and to navigate gatekeeping with intentionality. We offer specific suggestions for mental health providers to improve their therapeutic relationships and to follow ethical guidelines for decreasing barriers for TNB people to access mental health resources. Finally, we provide sample letters in the cases where a referral letter is required by a clinic or provider.

Budge, S. L., Lee, J., Tebbe, E. A., & Domínguez, S., Jr. (2023). Using the companionship model when writing referral letters for transgender and nonbinary adults. Psychology of Sexual Orientation and Gender Diversity. Advance online publication. https://doi.org/10.1037/sgd0000684  

Overview: Site provides links to a wide array of useful resources for LGBTQ+ patients. 

Human Rights Campaign. (n.d.). (Resources for LGBTQ+ Patients). Retrieved from  https://www.hrc.org/resources/patient-resources 

Abstract – Objectives: This randomized controlled trial examined whether an 11-week synchronous (i.e., real-time) online training in lesbian, gay, bisexual, transgender, queer, and other sexual or gender diverse (LGBTQ)-affirmative cognitive behavioral therapy (CBT) could lead to increased uptake of this practice at LGBTQ community centers across 20 U.S. states and internationally. Method: A total of 121 mental health providers (Mage = 37.74; 78.5% LGBTQ; 60.3% non-Hispanic/Latinx White) were randomized to receive the 11-week training either immediately (n = 61) or after a 4-month wait (n = 60). At baseline and 4 and 8 months after baseline, participants self-reported their LGBTQ-affirmative competency, cultural humility, and knowledge of the minority stress theory and practice skills underlying LGBTQ-affirmative CBT. To objectively assess uptake of LGBTQ-affirmative CBT, participants demonstrated, through simulated practice, how they would respond to two video-based clinical vignettes. Results: Compared to waitlist, participants in the immediate training condition reported greater improvements in self-reported cultural competence (d = 1.24), minority stress knowledge (d = 0.78), LGBTQ-affirmative CBT knowledge (d =0.78), and LGBTQ-affirmative CBT skills familiarity (d = 0.91) and use (d = 0.96); effects persisted 8 months postbaseline. Cultural humility showed no significant difference by condition (d = 0.07). In objectively coded assessments of simulated practice, participants in the training condition demonstrated greater uptake of LGBTQ-affirmative practice skills (d = 0.82). Conclusions: Findings preliminarily suggest that mental health providers can be trained to deliver LGBTQ-affirmative CBT using the low-cost, efficient reach of online training. This training can help disseminate evidence-based mental health care to LGBTQ individuals and support its implementation across practice settings.

Pachankis, J. E., Soulliard, Z. A., Seager van Dyk, I., Layland, E. K., Clark, K. A., Levine, D. S., & Jackson, S. D. (2022). Training in LGBTQ-affirmative cognitive behavioral therapy: A randomized controlled trial across LGBTQ community centers. Journal of Consulting and Clinical Psychology, 90(7), 582-599. https://doi.org/10.1037/ccp0000745

Overview: This website provides an overview of working with LGBTQ+ clients along with specifics for mental health providers about working with bi+ individuals.

Still bisexual. (2022). The importance of mental health clinicians becoming LGBTQ+ competent: How to work with Bi+ clients. A guide for mental health clinicians. https://stillbi.org/a-guide-for-mental-health-clinicians/

Overview: The website provides information and resources to empower trans and gender-diverse individuals to advocate for themselves in healthcare settings. Effective self-advocacy fosters relationship building with doctors and health professionals, which is vital for achieving optimal health outcomes.  

TransHub. (n.d.). Medical affirmation. https://www.transhub.org.au/medical

Abstract: In October 2022, the World Professional Association for Transgender Health published updated international guidelines (Version 8) regarding Standards of Care for medical interventions for transgender and nonbinary (TNB) people. We encourage providers to use The Companionship Model when they are required to write referral letters for patients and clients. This model includes information regarding obtaining informed consent on the procedures from the client, collaborating with the client in navigating institutional gatekeeping, and utilizing the clinician’s knowledge and resources to increase the client’s access to critical resources. Clinicians are encouraged to use four actions to process gatekeeping with clients: validate (V), ask (A), share (S), and engage (E). The referral letter session includes the clinician validating (V) the client’s assumptions, reactions, and normative mistrust of gatekeeping processes, asking (A) for the client’s reactions to the letter-writing process, sharing (S) the clinician’s critical understanding of the letter-writing session, and engaging (E) the client as a collaborative decision-maker in writing the letter. To illustrate The Companionship Model, we provide two case examples of clients from a community clinic. By using this model, we invite clinicians to shift their typical role from assessor to companion and to navigate gatekeeping with intentionality. We offer specific suggestions for mental health providers to improve their therapeutic relationships and to follow ethical guidelines for decreasing barriers for TNB people to access mental health resources. Finally, we provide sample letters in the cases where a referral letter is required by a clinic or provider.

Crowley, D., Cullen, W., & Van Hout, M. C. (2021). Transgender health care in primary care. British Journal of General Practice, 71(709), 377–378. https://doi.org/10.3399/bjgp21X716753

Key Points: 1. LGBTQ-affirming behavioral health providers in primary care can offer a unique service by conducting tailored evaluations and interventions targeting the sexual and gender minority stress influences that perpetuate psychological distress in GCBTQ patients. 2. Evidence-based specialty behavioral health treatments can be tailored to meet the needs of LGBTQ patients more adequately while also adhering to the brief, structured primary care behavioral health model. 3. Establishing collaborative partnerships with LGBTQ people and ensuring that their perspectives are reflected in practice improvement initiatives can result in innovative and obtainable solutions for advancing LGBTQ population health.

Heredia, D., Pankey, T. L., & Gonzalez, C. A. (2021). LGBTQ-affirmative behavioral health services in primary care. Primary Care: Clinics in Office Practice, 48(2), 243-257. https://doi.org/10.1016/j.pop.2021.02.005  

Overview: The goal of this resource is to aid counseling psychology educators and increase the accountability of counseling psychology programs in making their curricula more inclusive of TNG-specific concerns. Our hope is that this resource will help counseling psychology programs equip future generations of mental health professionals at both the doctoral and masters level work toward the necessary competencies in TNG identities and concerns as outlined by the American Psychological Association. Although this resource is by no means comprehensive of the diverse concerns pertaining to TNG populations, it provides an overview of TNG-affirming literature relevant to counseling psychology coursework.

McGinley, M., Christie, M. B., Clements, Z., Goldbach, C. M., Kraus, E., Woznicki, N. W., Breslow, A. S., Budge, S. L., & Matsuno, E. (2020). A resource for incorporating trans and gender diverse issues into counseling psychology curricula. APA Division 17 Special Task Group, Making Room at the Table: Trans/Nonbinary Pipeline to Counseling Psychology. https://www.div17.org 

Overview: Toolkit helps integrated primary care sites to better address the needs of LCBTQ+ patients. 

Willging, C., Sturm, R., Sklar, M., Kano, M., Davies, S., & Eckstrand, K. (2021). LGBTQ primary care toolkit: A guide for primary care clinics to improve services for sexual and gender minority (SGM) patients. Albuquerque, NM: Pacific Institute for Research and Evaluation. https://lgbtqprimarycare.com/