Great. Welcome everybody to our webinar in our series. This is the first of two for the core concepts, a trans and non-binary overview for forensic nurses. Michael Munson will be presenting today and welcome to the first of this series. Before we start, I'd like to offer a quick disclaimer that the opinions and findings and conclusions and recommendations expressed in this presentation are those of the contributors and do not necessarily represent the official position or policies of the U.S. Department of Justice. Thank you and welcome, Michael. We'll let you get started. Thank you. Thanks, Shay and Amy who are kind of holding the fort today and for Jen for asking for this topic and for us to be together today. I want to just take a moment to start with a bit of a land acknowledgement and a bit of a just a moment for us to settle into the spaces that we're in right now and acknowledging that all of us are on borrowed land and that we're living in a world that's disrupted right now and having a difficult time. So if we could all just take a moment and remember where we are from and what this earth is about and for and how we can nurture it. Thank you. I also wanted to start with a visual description of who I am. I am a white appearing multiracial person with glasses and short brown and gray hair, more gray in my beard. I've got a very loud orangey colored shirt on and I'm in front of a black drape background. So I'm really excited to be here with you all today. We have a really simple and quick agenda, but we're going to have lots of information in this time that we spend together. So we're going to do a quick one-on-one reminders kind of thing about who trans folks are. We'll look at some data that's specific to trans folks and victimization. We'll look at seven barriers. We could talk about hundreds of barriers, but we'll pick seven of them and with each of the barrier there will be a survivor's quote, a trans survivor's quote, and a slide about how to increase access for that trans survivor. So what you all can do to increase access. We'll end with kind of what you can do, some kind of easy steps that you can implement right away if you're not already doing some of these things. And then we'll end with resources and questions. So that is our schedule for the day. I know that all of us do this work every day or all of the time and it's hard sometimes. I don't believe that anything in this session is going to be especially triggering, but please do take care of yourself, whatever that means to you. And I wanted to do just a check-in for the back-end folks. If it's supposed to be recorded, is it being recorded? Just to double check. Just to double check. Yes, it is. Got it. Sorry, I wasn't seeing the little button. So we are going to interact today in a couple of ways. One is through the chat feature, which I know we've all done Zoom a lot. So I'm sure that you all know where chat is, but let us do a little bit of a practice if we can. So make sure that you're sending it to the two to everybody. And why don't you share your name and your pronouns in the chat. Thank you. Y'all are fine in the chat, which is super. So name, pronouns. If you want to add location, that's cool too. And I know there's more than two of you. Excellent. Thank you. I'm going to let you all keep going. It's great for us to practice saying our name and pronouns, whether it's in text or verbally. So that was your practice for the day. We will also have some time at the end to have voice interaction, so we can unmute you and you can ask questions or make comments at the end. We'll have a couple of polls today, and the rest will be didactic or videos or some brainstorming in chat. So a quick snippet of who I am. I'm Michael Munson, and I have been with FORGE for 28 years as a co-founder. I am our primary trainer, and I do everything from making coffee to writing funding proposals to balancing our books, sort of. So I'm a full-ranged person doing lots of different things, but most of what I do is training, and that's what I like to do the most. FORGE is a 28-year-old organization that is a trans organization that is 100% focused on anti-violence issues. So predominantly, we do training and technical assistance nationally across the country, and we do a little bit of direct services with trans and non-binary survivors. Again, that's national, not in any specific locality. A little bit about what we can offer providers. Just a really quick rundown is, you know, we do typical training and technical assistance, so that's one-on-one support, publications, trainings, conferences, which I'm really happy to be going back to in-person conferences just a little bit, webinars like this one, site visits, either remotely or in-person. We've been doing a little bit more on policy work, especially as there have been more anti-trans legislative efforts going on, and that affects trans survivors. We love collaborating, especially with folks like IAFN, and we do a bunch of information referrals. For the work that we do with survivors, all of it is online, so there's some online support venues, some online social media groups that are private for folks, publications, conferences, trainings, all of those good things for survivors as well, and we really work to empower survivors to heal in a really difficult world. We have a super small staff. We have four full-time folks and a couple of non-full-time folks, and we are very playful and scattered across the country. We have two guiding principles, and I promise you we're going to jump in really soon to more exciting content, but our two principles are being trauma-informed, which to me always feels like chasing our tail, because there's always something new to pay attention to and to be mindful of, so we care about being trauma-informed both with the survivors that we work with as well as with you all as providers, and the same is true for being empowerment-based. I mean, a lot of us, we know we want to empower the survivors that we work with, but I care a lot about having you all feel empowered by the time you are done with a training or support that we provide for you, so if you do not feel empowered, even just a little bit, please tell me, give me some feedback on that, because that's my job here today, is to help you feel better about the work that you can do with trans and non-binary survivors. Please feel free to find us online. We like to make friends with folks. This is our primary vehicle for sharing new information, new publications, new webinars, new things that might be of interest to you and your work with trans survivors. I think I'm going to know the answer to this question about who you are, but if you'd be willing to put in chat what you do, if you're a forensic nurse, if you're a medical advocate, what kind of role are you in, just to give us a framework for who's here. Great, so I'm seeing victim advocate, a sane victim advocate, forensic nurse, prevention specialist, great, that's good to see, sane safe director, forensic nurse, excellent, cool. I anticipated kind of that divide between advocates and nurses, so I'm glad to see that that is true for who's here. Excellent, thank you. So I wanted to start with a conceptual framework, and some of you who have been on a FORGE webinar have probably seen this. This is a really useful tool, I think, to think about trans issues, and it's something from a really long time ago. So in the 1940s, Everett Hughes defined this concept that I'm going to share with you as master status, and then 15 years later, Gordon Allport, in his book The Nature of Prejudice, named the same concept the label of primary potency. So this is a little bit of a mouthful, but both of these terms refer to the tendency of observers to believe that one label, or demographic category, is more significant than any other aspect of the observed person's background, behavior, or performance. So this emerged out of a racial context of like saying, oh, just because I know somebody is Black, I'm going to presume that I know a lot of things about them, which is what we don't want to do. So when we think about master status in terms of trans folks, just because we know they're trans doesn't tell us very much about them. So we don't want to say, oh, I know they're trans, and therefore I know X, Y, and Z about them, because we don't really know anything about them. So let me offer you an example. So Robbie Conover is a friend of mine on Facebook, and he posted on his Facebook feed, I'm having surgery tomorrow. And all of his friends, his Facebook friends, were like, congratulations, way to go, I'm so happy for you. And they were going on and on and on and on about how, you know, happy they were for him having surgery. And the reality was that he was having surgery that involved amputating his leg because he had cancer. And so the perception was, oh, if you're trans, you're having surgery, you must be having gender-affirming surgery, when the reality for him was something that was very serious and not very celebratory. So it's an example of where we might make assumptions when we need to not make those assumptions. A couple of ways that master status can play out in action for providers are in these couple of ways. So we might be really curious about somebody's trans history, or their issues, or their experiences. And curiosity is great, but we don't necessarily want to ask about those things that we're curious about. Providers may ask types of questions that really focus on someone's transness, rather than why they are there to see that provider. Providers might ask intrusive or inappropriate questions. Again, this may not be intentional, but it may be intrusive or invasive in ways that wouldn't be asked of other people who are not trans. Providers may do things like redirect conversations