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Program Progress

PHSA became responsible for the provincial coordination of transgender health services in BC in fall 2015. Since then, PHSA’s Trans Care BC program has been under development.

ProgressUpdateFeb2017Image.pngView the Feb 2017 Trans Care BC Program update 

The Trans Care BC program now includes: a provincial program director, a medical director (physician), an administrative assistant, project managers, nurses, health navigators and a booking clerk. 

 

Two existing provincial resources, the Vancouver Coastal Health (VCH) Transgender Health Information Program (THiP) and VCH/ Health Canada funded CALL Out! project have integrated with the Trans Care BC program.

 

The work of Dr. Gail Knudson's office for coordinating surgical assessments has transferred to PHSA from Vancouver Coastal Health and has now fully integrated with Trans Care BC.

 

care coordination team has been established.  Two Trans Care BC nurses are now trained and offering surgical care planning and assessment visits. The care coordination team will work alongside health navigators who joined Trans Care BC from the Transgender Health Information Program (THiP) and the CALL Out! project staff. 

 

Education

A multi-faceted education strategy, with a focus on enhancing the capacity of systems and health care providers to provide gender affirming care, will be an integral part of our program and is under development.  In the past 6 months we have visited communities, teams and organizations including training health service providers in Nelson, Kelowna and Cranbrook, the Chilliwack and Langley Divisions of Family Practice, BC Children's Hospital, UBC, PHSA leadership and Providence Health. 

 

Discussions are underway with BC's health authorities about opportunities to enhance care options, with a focus on primary care as a foundation for gender affirming care where possible. An inventory of health care practitioners providing care for trans people in BC is being gathered as we become aware of them and can be accessed via the Trans Care BC health navigator team until an online version is launched in 2017.

 

A primary care working group is developing a framework for gender affirming models of care for children, families, youth and adults.  Levels of care will be defined, and clinical standards, guidelines, pathways, resources and competencies will be identified or developed. The working group includes health care providers with primary care expertise and a strong knowledge of trans care, as well as community members. A key outcome of this work will be an education strategy to support adoption of a consistent trans care model in primary care practice across the province.

 

Another key priority for Trans Care BC is to develop a more patient-centred, streamlined system for referrals to gender-affirming surgery and procedures. Work to standardize the surgical assessment referral pathway and documentation launched in December 2016. Through the development of a standard health care framework, with educational resources and practice support documents, we will be better able to bring on more publicly funded assessors for procedure referrals in the future. To improve current support, we are providing care coordination and system navigation support directly through the Trans Care BC program.

 

Work is also underway to review client experiences of surgeries and to increase surgical options in BC.  

Our long-term goal is to enable gender affirming surgical services to be provided closer to home, but this solution is several years away to account for planning, recruitment and training. 

 

Lower surgeries

Lower gender affirming surgeries in Canada are performed at GRS Montreal. In October 2015, Trans Care BC announced funding for aftercare in Montreal (at L'Ascelpiade) meaning clients no longer have to pay out of pocket for this service.

 

Trans Care BC continues to work with GRS Montreal, as well as review other options available, to improve access to appropriate gender affirming surgery options.

 

New – Out-of-country options for Metoidioplasty and Phalloplasty 

Metoidioplasty and Phalloplasty are complex and are known to have high complication rates. Trans Care BC has been working with the Medical Services Plan (MSP) to provide additional options in the US at centres in Austin, San Francisco and Chicago for BC patients undergoing these procedures.

 

For more information, please contact the Trans Care BC care coordination team at: 1-866-999-1514 or transcareteam@phsa.ca

 

Chest surgeries

Waitlists are being harmonized and data is being gathered related to chest surgery access, wait times and flow across the province.   

 

Those waiting for chest surgeries now have the option to access surgery in Victoria where Dr. Jennifer Robinson and Dr. Christopher Taylor are offering this care. Work is underway to build more capacity for publicly funded chest surgery and breast augmentation/construction options closer to home. During the first six months of this year, 51 surgeries were completed provincially, and year-end volumes are expected to double that of prior years.

 

 

Gathering input from transgender, Two-Spirit, and gender-diverse communities and their families is critical to the development of a provincial network of services. We are currently meeting with communities across BC to validate current services, identify needs, and explore opportunities to work together to provide care and support closer to home.

