No abstract

Despite the growing literature on barriers to mental health care experienced by gender-minority individuals, there are few studies that describe mental health providers' competencies for delivering care to transgender clients of mental health care. The current study was designed to explore the relationships between mental health care providers' (N ϭ 107) transphobia, gender minority-specific knowledge, and hypothetical treatment decisions when working with gender-minority clients. Online surveys gauged providers' transphobia using the Genderism and Transphobia Scale (Hill & Willoughby, 2005) as well as their knowledge based on self-reported understanding of gender minority-related issues. Treatment decisions were based on three sets of vignettes that measured providers' responses to both transgender and not explicitly transgender clients in comparable situations. Transphobia negatively predicted knowledge, such that higher transphobia scores were correlated with lower knowledge scores, F(1, 85 ϭ 24.16), p ϭ .02, R 2 ϭ .22. Similarly, transphobia was significantly predictive of treatment decisions in the sample, F(1, 76) ϭ 33.66, p Ͻ .01, R 2 ϭ .31, wherein higher transphobia scores were associated with a wider discrepancy in treatment decisions between transgender and not explicitly transgender clients. The significant relationships between these variables warrants a call for targeted bias-reduction efforts among mental health providers to improve services for and reduce discrimination against genderminority individuals accessing mental health services. Public Significance StatementTo address mental health disparities that are well documented among transgender individuals, the current study explores the relationships between mental health care providers' transphobia, knowledge of transgender issues, and hypothetical treatment decisions when working with transgender clients. The results of this study suggest that more knowledge of transgender issues may be related to less transphobia among mental health care providers and that less transphobia may be predictive of more equitable treatment decisions when working with transgender clients. These results demonstrate the urgency for more targeted efforts to reduce providers' transphobic biases and improve their preparedness to provide affirmative treatment to transgender individuals.

Although Veterans Affairs (VA) directives and initiatives have sought to ensure an affirmative environment for transgender and gender diverse (TGD) veterans, barriers to care persist, including enacted/anticipated stigma as well as providers' lack of knowledge regarding specific health concerns of the TGD community. These barriers are significant in light of prior research, which has demonstrated a relationship between fears of transphobic discrimination and avoiding or delaying health care engagement. The present study seeks to explore the relationship between perceptions of providers' competence with TGD patients, veterans' minority stress, and veterans' treatment engagement in gender-related services. To this end, analyses were performed on data collected from 42 TGD veterans. Results suggest that perceptions of providers' competence are positively correlated with engagement in gender-related services. Global gender minority stress was not related to engagement, but the discrimination subscale was significantly correlated with engagement. When entered into a simultaneous regression, both the discrimination subscale and provider competence significantly predicted engagement. Results require replication in larger, more diverse samples, but suggest improving provider competence may bolster engagement for TGD veterans. Impact StatementThis manuscript describes the relationship between past experiences of discrimination, perceptions of providers' competence in transgender and gender diverse (TGD) health, and TGD veteran's engagement in gender-related services within the Veterans Health Administration. Additionally, addressing the impacts of discrimination may further enhance engagement. The results have implications for individual clinicians, whose direct work with TGD veterans poses an opportunity to facilitate affirmative (Shipherd et al., 2010) spaces and assess for gender minority risk and resilience. Moreover, these findings emphasize the role of policy makers in creating systems-level safeguards for ensuring TGD-affirmative health care settings.