back to transness. Again, maybe out of that curiosity factor, again, usually not out of an intentional harmfulness kind of framework, but because of curiosity. And there might be causalities or correlations made that may be true or may be false between someone's transness and any other things, like victimization, or poverty, or family relationships. So those are just a couple of areas where we see master status in action. I'm going to share with you a couple of videos today. And this video is going to share a little bit about what I just shared with you, which is about master status. And in this video, we recorded this about three months ago, and it's a group of mental health therapists. And this one therapist is really talking about master status, but doesn't name it as such. So let's take a listen, and you might need to turn up your volume on your speakers, because we're having a little bit of a volume issue. Being that affirming presence and being outspokenly affirming is really great. But I think the other thing, the last thing I would say about that is, one of the things I like is that, we're all people, right? And so often, I like working with trans and queer people, because we're people at the same time. So a lot of people come into my practice, and they say, well, actually, I didn't want to talk about being trans. I wanted to talk about this other thing, but I need to make sure that you don't want to talk about me being trans. And so that was really kind of eye-opening for me. And I thought, oh, yeah, we still talk about transphobia. And transition, and those kinds of things. But at the end of the day, people want to talk about that thing that their friend said that hurt their feelings as well. I'm really glad you shared that, because that's, I think, so pivotal that a lot of times providers think, oh, this is a trans person. They're going to want to talk about their trans stuff. And it's like, well, not necessarily. So we're complex people. We have more than just this one issue to talk about. So I really appreciate it. So that's just an example in a therapeutic session. And obviously, you all working with survivors in an ER or in an emergency setting are going to want to focus on why they're there, which is a post-assault reason, or whatever it is that they are there for. You all know that. I'm preaching to the choir here. So let's do a quick review of kind of 101 concepts. And this will be really basic and really brief. And some of you are going to be a little bit bored with this. So hang on, and we'll get to some things that are better. I really want to start off with you know how to do your job, and you know how to do your job well. That's my presumption, and I'm hoping that that's true for everybody. And my job is really to just help shine a light on the trans pieces that help you do your job better with trans and non-binary clients. One of the quits that I really love to start with, especially when working with medical folks, is the reminder that transness is not a disorder. So no one's identity is a disorder. And that quote is from Lynn Fraser, who is the past president of WPATH, which is the World Professional Association of Trans Health, I think. I always forget what WPATH stands for. And she's really, you know, really right. And again, it goes back to that master status that people are not one thing. They are not a disorder because it's their identity. So Amy, if you could pull up the first poll, I would appreciate it. And for those of you who are attending, if you could respond to what percentage of the population do you think is transgender? So 0.6%, 1%, or 9.2%. So what percentage of the population is trans? Excellent. Thank you all for voting. So it looks like the majority of you said 1%, and probably a pretty equal number of you have said 0.6 or 9.2. Thank you for voting. So the answer is that you're all right. Everybody's right. We don't really know what percentage of the population is trans. The Williams Institute out of UCLA guesses, estimates, educatedly educates, that estimates that it's 0.6%. I will try to speak better as we move along today. Lynn Conway and some other researchers have, you know, estimated that it's around 1%. And I'm going to get to that 9.2 number in just a second. But 1% is probably the most commonly accepted number for how many folks are trans in this country. When we look at that 1%, so this chart in the middle is the 1% of the population that's trans. The National Center for Transgender Equality did a really, really, really large-scale survey in 2015-2016, with just under 28,000 trans and non-binary respondents. As you can see on the slide, the biggest piece of the pie here are non-binary folks. So there's about a third who identify as trans men, a third that identify as trans women, a few that identify as crossdressers, which is a controversial word, but it was a word that was used a few years ago. But the biggest piece is non-binary. So why that's important, and I hope that you will think about this as we move through today, is that if somebody needs a support group for post-sexual assault, is that support group going to be gender segregated? Is it going to be for women only? And if so, where is that non-binary person going to go? Are the trans men going to be able to access that women's only support group? But equally importantly, where are the non-binary folks supposed to go when there are gender or sex segregated spaces? So let's just keep that in mind as we move forward today. What we do know is that there's an increasing number of folks who are identifying as trans, identifying as agender, non-gendered, identifying in that spectrum of folks who don't identify firmly in a male or female camp, or don't want to stay in the camp that they were assigned at birth. Someplace between 1.8 and 9.2 percent of folks are identifying as trans or gender diverse, according to the Youth Risk Behavior Survey from 2017. So there's newer numbers coming out, and I anticipate that we will see that number continue to rise. We'll make sure that if you didn't get it already, that we will send out a handout. It's this handout of a unicorn, and it's the gender unicorn. So it's a really useful and really simple chart to remind us all about the differences between gender identity, gender expression, sexual romantic orientation, and the sex assigned at birth. So let me just quickly review this. Gender identity is what we all have. We all have all of these things. So gender identity is what's on the inside. So how do we identify our gender? Do we identify as a man or as a woman or as male or as female? Some academics would argue with what I just said in terms of man or male, because sometimes there's a distinction between those things. Gender expression is also something that we have. It's how do we express our gender to the world? What do we put on in terms of our clothes? How do we style our hair? Do we wear makeup or not? Do we have jewelry or not? How do we walk? How do we exist in the world? And what gendered messages do we intentionally or not intentionally share with others? Sexual romantic orientation or attraction is who we love, who we care for, who we want to have sex with, who we want to partner with. Again, all of us have a sexual orientation, even if we're asexual or don't have any interest in having a sexual relationship. And then the last piece on this slide is the sex assigned at birth. So most of us are identified as male or female when we are born. It's usually not based on anything other than the genitals that are seen or not seen. A lot of times that's not a good predictor for what gender somebody will grow up to be. I think we all know that language matters, and language matters for a lot of different things, and it matters a lot for trans folks and non-binary folks. A quick reminder that language is always, always, always changing. It's always evolving. It's both really, really complicated, and it's really, really simple, and it's kind of messy sometimes, but the solutions are pretty simple, even though it's messy. So on the screen, it's not intended to be read, but there's a hundred different gender identity words in that word cloud. So just a reminder that there's a lot of different ways that people talk about their gender, identify with their gender, express who they are. This slide will age me a little bit, and many of you may know who the Abominable Snowman is or was, but this was in the Bugs Bunny cartoons, and the Abominable Snowman would pick up Bugs Bunny non-consensually, squeeze, and say, I will hug him, and pet him, and squeeze him, and call him George, and I'm just looking through the attendees list, and I don't think I see anybody whose name is George. So if you were Bugs Bunny in this particular situation, and the Abominable Snowman was calling you George, you'd probably feel like, who is this person? Who's this guy talking to? What's going on here? So we want to know what people's names are, right? We want to ask what people's names are, and we also want to know what people's pronouns are. So I'm going to share with you a very short clip of how we can ask our clients what pronouns they use, and I do see that one of the people on the call today is actually in this video, so you will see it in just a second, and it's a really lovely little clip. This was created by EVOWI, the End Violence Against Women International, for the virtual practicum. So you can see in that clip, Jordan, who has not disclosed that he's trans yet, is kind of like, hey, what the heck are you talking about? Why are you asking me my pronouns? But the advocate is just like, hey, these are what my pronouns are, I'm going to ask you yours, and then they move on and talk about the rest of why he's there. So it can be a really simple interaction. There are loads