Using telehealth to improve access to gender-affirming care for BIPOC and rural gender diverse youth

项目摘要 该提案旨在改善对特别强调通知中所列特定人群的护理（非- HS-21-014），通过增加涉及变性人和性别的卫生服务研究来促进卫生公平 不同的青年，青年谁确定为黑人，土著，或有色人种（BIPOC），青年生活在农村 社区.确定BIPOC的性别多样化青年以及生活在农村社区的青年， 比同龄人更容易经历抑郁和焦虑。1 -5此外，BIPOC和农村GDY 在儿科性别诊所中比例不成比例地偏低，6-8限制了他们获得儿科性别- 确认护理，这已被证明可以改善心理健康结果。 改善目前在大型学术医疗中心提供的性别平等护理的可及性， 促进其在社区环境中的交付。先前的研究表明，GDY和社区儿科 提供者对基于社区的护理提供模式感兴趣，特别是那些 性别问题专家的技术支持; 11，12然而， 需要确保干预措施满足GDY及其家庭的需求。鉴于很少有供应商收到 在这方面的培训13 -15，大多数缺乏机会咨询变性专家，远程保健 远程医疗和电子咨询等模式在促进提供 以社区为基础的性别平等护理。不幸的是，关于现有模型是否提供 为GDY及其家人提供必要的社会心理支持。在这个K 08提案中，塞凯拉博士将在她的基础上 现有的研究与GDY，他们的家庭，和社区儿科提供者：1）确定现有的障碍 BIPOC和农村GDY接受性别肯定护理的经验与探索设计与实施 促进通过远程保健获得护理的考虑因素，2）制定基于技术的增强性别平等 支持（TEGS）平台，以促进在社区提供全面的性别平等护理 儿科环境，以及3）进行试点研究，以确定TEGS平台的可行性和可接受性 在社区环境中使用。此外，该K 08奖将提供必要的技能和初步数据 告知未来R 01提案的制定和提交，以进行随机试验， TEGS平台使用对GDY的心理健康和感知的护理需求以及社区的有效性 提供者的知识和行为。

PROJECT SUMMARY This proposal aims to improve the care of specific populations included in the special emphasis notice (NOT- HS-21-014) to advance health equity by increasing health services research involving transgender and gender diverse youth, youth who identify as Black, Indigenous, or People of Color (BIPOC), and youth living in rural communities. Gender diverse youth (GDY) who identify BIPOC, as well as those living in rural communities, are more likely to experience depression and anxiety than their peers.1-5 Additionally, BIPOC and rural GDY are disproportionately underrepresented in pediatric gender clinics,6-8 limiting their access to pediatric gender- affirming care, which has been shown to improve mental health outcomes.9,10 One proposed solution for improving access to gender-affirming care, which is currently provided in large academic medical centers, is facilitating its delivery in the community setting. Prior research suggests both GDY and community pediatric providers are interested in community-based care delivery models, especially those that incorporate technology-based support from gender specialists;11,12 however, additional stakeholder-engaged research is needed to ensure interventions meet the needs of GDY and their families. Given few providers have received training in this area13-15 and most lack opportunities to consult with transgender specialists, telehealth modalities like telemedicine and electronic consultation show great potential in facilitating the provision of community-based gender-affirming care. Unfortunately, little is known about whether existing models provide necessary psychosocial support to GDY and their families. In this K08 proposal, Dr. Sequeira will build on her existing research with GDY, their families, and community pediatric providers to: 1) identify existing barriers BIPOC and rural GDY experience to receiving gender-affirming care and explore design and implementation considerations for facilitating access to care via telehealth, 2) develop a Technology-based Enhanced Gender Support (TEGS) platform to facilitate comprehensive gender-affirming care provision in the community pediatric setting, and 3) conduct a pilot study to determine the feasibility and acceptability of TEGS platform use in the community setting. In addition, this K08 award will provide the necessary skills and preliminary data to inform the development and submission of a future R01 proposal to conduct a randomized trial to evaluate the efficacy of TEGS platform use on GDY’s mental health and perceived care needs as well as community provider knowledge and behavior.