Trans Care BC aligns its practices with World Professional Association for Transgender Health (WPATH)
Standards of Care Version 7. The model of care being developed at Trans Care BC is shown below with four tiers. The intent of the model is to encourage shared care with the primary care provider jointly planning care with providers and specialists, in other tiers of care.
Tier 1 service offers a culturally safe, inclusive and accessible health care environment that supports clients across the gender and age spectrum (child, youth, adult, older adult). All staff and health care professionals would have a good understanding and incorporation of appropriate use of language, the importance of the used name and a client’s preference of pronouns.
At this level a health care professional would have a good knowledge of where to refer clients for resources and system navigation. Services provided should include prevention, harm reduction and health promotion strategies. Counselling services at this level would be general in nature but provided in a gender-affirming approach along with a solid understanding of the stages of development for children and youth.
Clients and/or families would be encouraged and supported in taking an active role in their care.
Tier 2 services include health care professionals with competencies for trans specific care such as conducting a culturally sensitive physical exam, supporting a client on hormone therapy, familiarity with medications and side effects and the provision of individual counselling (relevant to trans and gender diverse people such as coming out, starting hormone therapy, puberty blockers, exploration of gender identify, etc.).
Clinicians at this level should be able to differentiate coexisting mental health conditions from gender dysphoria and be able to assist families in adopting a more accepting and nurturing response to their child/youth’s gender expression. Health professionals at this level may work in a shared care model with clinicians with more advanced practice competencies.
In tier 3, health care professionals have the necessary competencies to complete a hormone or surgical readiness assessment and are comfortable initiating and monitoring hormone therapy, and providing or coordinating complex post-operative care.
At times, clinicians functioning at this level may support colleagues working at Tier 2 in a shared care model of care related to the completion of assessments, supporting a provider starting a client on hormones, etc.
Clients at times may require the support of specialists to assist in the management of health conditions and/or to support them achieving their gender-affirming goals (endocrinologist, gynecologist, surgeon etc.).
The goal is to transition clients to Tier 4 services as required with the client remaining attached to their primary care and/or mental health teams in a shared care model.