of ways that you can share your pronouns and ask others of theirs. This is a physician in Minnesota who was allowed to put his pronouns or their pronouns on their jacket, their scrubs. Not everybody is going to be allowed to do that, but it's really great when the name tag can have your name and your pronouns on them. So just a reminder that when somebody discloses that they're trans, it really doesn't tell you very much about who they are, and that's true for any identity, like we talked about with master status. When Forge talks about trans folks, I'm just going to give you a rough idea of who is in that big umbrella that we're talking about. So we're talking about folks that are transitioning from one point to another, oftentimes male to female or female to male, sometimes male to someplace else not female. Lots of places to transition to and from. We're also talking about people who are questioning their gender. So this might be when they're five years old or when they're 95 years old. So just questioning like, is my gender right? Does it feel right to me? We're talking about people who don't fit into the binaries, who don't fit into the mailbox or the female box. We're talking about folks who are gender nonconforming. So who don't like the gender norms of male, female, or other genders. We're also talking about folks who are gender conforming. So they have a trans history, but they identify as male or female. They don't identify as trans, and they generally don't disclose that they're trans, even though they have a trans history. We're talking about folks who are multiply gendered. So that might be that they live part of their life in one gender, part of their life in another gender. It might mean that they embody more than one gender. So that complex reality of non-singular gender. And at FORGE, we include significant other friends, family, and allies, and many of the folks that are around trans and non-binary people, because we know that violence doesn't just happen in a vacuum. It doesn't just happen against a trans person. It affects that whole system of support, that whole system of love, that whole system that surrounds that trans or non-binary person. And when we start to look at barriers and access, we, of course, need to pay attention to the intersectionalities that we all embody in some way. So a Black trans woman is going to have a really different experience in life than a white trans man. Just really two different experiences. And none of those two are going to be the same. We could take a lot of trans women of color, and they all are going to have different experiences, of course. I'm telling you things that you already know, of course. But we want to make sure that we understand what somebody's history is in a really complex and nuanced way, so that we can better serve them. So generally, trans folks will think about these three areas and figure out if they want to take action in any of these areas. So we're looking at medical options or actions, social options or actions, and legal options or actions. So all of these options are equally valid. The options might change over time. They may reverse. They may be very fluid and movable. So when we look at that social category, this is mostly about, do I come out to my family or friends or school or work? How do I present my gender in these situations with these people? What do I do with my social activities, my faith communities, my casual interactions? And it may be that somebody is not consistently expressing their gender in all areas of their life. It may be that there's a slow creep for how they come out or if they come out or when they come out. So those are all about interacting with the world. Some folks may make legal changes and some folks may not. So legal changes could be name on ID documents, gender on ID documents. There are hundreds and hundreds of identity documents. If anybody has changed their name, I'm sure that you know how many hundreds and hundreds of things there are that you need to change if you wanted to change everything. For a lot of folks, it may be difficult to change their name or gender if they wanted to because of cost, because of concerns about losing their job or their family. So they may not want to make those legal changes because of some of those things. And for those non-binary people, so that biggest piece of the pie, those 35%, changing their name or their gender may not feel affirming if there's no gender that feels affirming on a male or female driver's license, for example. So some of the states that have the option of an X or a third gender, that's great. And they may feel comfortable with that option or maybe not. So again, this is something that people may choose or may not choose. And then the third category where choices or options are made or thought about are medical. So do people want to access medical care in terms of hormones or surgery? And again, this may or may not be something that affirms somebody's gender or doesn't affirm their gender. They're just options to make people feel more aligned with who they are, whether that's a choice to do something or not to do something. And just like with legal things, medical transition is sometimes very expensive and some insurances don't cover, many insurances don't cover. So costs can be really prohibitive. It certainly is a challenge for folks that are young, for folks that have low income, and sometimes it really depends on others in your life. So people may have parents that say no or a partner that doesn't want to invest money in that way. So there's a lot of options and choices around medical access to transition-oriented care. So when you think about some of those things and you're working with a client, what are some of those things that you need to know? Do you need to know what a client's social, legal, or medical actions are? And what kinds of questions might you need to ask? Can we use the chat for a moment and think about what do you need to know when you're working with a client? Do you need to know if they've had surgery? Do you need to know if they've changed their name? Do you need to know if they're on hormones? Those are just three examples. Anybody want to offer a guess or a comment? Okay, people are being quiet and that is totally cool. So all of these answers are, it's going to be an it depends, right? So you may need to know if somebody's on hormones because it may affect the care that you're providing. It may affect if their vaginal tissue is going to be full, if their vaginal tissue is going to be fragile or sensitive or more painful. You may need to know their legal status if you're charting and they may want to report to law enforcement. Some of those things you may need to know in order to provide better care, but a lot of times some of those smaller choices you're never going to need to ask or know to provide really good care. Just a couple of references if folks would like to learn more about transition-related services or medical-related care. The ICATH model, so it's an informed consent model of trans health, is really a preferred model versus a more constricted version of WPATH, which really requires people to jump through a lot of hoops. The Center of Excellence for Transgender Health is also a really, really good resource for general primary care provider type folks who are looking at working with trans folks. Many of you will not need to look at these kinds of things, but if you're interested in learning more, you have access to those resources. Let's move and talk about some national trans-specific victimization data. Many of you will know already about ACEs, so Adverse Childhood Experiences, and I'm not going to go into really what they are. If you'd like to have some conversation about it, I would be happy to have a conversation after today about what they are. Basically, it's what happens in childhood that creates negative outcomes, negative health outcomes in adulthood. We can look at some core ACEs that are defined by the CDC and Kaiser, and we can also add in some trans-specific ACEs. There's a webinar on our website that you can look at trans-specific ACEs in more detail, which I won't talk about today, but when we just look at the basic core ACEs, we know that there are some really dramatic differences between trans people and non-trans people. Folks can have a wide range of ACEs. For example, one ACE is the use of alcohol as a coping strategy, or just the use of alcohol. If that was the one ACE that people used, the general population, about 58% have one ACE. 91% of trans folks have one ACE. When we look at folks that have four or more ACEs, we look at the general population as being 20% of having four or more ACEs, and for trans folks, it's 61%. We can see that there's just a really big disparity between what trans people are experiencing in childhood and what non-trans people are experiencing. When we look at general data of trans and non-binary folks in terms of sexual assault and intimate partner violence, the slide on the screen is probably a low estimate, but these are combining lots of different studies together, and the majority of folks think that 50% or greater are folks that have experienced intimate partner violence at some point in their life. For sexual violence, more and more studies are showing that it's 66% or higher. Sometimes in some communities, some smaller trans communities within trans communities, it's a little bit lower, and for some trans communities, it's much, much higher. This is a really high percentage of folks who are experiencing sexual violence or intimate partner violence. If you're not seeing trans clients coming in, there are some of the barriers that are likely causing that to be, not that trans folks are not experiencing sexual violence. If we can pull up