Transgender issues in Inpatient Rehabilitation


Hi all! I hope this week is treating you right. It has been super busy for us here in the ARC-isphere, like always…lots of meetings between me, Allison, and Ruth. But the great thing about having so many meetings is that creative juices get flowing, and we usually leave with 50 more items on our to-do list, just ‘cos we got so inspired!

Of course, you guys may know by now that most of my clinical life is spent in an Acute Inpatient Rehabilitation facility. That means that day in and day out, I am meeting the most diverse population you can imagine: culture, race, socio-economic class, sexuality, gender…all united by one thing- they got sick, now they need help-our help!- to get back on track.

We recently had to complete one of those online diversity trainings in order to be compliant with ‘corporate policy’. I was taking it, clicking through, and thinking in my head- where are transgender people being represented here?

With the growing awareness and visibility of transgender issues, we are all learning and being exposed to the challenges this population can face. From mis-gendering and dysphoria all the way to physical violence and murder, trans people are under constant pressure and threat. It isn’t at all surprising that the sensitive needs of this population require us, as health professionals, to have some additional training and some guidelines on how to create a safe, comfortable, and accepting space.

But how do we manage this, at an institutional level??

Transgender ally infographic

I don’t know about you guys, but any education I got on cultural competency or diversity was general and vague at best. Religion, race, sexual orientation, and gender identity were lumped together as one large group of ‘other’, that we should respect and treat equally. While I totally agree with the sentiment- we are all equal, after all, and owed total respect as humans- it doesn’t really set us up for success, does it? I mean, we have specific protocols for dealing with nearly every situation in the hospital I work in- but yet, when we had a transgender patient a few years ago, the height of the education and guidance given to me as an OT was being pulled into the Directors office and being given ‘the heads up’ prior to initiating ADLs.

It goes without saying that thinking it through, implementing proper guidelines, and establishing wherever you work as an allied establishment will make us all better, more compassionate and well-rounded professionals.

So I started doing some reading around the topic, and found some really great results, for all healthcare professionals. For anyone who wants to really learn about this, I really recommend reading around. Given my particular interest in the inpatient, non-mental health focused physical rehab setting, though, I found this insightful and thoughtful thesis by two OT students from University of Wyoming, discussing a product (lecture and workshop) they had developed to help OTs become advocates for transgender people. Their whole thesis is one I read with fascination from start to end! But some extremely helpful, and practical, tips jumped out that I will include here.

First, you might ask whether Occupational Therapy has a big role to play when working with this population- and I definitely feel it does.  As OTs, we learn in school that your occupational identity is formed by your roles. The roles you play as mother, daughter, worker, friend…these can all shift radically if you are in transition. Given our deep understanding of these roles and the powerful effect they have on our self-image, esteem, and place in the world, what better ally than an OT to help navigate through those changes?

Transitioning from one gender to another is a massive step, that can involve surgery, hormones, coming out and explaining your identity both to your family, friends and close network, and your colleagues, bosses, and employees. OTs are often trained in coping strategies, and this can be a handy tool to teach to a client who may be facing unusual stress. Administrative work like name changing; getting used to workplace shifts and new social dynamics; daily tasks like voice training, self-care; and (sometimes) medical care also make up some of these new or transitional occupations. We may even need to assist with access to legal care if our patient is fighting discrimination, or education regarding their options if facing unjust treatment in work or other situations. I can’t imagine how intimidating and overwhelming all of this can be, especially if you feel that you are misunderstood-or at worst, judged– by health professionals whose care you seek.

Access to mental health services is key, given the extreme stress that trans people can face; and access to inclusive and safe healthcare services with supportive environments is something we should all strive to provide. Many healthcare providers are going to be challenged by this population: what do I say? How do I act? What do I do?- so supporting and educating each other is vital. Sometimes we need a moment to gather ourselves and check in to be sure we are being the best professional we can be- and that is ok! What is not ok is watching or allowing yourself or another healthcare professional, intentionally or not, discriminate or create an unsafe environment for someone who has come to us for help- regardless of their identity.

So what can we do? Well I encourage everyone to read the fantastic Preparing Occupational Therapists for Treatment of the Transgender Population: A Training Guide for Supportive Care by the brilliant Nicola Grun and Lauren Trokhimoinen- excellently useful tips. Some of which include:

Creating a safe environment- It is imperative to speak with the administration of the facility you work in to see what can be done.  Certain changes can be done very easily – such as increasing the volume of information available, and making brochures, posters, etc. more easily accessible and in more visible areas like the lobby or staffrooms.  Facilities can also advertise affiliations with various organizations in order to demonstrate increased support of the LBGTQ community.  Bathrooms in common areas can be changed to non-gender specific or unisex.  Other considerations, such as room assignment, would require more careful thought and discussion in order to come up with the best procedure to follow.  A private room would be ideal, however is not always possible.  If a transgender person has to be placed in a semi-private room, it is not as easy as simply placing them in a room congruous with the gender with which they identify.  Their potential roommate may become aware of their transition and become uncomfortable themselves.  No matter how much we want the general population to be as empathetic and understanding as we are… we are just not there yet.  This in turn can potentially create an unsafe environment for the roommate and for the transgender person.  This and other topics about environment definitely need further discussion in order to facilitate the best possible scenario for all patients involved.

Maintaining confidentiality and discretion should be part of our treatment of all patients, and becomes even more relevant with the transgender population. Ensuring that we are using the person’s preferred name and pronouns, even if insurance identifiers require the legal name to be used in documentation; and being advocates for our patients’ rights and needs will all contribute to the physical and emotional construction of a safe space.

Identifying in the community a network of trans friendly healthcare providers, so that appropriate referrals can be made, will set the facility and the person up for success in ongoing medical care. By being an advocate, the OT can also educate other HCPs about advocacy, their unique role with the transgender patient, and become a resource to other providers.

As with any patient who faces specific and exceptional issues, health care providers may have their own challenges. Especially if you are working in a facility without any protocols, guidance, or support from administrators, caregivers can struggle with their own preconceived ideas and lack of knowledge. Seeking help and guidance from our peers and from other resources is key to being an ethical professional in that situation.

As you can see, this can be an area that as clinicians, we can make a profound positive difference in- or can contribute to the existing body of ignorance (if we are not mindful!). I myself, although considering myself an ally to the transgender community, still found it massively useful to consider my professional capacity through some of this reading. We need to do much more to support trans people, actively announcing support and developing standard protocols as opposed to passively saying nothing! We can all benefit from asking: If I were a trans person seeking treatment for a medical condition, how do I know I am safe in your care?

To read the article I cited above, visit: Preparing Occupational Therapists for Treatment of the Transgender Population: A Training Guide for Supportive Care

For more reading around this topic: Network for Lesbian, Gay, Bisexual & Transgender Concerns in Occupational Therapy; The Role of Speech-Language Pathologists in Transgender Voice Modification Therapy; Working with transgender clients: Learning from others to improve occupational therapy practice;

Interested in more clinical tips, articles, and resources for your practice? Sign up for our bi-weekly mailing list below! We promise to treat your inbox with the respect and love it deserves 🙂

We would love to know what you think! Reach out on Facebook, Instagram, LinkedIn or through