 

  • In partnership with Island Health, a series of knowledge exchange and community action planning sessions have begun in four communities to hear from local community members and service providers. The results of these sessions will inform the roll out of Trans Care BC program activities in partnership with Island Health and key stakeholders.
  • In the east/west Kootenays, the team hosted a first community action and information session in partnership with Trans Connect, with trans and gender-diverse community of all ages.
  • In Northern Health, we will be partnering with local community members to develop opportunities in Prince George for community action planning and knowledge exchange in 2017.

Trans Care BC is committed to hearing from peer and community support service providers and members of the community across the health regions over the next year. Our goal is to support the development of local, regional, and provincial peer and community support networks.

 

 

Many children express their gender in creative and expansive ways, and this is very normal childhood behaviour. Some children are more consistent, insistent and persistent over time in letting parents and others know that they have been assigned the wrong gender at birth. For all children, having safe and supportive environments where they feel they can be themselves as they develop are important factors in promoting health and well-being. 

 

A small portion of gender creative and gender expansive children may be transgender and may require assessment and ongoing psychological and medical support as they approach puberty in order to explore gender affirming health care options. 

 

Trans Care BC is working to enhance timely and affirming care. Each child and family has unique issues to consider when determining the best pathway for them. While many families may still need to seek care from specialists, some families are better served close to home in primary care and/or pediatrician settings. Trans Care BC is working to build up trans and gender diversity cultural safety at all points of the care journey so that, in the future, families will be able to more easily find GPs and other health care providers who can support their care journey, whatever it may be.

 

Trans Care BC is working with BC service providers to clarify pathways for families of trans, gender diverse, Two-Spirit and gender creative children and youth who need support and access to services. Trans Care BC has a Care Coordination Team with health navigators who assist clients and families in navigating care. 

 

PHSA is working towards a standard model and care pathways for trans, gender creative and gender expansive children and youth. A collaborative practice leader has been hired by Trans Care BC, to support the creation of provincial guidelines, standards of care, and educational strategies for children and families who require it. This work is done in partnership with the clinicians and other child and youth service providers in BC, BC Children's Hospital, the Ministry of Children and Family Development, the Ministry of Education and other child and youth serving resources.  A Family network consultant has also been hired to work with parents and caregivers around the province to plan regional and provincial peer support and engagement networks with and for families of gender creative, Two-Spirit, trans youth and children.

 

We are committed to regional family and community engagement in each health authority and we are also keen to have families more involved in plans for future engagement both locally and provincially. In the coming year, we will be traveling to local communities across the province to consult directly with parents, to learn about local needs and to inform planning for a provincial family event in 2017. 

 

Trans Care BC started an Indigenous community education and engagement process in April 2016, with the intention of completing several engagements in all five regional health authorities over an 18-month period. The process is aimed at providing education around LGBTQ2S with a specific focus on the transgender community, and dialogue to generate discussion about the needs of Indigenous communities.

 

To date, two community events have been held in the Vancouver Coastal Health (VCH) region in Stl'atl'imx communities and the three host Nations in Vancouver (held at Tsleil-Waututh Nation), which was also supported by VCH Aboriginal Health and Prevention teams.

 

Trans Care BC has also recently supported and attended the Aboriginal Youth LGBTQ2S conference in Victoria hosted by the local Aboriginal Friendship Centre. The Victoria youth event was a partnership between First Nations Health Authority (FNHA), Vancouver Island FNHA regional office and Trans Care BC.

 

Four additional engagement sessions are planned for Vancouver Island before March 2017 and a further eight engagements in other regions in the 2017-2018 fiscal year. Engagements will include a mix of First Nations (on-reserve) community sessions as well as urban/off-reserve sessions working with friendship centres and university groups.

 

Trans Care BC is partnering with the University of British Columbia (UBC) Stigma & Resilience Among Vulnerable Youth Centre (SARAVYC)  to gather data about service users' experience of care related to gender affirming surgeries and assessment. Input from the February 2016 peer and community support gathering was used to design the survey content. Over 200 surveys and 35 detailed interviews were completed through summer and fall 2016. A final public report will be published in spring 2017.  

 

Tools and methods for monitoring quality and outcomes of services are also being developed.

 

More information about the program model and plans will be shared in the near future for further community feedback and engagement.


 

SOURCE: Program Progress ( )
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