the next poll, please, I'd appreciate it. The question is, trans women or trans feminine people experience more sexual violence than trans men or trans masculine people. Is that true or false, or the rates are the same? Trans women or trans femmes experience more sexual violence than trans men or trans masculine people. Okay. I see that there are some that say true, and the majority of you said that the rates are the same. Thank you for voting. What we have found, and what other studies are also finding, is that the rates are pretty much the same across the board. We looked at, in 2011, we looked at childhood sexual abuse, adult sexual assault, intimate partner violence, and study of sexual violence in the United States. We found that the rates are pretty much the same across the board. We looked at adult sexual assault, adult partner violence, and stalking. And you can see on the chart that trans masculine and trans feminine are pretty equal across the board, with some of the vectors being a little bit higher for trans masculine folks. And I'm really glad that most of you said that, you know, it's about the same. Because I think a lot of times in our culture, we think that sexual assault is a women's issue, and therefore, are experiencing abuse. I wanted to share a couple of other pieces of data with you all. And this kind of goes back to when we talked about ACEs, and where some of the stuff happens in childhood, and how that affects things in later life. So we know that children are experiencing a lot of sexual assault, and physical assault, and harassment in childhood, at school, in their life. Those are the stats that are important, but I think almost more important are what's at the bottom. So how many trans kids have been expelled from school, or how many have left due to violence? And so those two numbers at the bottom, 6% and 17%, that's over 20% of trans kids end up getting kicked out of school or leaving school because of violence. And so where are they going? They're going to the streets, they're probably getting kicked out of their house, they're surviving through street economies, through sex work, through selling drugs, through selling other things, and that's going to expose them to more violence and more sexual violence. I wanted to share this slide about suicide, and I know that that might be a stretch for folks to think about, well, what does suicide have to do with sexual violence? But it does. So if you'll bear with me for a second, I will show you the connection. But this is a profound number on the screen right now. So the general population has attempted suicide roughly 5% of the time, 5% of the people. And when we look at trans respondents, 40%, 4-0% have attempted suicide. So not thought about, but attempted suicide. So in this next screen, again, we're going to look at roughly 5% of the general US population. When we look at a broad spectrum of trans folks, it's 40%. When we look at trans folks who've experienced sexual assault, that rate goes up to 64% who have attempted suicide. Sexually assaulted by teachers, that goes up to 69%. So it's just a reminder for us that when folks are coming in, they have likely experienced multiple forms of trauma. They've likely experienced a lot of mental health distress because of that trauma or because of the hard realities of the world and the discrimination that exists. One last data slide about these kind of general stats is the rate of polyvictimization. And this probably does not surprise any of you that a lot of trans folks have experienced many different types of victimization over the course of their life, sometimes repeatedly at early ages, at middle ages, at older ages. So again, you can just see at this chart that, for example, if we look at intimate partner violence, 76% of folks who had experienced intimate partner violence had also experienced stalking or dating violence or adult sexual assault or childhood sexual abuse. So really high. So again, just the level of care and compassion that we have for our clients just to recognize that on top of what they're coming in with their current sexual assault. So I'm going to share with you another little video. And this video is from a film called Transforming Healthcare. It's quite old, but this clip is really poignant and really a good frame. There was one time in particular where I went to get STD testing and the woman was like, I've never met a transgender person, ever, I don't usually work at this clinic, I do pediatrics, I don't know what to do with your body, like, you know, if you were a guy I would just have you stand here, if you were a girl I would have you lay down at the table, she's like, but I don't know what to do with you, and she was perfect, she was like, right up front about it, and I was like, uh, and I didn't know what to say, like, I was like, I don't know how to do your job, I don't know what you're looking for, I don't know what you want me to do, and she didn't know what to do either, so we were just kind of like, take this, and then I left, and I was pissed that I didn't get healthcare, I didn't receive any healthcare. So again, this was a little bit older, and fortunately a lot more folks are being trained now, and probably would not have that response, and I'm very confident that you all would not have that response, but this is something that a lot of trans people experience, of accessing healthcare, and not receiving the healthcare that they went in for, so just know that folks may have that experience in their past, and that may be what they're bringing into a medical situation with them. Let me share with you a couple of more stats on medical-specific issues, or related to trans folks and barriers to accessing care. So 19% of the folks in this really large survey said that they were denied medical care, so the door was literally kind of shut in their face, they could not get in the door to access So that's a really substantial number of folks. So those folks that have experienced that denial are not going to be very eager to go back and seek medical care in the future. Again, from this really large sample, we know that someplace between 20 and 31% are fearful of seeking healthcare, so they avoid seeking healthcare because they don't want to be disrespected or mistreated. And I put the range there because when we look at data from this particular study, they broke things down into non-binary folks, trans women, and trans men, and so you can see there's a range of things that are different for non-binary folks versus trans women and trans men. When we look at things like abuse by providers, this slide, it always makes me pause and really think about what our world is like and what the world is like for trans folks who have experienced this level of violence in a setting that should be safe and supportive. So trans folks have been sexually assaulted in providers' offices, in healthcare providers' offices. 10% of trans people have been sexually assaulted by a healthcare provider. And just over a quarter have been physically assaulted by a healthcare provider. So that is a really stunning set of numbers. And again, when we look at these things, when we look at people who have been denied care, it's not likely that these folks who have experienced trauma and violence or who know people who have experienced trauma or violence, it's not likely that they're going to walk into an emergency room or for a forensic exam. They're just not going to. We can do some things to try to make that better, but that history is going to take a while for folks to get over and move into a trusting relationship that they won't be harmed. So I wanted to share another video. It's also from this therapist panel, and it talks about people's past experiences and how that really influences their decisions about what they do today. So if we go back to our predetermined questions, let's talk a little bit about prior barriers. So I think all of us know that many trans and non-binary people have experienced difficulty accessing trans-affirming, trans-knowledgeable, and trans-celebratory services and providers. So what are your thoughts on that reality in general? Or more specifically, how does a client's past experiences with service providers impact your working relationship with them in the present? So I'm probably not the only therapist, right? But people do come in with really horrifying stories, right? I'm getting the nods, yes, of the, this is what my last therapist said to me, or this is, I haven't been back to therapy because the last one said this. And it's a spectrum, right? Sometimes it's downright hostile and unwelcoming, and sometimes it's just clumsy and foolish, or I had a feeling when I wanted to talk about this that my therapist was uncomfortable, right? Like that they wanted to move away from it. So, and yeah, so, but when somebody comes in with that story, you know, one of my first questions is, have you ever done therapy and how did it go? I guess that's two questions, but, you know, is to say, you know, you have every right to be, well, A, to praise the person for even trying it again, right? You would have every reason to like protect yourself and not want to go through that again. But then also to say, you have a right to be skeptical here, right? And check me out, right? Like, don't take my word for it that I'm transaffirming. Really listen to yourself and check in with yourself, and I'll check in with you and we'll see how it's going, just, you know, because I tend to go strengths based and empowerment based. And so I want to make sure that that person really is like looking to themselves and not just to me as like some expert. So yeah, I think those barriers are still very real. It happens all the time today. And you know, I think my job is like to help do some of that repair work, not to make up for what other therapists have done, but to say, you know, how do we heal from that? How do you do that really big scary thing, which is to trust somebody again with your story and with yourself? Thank you. So I know, again, this is a therapist panel, and you all are not a therapist. Most of you are not, at least. But I think there's a lot of similarities, right, about how do we build trust with our clients? How do we build trust, especially when we know that there's been past harm? How can we make sure that we check in repeatedly with clients, which I know so many of you already do? But, you know, is there another level that needs to happen, another layer that needs to happen when working with trans survivors because of so much harm that's been done in the past and so much trust that's been violated? So just kind of a reminder again of, you know, what people are bringing in with them and how that might affect the care that you provide. So we're going to move on next to talk about seven additional barriers. Not denial of care, not some of those other things that we've already talked about, but some additional things that we know are true for folks who are trans or non-binary. And then we're going to share a little bit about how we can increase the services that we provide, increase the respectfulness, increase the sensitivity to what we're doing with our clients. And for each of these, I'm going to offer what the barrier is, a quote from a survivor, trans survivor, and then some of the ways that we can increase the access. I wanted to start us out with a quote, and this is really about being afraid to seek help. So this quote says, I'm afraid to go anywhere for help because they will say that my transgenderism is related to abuse or that I somehow egged it on by being a freak. I do not want to have it affect my ability to rightfully claim my rights. I do not want to have it affect my ability to rightfully claim my own identity. I was transgendered before I was ever abused, but I don't think they will understand. So a couple of things in there. I wanted to note that we left this quote exactly as it was written to us, which includes transgendered. And I know a lot of times people are saying today that that's a no-no, we shouldn't be adding the ed at the end of transgender. But this is how this person talks about themselves. So that's just one little thing that I wanted to point out here. The fear that this person is experiencing is, I don't want to go anywhere because of the fear that I'm experiencing. So again, that's just something that brings, you know, comes along with them. If they make it to your office, that is amazing that they've made it there, given that so many folks have that pervasive feelings of fear of what's going to happen or being mistreated. So I'd like us to think together, if you're willing to type in the chat, what do you think some of the barriers are for trans folks that are seeking post-assault care, forensic care? What do you think some of those barriers are for trans folks? It could be something small, could be something big. Screening questions. Forms and paperwork, yes. Fear of having to interact with the police, bias. What are some other things that might be barriers that trans folks face? Fear of being with a provider that doesn't know how to care for their body. Yeah, those are all great. If you think of some more, keep on placing them in the chat, and let me share with you some of the things that we've learned that may be helpful for you in terms of looking at barriers. So this first one is, you know, going to seem a little bit weird potentially for some folks, but, you know, really looking at the Maslow's hierarchy of needs in terms of that being a barrier to receiving care. People may not have had food, may not have stable shelter, may not have education or work that they can go to. They may not have those basic needs being met every day. They may be fearful that seeking medical care or health care or advocacy is going to be something that costs them money. We know that it doesn't, but, you know, they don't know that. So that Maslow's hierarchy is really something that may be a barrier for trans and non-binary survivors. One survivor said, I haven't had a warm place to sleep for three weeks. The only food I've had comes from grabbing food from my trick's house. So that's just an example again of like, you know, if somebody is worried about where they're going to sleep, where they're going to eat, post-sexual assault care may not be what's top of their priority list. So some of the things that we can do to increase their access to receiving care, we can recognize and ask survivors about their basic needs. Sometimes we do that. Sometimes we don't do that. We might need to be prepared to provide layers of support for basic needs. So, you know, I know a lot of sexual assault centers provide things like food coupons or shelter or transportation, but we may need to think about how do we connect folks to those services in the longer term, not just for that day or the next week, but really connecting people with resources so that's not their sole existence, living at that base level. The second barrier is around the violence against women paradigm and violence against women, that phrase, that concept has been really, really, really useful to the movement for a really long time. And it's proving to be less useful when we acknowledge that not only women are victims or survivors of sexual assault. So the violence against women paradigm has this presumption that women or female folks are victims and men are perpetrators, and it doesn't really divide out much more than that. That's what the paradigm is, that's what the presumption is. And so what that does is it really erases trans survivors, it erases almost all trans survivors, even the folks that identify as trans women or as women who have a trans history. It complicates their belief and their understanding of their survivorship. It also erases, you know, men who have male perpetrators, women who have female perpetrators, anybody who has a female perpetrator, it erases a lot of people. And it makes people say, am I a survivor? Is what happened to me really sexual assault? Is that really what happened? So there's two quotes that I'd like to share with you about violence against women and that concept. So this first one is from a trans woman, and she wrote, this is what it means to be a woman. So we hear from trans women a lot that because sexual assault is so linked to femaleness, womanhood, being a woman, that for a lot of trans women, they think, oh my god, well, I was sexually assaulted, that must mean that people see me as a woman, that must mean that I'm a real woman. So it's this convoluted way of connecting these two concepts. And it's really scary and really sad to see that. Another way that the violence against women paradigm plays out, and this is for trans men, this quote says, there was no way for them to understand I was assaulted. I am male. Where am I supposed to go? I was too embarrassed to admit being sexually assaulted as a trans man. So again, that feeling of like, nobody's going to believe me, I'm male, I can't seek services is happening here. And I want to read one quote from a provider. So this is from DV Shelter. And this person said, our services were designed for women and children. So our agency is not trauma-informed when it comes to transgender survivors. We also do not have services to support transgender survivors. So my question to you all, when you look at that, when you think about that, is what's true here? How can this thinking shift? So being trauma-informed doesn't have anything to do with welcoming trans folks into your midst. There's a lot of things here that just don't quite fit the mark. So what are some things that we can do around that violence against women paradigm? So we can do some outward facing things. So some of those outward facing things are like forms and paperwork, which allow survivors to have a wide range of answers about who their offenders were, how they identify their gender, what pronouns they use, all of those things that they can respond and that you can chart. There can be visual signs. So these are some of the basic things of like having brochures and including trans-affirming messages on websites or having photos in offices that are not just of women. Lots of things that are just those outward facing signs and signals. There can be programming and services that are developed for all genders. Maybe not so relevant for you all, but support groups. Are they open to people of all genders? What about shelter? What about advocacy? What are the things that everybody of every gender can access? And then the last piece on this one is when you're referring folks to other agencies, do you know what their policies are? Do you know if they have a women-only policy? Do you know if they shelter people of all genders? Do you know if they've had training around trans issues? So kind of knowing who you're referring agencies are and who you're referring providers are is really helpful in not re-traumatizing trans and non-binary clients. So the third barrier is law enforcement. And someone in the chat definitely made a comment about the fear of having to deal with law enforcement. It's a really large fear for a lot of trans folks. So survivors, just like a whole bunch of folks, do not believe in the criminal justice system's effectiveness or the ability for the criminal justice system to work in their advantage. There has been historically a lot of police misconduct. So from prior to Stonewall, all the way through to the present, and trans folks get a disproportionate amount of police misconduct. There can be a lot of concerns about being outed in the criminal justice process. So being outed in the criminal justice system may result in losing their job, losing their relationship, losing their kids, their status in the community. What if their neighbors find out? And it could affect their safety if they're outed. So those are just some of the ways that the barriers are around law enforcement. One of the quotes from a survivor about law enforcement is, they referred to me as female at first, but after they checked my ID, they referred to me as male. They treated me as a prostitute and told me to leave or else I'd be arrested. So this is a really common experience for trans women, and particularly trans women of color, who are walking down the street, going to the bus, going to work, and they're perceived by law enforcement as engaging in sex work. And they're not. And even if they were, that'd be okay, but they're not engaging in sex work. And so they're perceived that way, and they're oftentimes arrested out of that presumption. So there's a lot of stuff that's happening, either when they're being picked up, unfairly, or if they're seeking care and reporting a crime, it flips back around at them. I want to share with you a kind of a cut-up video clip from a recent event that we did this spring. It was called Trans and Nonbinary Speak Out, and we had four speakers, four presenters, share their stories in really creative and artistic ways. And the clip that I'm going to show you is from John, who uses no pronouns or they them pronouns. And they talk about their interaction with law enforcement and how that played out. So let me play this for you, and we'll talk a little bit about it at the end. While transition helped me live my life more fully, I began dealing with discrimination and harassment at levels I had not faced before. My attitude was always to just keep moving forward and not let these violations set me back. That seemed to work for a while. But a few days before Halloween in 2018, I was raped late at night on my way home from community events. Unknown to me at the time, one would follow me off the bus, one who targeted me because he knew I was trans. I was forced to watch him follow me off that bus during my second interview at Metro Transit Police Headquarters. From Saturday until Tuesday, I was checked out. On Sunday, I messaged my primary care provider to get post-exposure prophylactis. I've learned from my colleagues in transgender rights and support communities that many of us contract STDs through rape and sexual assault. I knew I had 72 hours to start treatment, so even in my fog, I was able to get the needed shots and pills. My second interview with Metro Transit Police left me feeling assaulted again. This happened without a female detective in the room to protect me from the accusations from the male detective that I was asking for it and proof that I wasn't. It's common for a male detective to It's common when investigating crimes of sexual violence that we are victimized by those who are supposed to be our champions. Without my caseworker being there, this would have been an even more traumatic experience. So one of the things that I'm hoping that you heard in that was John had a lot of knowledge about what may or may not need to happen in terms of protecting themselves, but a lot of things didn't go very well for John. There were comments in there about, he knew I was trans, which was about the perpetrator, but John also didn't have the access to things like a female detective being present or anyone who was female identified being present. And the cops wanted to know, basically had to prove, John had to prove why they weren't asking for it, why they were assaulted, basically. So there's a lot of things that didn't go right in that interaction, even though John was very well informed and should have had a better experience. So some of the things that we can do around law enforcement and systemic barriers are really providing that proactive advocacy in situations where law enforcement might be present. So in the care offices that you all are in, in law enforcement interviews, different states are different about who's allowed to be in the room when law enforcement are there. But if law enforcement, if somebody wants to talk to law enforcement, let's see if there can be an advocate there. Let's see if there can be a non-abusive partner or friend there. Let's make sure that that situation is as safe and supportive as possible. One of the things that you all tend to know that survivors don't is that you know what trans folks or what people's rights are, whether it's trans folks or non-trans folks, you know what survivors' rights are. Trans folks don't necessarily know that. Survivors in general don't tend to know what their rights are. So reminding folks, hey, you don't have to report if you don't want to. Here are your options. Police is just one out of many options that you can pursue. And it's really important, I think, for us to learn about police misconduct and the reticence for trans people to access police care, especially folks of color. So understanding what some of that history is, understanding what it's like in your community, those will help give greater understanding to why people are feeling some resistance or some fear. A few years ago, we worked with the Vier Institute of Justice and created a couple of different law enforcement and sexual assault guides and webinars. So we encourage you, if you're interested in looking at law enforcement and improving those relationships, to check out those resources. So the fourth barrier is around cultural insensitivity. So that's, you know, generally when we think about that, it's about lack of training, lack of culturally, you know, competent services. And oftentimes people are unintentionally culturally incompetent. I mean, people don't generally try to be insensitive to other folks. It's rare when people are intentional in their harmful behaviors. And like I shared with you before, like sometimes there's intrusive questions and people don't even realize that they're intrusive questions. Sometimes people out trans folks and they don't even realize that they're outing somebody. There's a lot of ways that that may play out. So, you know, some of those things are really being culturally insensitive and the providers are not even knowing that that's happening. One of the things that happens a lot, and this is especially true with sex-segregated services, is that there are unequal services or discrimination in services. So I'm going to go back to kind of like the women's only shelter, the women's only support group. Those things may be, you know, creating an unequal environment for healing when trans folks who are masculine or non-binary folks can't access those services. Cultural insensitivity really kind of wrings out this sense of bias, even though it may not be intentional. So it might be explicit or implicit with bias and that relationship to cultural insensitivity. So this is another quote from a trans survivor. They say that transphobia and lack of understanding of trans issues would be the biggest barrier. If I'm having a hard time explaining my gender in regular social settings, I would be even more petrified to explain it in a sensitive situation, such as a sexual assault. And here's another quote that's from a provider. So this provider writes, I believe that our lack of 100% confidence is felt by our clients and in turn does not provide transgender clients with an experience full of compassion and dignity. And I really, really love this quote because it reminds us that we don't have to be perfect in how we do our jobs. We don't have to be like up on trans issues or up on whatever it is that we're doing. But when we don't have confidence, when we don't believe that we are going to do a good job or when we're fearful of messing up, that's going to be felt by our clients much more so than if we really don't have that knowledge. So, you know, really kind of get comfortable in our skin and knowing what we can provide and that we want to provide services. That level of confidence is going to shine through and make people feel more at ease and more willing to engage and trust. So some of the things that we can do for cultural insensitivity is require, and I hate that word, but, you know, encourage people to have trans-specific training, and that needs to be for all staff. So front desk staff, maintenance staff, providers, ideally board of directors and non-profits, the whole range of people to have some trans-specific training. If it's possible to have some safe zone training or other kinds of certificates where people can know that, hey, there's a rainbow flag or there's a trans pride flag that's a decal on the door, I can feel a little bit more confident that people who are working here are going to be okay with me and who I am. There can be a good commitment to ongoing learning. So again, we don't want to have like one training and then it's done. You know, how can we bring in trans issues in staff meetings and case reviews in our everyday interactions with each other? Can we have trans case examples in our non-LGBT training? So bringing in different types of people within our mainstream advocacy trainings or other types of trainings. And then we need to kind of look at things like what are our non-discrimination policies and are they in place and are they enforced? So how do those things play out in our agencies? Number five is about identity documents. So it's a barrier that really impacts a lot of people, sometimes subconsciously. So I've got the word incongruent in quotes because the incongruence of somebody's identity documents might be incongruent for the outside observer and not for the person who owns that ID. So when somebody's incongruent identification, maybe the person comes in and you perceive them to be female, but they have an M on their driver's license. So that would be incongruent. That person may feel like, oh my god, what's going to happen? And they may be denied services. That's what they might be fearful of. They might be fearful of being outed or somebody drawing attention to what's on their ID versus how they are living their life. We mentioned, I mentioned before about cost being a barrier to changing identity documents. Sometimes people want to change their identity documents, but they just can't because of cost. And for some folks in some states, you can't change things like birth certificates. So it makes it more difficult just because you can't change something. And in the mix of all of that are things around immigration status. So identity documents are not just about gender, but it may also be about country of origin or citizenship. So let me share this quote about identity documents and the serious implications that it has. So this person writes, people, we still have so much to do to make sexual health services aware of and positively responsive to trans identities. I just left a clinic in tears, having tried to register for a pap test. Getting there was hard enough. Being humiliated by the receptionist, holding up my health card up in front of my eyes and tapping it where the girl names still is saying, your name is not Robin. Well, three clients looked on, was just too much to handle. I left without getting the pap. When I go back, I'll take a friend. Robin was able to go back and get GYN care, but unfortunately did die of cervical cancer. So there are some serious implications when people are denied care or when people have negative interactions related to their identity documents. So some of the things that we can do is be mindful of what our forms and paperwork include. So do we include things like sexual orientation, partnership status, gender identity, the name of use, pronouns of use, so that we can know that piece of information upfront or as we work with our clients? What are our confidentiality and privacy policies? Do we make sure that we can protect that sensitive data of people that do share their trans identity with us? What kinds of non-discrimination policies or other policies are in place, again, that will protect trans clients and it will protect all the other clients as well? And then how do we do our charting? And I know that part two, we'll probably talk a lot more about charting and how that can be done in a way that is both kind of legally accurate and allows things to go forward legally if that is desired, as well as being respectful to that trans client. Number six is about small communities. So trans communities, no matter if you're in New York City or in rural Iowa, all trans communities are tight-knit. People know each other, people connect with each other, people send rumors around about each other, but people also send rumors around about who the good providers are and what's happening. So there's a positive and a negative to that small communities. Rural communities definitely have some huge challenges for trans folks, just like for every other survivor around things about confidentiality. If people have been a survivor, if people are trans, maintaining that positive community reputation, lots of times people have dual roles. So when we saw the video from John, John is both an advocate, a sexual assault advocate, and was a survivor. So there's a dual role there. So where does that line get drawn, and how can John get services which they didn't get appropriately? So a quote from a survivor about small communities. My trans ex and I are part of a very small trans community, and as a result of our breakup, I have become largely alienated from our community. He is a respected leader in the trans community. He spreads rumors about me. So one of these people got kind of kicked out of the trans community, and one was kind of allowed to stay in. So some of the things that we can do around that small community barrier is we can make sure that we definitely let folks know that we will be confidential with their information. We will be professional with them. We will proactively do outreach if they would like us to. We will get their verbal consent when we're meeting with a client, not just, you know, presume that we have consent. We can do things like having referral networks, and I mentioned this before, that we know who those referrals are, know if they're trans-informed, know what their confidentiality policies are, know some of those good things about those referral networks. We can also operate under a harm reduction or restorative justice approach. So some of the folks that live in small communities or are in small communities may not be able to take some legal routes or take some traditional routes, but may need to use restorative justice approaches to find some resolution. So number seven is probably the more, I don't want to say controversial, but the most hot right now, and it's the barrier of the political climate and legislation. So right now, it would be hard to not notice that we live in a very polarized environment. There is loss or potential loss to current services that trans folks might be receiving. There is a lot of fear about being outed in a lot of different ways. We could talk for hours about all of these things. There's a very dramatic increased risk of safety because of hate-motivated crimes. There's a lot of concerns that people are having about not being treated at all. So this is even more so than before, so more so than what the data was reporting before, with more and more anti-trans legislative efforts and cultural belief sets, more and more people are concerned about not being able to receive services. We know that there's legislative stuff, but there's also the reproductive rights stuff, which affects trans people too. So there's a whole bunch of stuff that we all know about that are affecting trans folks. And the problems can be on a local or state or federal level. They can be in schools, they can be in health care, they can be in social services, they can be in a whole bunch of different things. There are many articles that I'm sure that a lot of us have seen, so this is from a couple of months ago, but the Texas Attorney General, for example, was saying that transition care for minors is child abuse under state law. So parents were getting visits from Child Protective Services when they were loving their kids and getting their kids protective, good puberty blockers or medical care for their transness. We're also seeing in other parts of the country that pediatricians and others who are serving trans youth are facing harassment. They are being threatened to lose their license. So it's some really profound stuff is happening legislatively, specifically around medical care. One quote about the political landscape says this. It says, every day I wake up to my news feed flooded with another person killed by police, another new law that takes away LGBT rights, another slew of protests because Black Lives Matter, another set of memes with quotes that real people in government mocking who I am. As a Black queer survivor of police violence, I don't know how much more I can take. And that's a really common feeling for a lot of us, for a lot of trans folks, for a lot of trans folks of color. So some of the things that we can do are to really stay current with what's going on in the landscape of things. We can know what the rights are for trans folks. If you're receiving federal funds, know what your agreements are with Department of Justice or HHS or wherever you're getting funded, most of whom have non-discrimination policies that protect trans folks. Partner with other organizations that are committed to serving trans communities. And then creatively find ways to serve folks even when there are roadblocks. So let me show you a short little video again, and then we will wrap up and move towards questions. You know, a couple of things that you all said, and this is going to be a toss in the ball new question, is it reminds me of what our political climate is right now, and how in both in Wisconsin and in Texas and all across the country, there are a lot of things that are really harming trans folks in terms of accessing medical care, conversion therapy, things coming back up. And I'm wondering if you could talk a little bit about how is that impacting the clients that you see, your approach to working with things, has it shifted you in your practice at all, knowing what's going on, you know, either in your personal community here or across the country? I can happen. Again, I don't know if I'm talking over anyone. I apologize if I am. But yeah, definitely coming up. And I think one of the things that it is making me be aware of is making sure that my colleagues are aware of what's going on out there, because I think a lot of times, I mean, obviously, I follow this stuff really closely. And I know, like what's happening. But a lot of people don't. And so I guess it kind of gets back to this, like, what do I see as being my job, aside from doing doing therapy. And one of the things I think is part of my job is educating, working on working on advocacy, but like making sure that my colleagues know about what's happening, because things are going to come up in session. And if you're not really aware of the context of what's going on, then the likelihood is that you're going to miss something. And you probably will miss something anyway. But so I think that that's that's one, one thing I've been aware of lately. Yeah. Sorry about the video glitch. Hopefully you all were able to hear the video. We had a brownout, which dropped my connection for a second. So hopefully you were able to hear the whole video and hear how Kim was talking really about how, she's in the know, but not necessarily all of her colleagues. So where can we show up? How can we help make sure that everybody has the same or similar knowledge? I know that we're almost done, but if you need to stretch, please feel free to stretch. I know we've had really a lot of content in this hour and 15 minutes. So please feel free to stretch and move around. And let me share with you a few things that you can do in addition to what we've already talked about. One of the resources that I'd like to offer you all is an assessment tool that we developed a long time ago and we've modified it a few times. And these are really, I think it's a really interesting tool to do with your colleagues and kind of go through your office and go through your policies and go through kind of this really, it's a fairly long and detailed checklist and just kind of see where you land on the checklist. And if you wanna make changes or don't wanna make changes based on improving the ability for trans folks to feel comfortable and good in your environment and receiving care. So, all right, things that you can do. Number one is do what you already do. Do your job well, make sure you do your job and try to not let the trans stuff get in the way. Which brings me to number two, which is to stay person-centered or issue-centered. Again, what you all are already doing. So just stay laser focused on why that client is there and how you can help them. Can remember to introduce yourself with your name and pronouns and ask other people what their name and pronouns are. Use them consistently unless if your client tells you to not use them in certain settings, but really pretty simple and easy thing to do with all of your clients. Keep open the options of like, there are alternatives to police. And again, all of you know that, but like, let's make sure that the clients we're working with know that there are some alternatives to reporting. You can be an upstander. So this might be, you know, speaking up if law enforcement says something that's insensitive. It might be stepping up or speaking up if a colleague mispronounced somebody. It might be calling in somebody and just saying, hey, you know, I heard this thing and it's a little bit offensive, you know, let's talk about that. And it really is about all of us taking those steps to make a positive change in the gestalt and the whole. If you're able to show up, show up. I have permission to use this. This is my personal doctor. And we did Pride Fest here in Milwaukee a couple of weeks ago, and she showed up. She showed up for lots of reasons, not because of whatever, but she showed up and she's active in the community. And it's really lovely to see providers being willing and able to show up, to volunteer, to be present. So if you're able to, show up. These last two things are soft things, but they're really, really, really important. And they make a huge amount of difference for trans survivors. And that is to see and affirm resilience. So trans folks are oftentimes really, you know, pushed down and made to feel not good about themselves. So when we can see things and notice things and comment on things that help folks know that they are wonderful, incredible, resilient people, that can really make a big difference. And that relates to number eight, which is to be kind and sensitive and gentle. And I know that that is what folks already do. But again, you know, when people are treated so unkindly, I don't think that's a word, but not kindly by the world, having that kindness shown in that one-on-one interaction is really, really, really powerful and can build trust and respect in a whole bunch of different things. So those are the soft cells at the end, but the really important things at the end. I know that we have only nine minutes left. I'm happy to engage with folks about comments or questions or however you'd like to interact in these last few minutes. And I'm going to put up my contact information so that y'all can have that as well. And Shae or Amy, I'm curious if anything has come in that I have not seen in the chat. I was just going to say, I don't know if you noticed there was a question if we would get the deck of slides sent out. And I don't know if you're comfortable with that or... Yeah, I am. Okay. I trust that you will do that if I send them to you. Okay. And then there was another one about the recording. We will be putting that up on our website for people to access later. So that is, if you know somebody that would benefit from watching this or you didn't get to see the whole thing and you want to, or maybe popped in the middle, it will be archived so you can view it later. It looks like there's... And Amy said the evaluation will be loaded into the Online Learning Center by the end of the week and she'll send an email letting you all know when it's available. So you need to be sure to complete that for your CEs. And then Maria would like to know, can you tell us more about the policy initiatives FORGE is working on? Maybe. Maybe I can. Loree Cook-Daniels is the person that does most of our policy work. And we do a lot of things where we sign on to amicus briefs or amicus briefs, however it's pronounced. We're looking at things across the country about people who are getting denied healthcare, especially the children. So I know it doesn't really relate to sexual assault but it does because when kids are not allowed to access medical care, it affects their ability to survive in this world and live healthy lives. We are doing a little bit of stuff in different cities across the country when folks have reached out to us for TA and we're helping them craft sample language or sample policies for their school districts, for their healthcare clinics. So we're helping with kind of that policy writing development and the rest of it I don't know very much about because it's kind of not in my wheelhouse. So I'm sorry, I didn't have a better answer for that. The second part of Maria's question and I have one other one is, if you could wave a magic wand and improve something for trans patients in a hospital setting, what would that be? Oh my God, Maria, that is not fair. That is not fair. That is not a fair question. I think if I had a magic wand, I would want the trans person that's entering through those doors to feel that they could trust that they'll be treated with respect. See, that's a magical answer, right? Magical answer to the magical wand. So I don't know how we get there, right? We get there through all these little incremental steps. So I don't know that there's one thing that I would wish like use people's names and pronouns, respect people, all of those things, but the magic wand would be that people would feel that they could trust and get the care that they needed when they walked in the door. That's a really good question. Thank you. Just really quick, there's a, do you recommend the wording group open to all genders? That sounds good. That sounds really good. Yes, thank you. There's a lot of different ways to write that as well, but that definitely avoids a binary construct. So lovely, that's really lovely. Then Kim Nash says, is there a reference list? I'm particularly interested in the data related to sexual assault by healthcare providers. This would be helpful to cite when creating policy. Yeah, the one place where some of those stats are is in the National Center for Transgender Equalities 2015 US Trans Survey. So you'll find it there. You will also find it in some of the Youth Risk Behavior Surveys from some states, not the national ones. I don't know how high those numbers are and I don't know how accurate that would be, but the NCTE, National Center for Transgender Equality is a first stop for folks. I can also look up some of the other references for those. Yeah. I don't see any more questions in the chat. Just a reminder, we are doing a second part of this series on the transgender, gender confirming, sorry, Jen. I'm trying to- Big mouthful, right? It will be August 23rd at the same time from one to, or sorry, we're on Eastern time. So it is- 4.30. Yeah, so three to 4.30, yes. So that will be on August 23rd and Ashley Stewart will be presenting that. Again, this is through the, there's Ashley. This is through the Office of Victims of Crime grant funded through, and we did it through the IFN. So if there's any more questions, oh, wait, hold on, Maria has one more. Will you be talking about the organ surveys in the second part? That's probably an Ashley question. Hi, thanks, Maria. Yeah, we are going to talk about how to more inclusively get some of that medical history, but more importantly, just to ask what's relevant. So we'll talk about, you know, if my patient has an oral sexual assault. Personally, I don't think I need to know about what other organs they may have unless my treatment is going to impact the care I'm getting. So we will touch on that. Thanks for that question. And I want to apologize for everybody. I've had a little bit of breathing problems lately, so I'm sorry about my ums and my gasps. And hopefully that was not distracting for folks. So I'm sorry about that. I wanted to thank folks too for being here today and Shay and Amy and Jen and Ashley, thank you for, you know, the invite and I welcome being here and I look forward to two weeks from now. Yes, thank you so much, everyone. And again, the evaluations will be sent out and without further ado, I guess it's almost 2.30 on the notes. So thank you so much, Michael and Ashley for being here and we will see you all on the 23rd.

webinar

Michael Munson

barriers

trans

non-binary

accessing healthcare

misconceptions

sensitivity

trans survivors

post-assault care

cultural insensitivity

supportive environment