For most transgender people living in New Jersey, competent, compassionate healthcare is hard to find.
Only a handful of states have facilities that offer comprehensive medical and behavioral health services tailored to transgender patients, forcing thousands of individuals to travel outside New Jersey to get their complex healthcare needs addressed.
That is now starting to change. Several major healthcare institutions have started to reconsider how they treat transgender patients, as well as gay, lesbian and bisexual individuals seeking medical care. Efforts are underway to create dedicated clinical services and programs tailored to the needs of these patients, and to provide family members of transgender patients with emotional support through regular support group meetings.
Leaders at Robert Wood Johnson University Hospital Somerset are working to open what would be the first health clinic in the state devoted to treating transgender patients, which could start operating later this year. Officials at Rutgers New Jersey Medical School, in Newark, are considering creating what would be New Jersey’s first transgender surgery site.
“There’s really no place in New Jersey that can service the transgender community in their (healthcare) needs,” explained Anthony Cava, the chief administrative officer at the hospital, which is actually located in Somerville. “From my perspective, I was stunned by the number of people who were traveling outside New Jersey” to receive appropriate care, he said.
According to one recent study, as many as 10,000 transgender patients a year seek treatments out of state; in addition to time lost and aggravation, the trips can be costly and result in additional out-of-network charges not covered by their health insurance. “Whatever population you’re talking about, that’s a large number,” Cava said.
Transgender individuals — born with sex organs that don’t match their true gender identity — often face public harassment and discrimination based on their appearance, including at the doctor’s office. Some require behavioral healthcare as a result. Those who choose hormone therapy, gender reassignment, or confirmation surgery also depend on specially trained endocrinologists, surgeons and other experts for optimal care. And then there are the health concerns – like cervical or prostate cancer – which require doctors to screen patients for a disease that may not appear to match their sex.
Nationwide, there is a growing awareness of a need for more compassionate healthcare for transgender patients, as well as gay, lesbian and bi-sexual individuals. The non-profit to help hospitals implement more compassionate policies; the group cited Robert Wood Johnson University Hospital as one of a number of leaders in this area in a 2016 report.
The New Jersey Hospital Association held a forum on LGBT care in June and will host an “education session” for members this fall. Garden State Equality, a statewide justice advocate, launched an online effort called “Map + Expand” that seeks to gather data, map the availability of compassionate healthcare providers, and encourage an expansion of appropriate care.
In addition, the Department of Psychiatry at Rutgers Medical School held a conference focused on transgender health in June. The department chair, Petros Levounis, said in a Q&A published in advance that, with Medicaid and Medicare programs starting to cover certain aspects of transgender-specific care, treatments are becoming more common and new teams of specialist are joining forces to meet the pent-up demand from patients. That evolution led school leaders in Newark to start thinking about a “truly multi-disciplinary, multi-professional, state-of-the-art Transgender Health Center,” he said.
“Transgender patients do not have it easy. Part of the problem has to do with flat-out prejudice and discrimination that many LGBT people experience,” Levounis said. “But there’s another major component to health care challenges for transgender people: lack of knowledge. People’s hearts may be in the right place, but healthcare practitioners simply do not know what to do with the ‘T.’”
Healthcare professionals are not alone in their confusion. Family members also can experience an emotional roller coaster when a loved one shares that they are transgender, or considering hormone treatment or confirmation surgery. That’s why Jackie Baras, a nurse manager at RWJUH, believed it was important to found the transgender family support group at the Somerset facility.
“If a transgender transitions, the family transitions as well,” explained Baras, a transgender woman who recalled her own struggles communicating with her father. “If your family doesn’t transition too, you will not be successful.”
Launched in June 2015, the group started with a handful of participants and the free, confidential meetings now attract as many as 20 people, according Nicole Brownstein, another facilitator. Brownstein, a board member at The Pride Center of New Jersey, where she leads adult support groups and a youth program, said the need for a family-focused forum has long been apparent. “It was the one thing that kept coming across, loud and clear,” Brownstein said. “And there is absolutely no place for them to go in Central New Jersey.”
The response has been very positive, she said, and they are hoping to add more meetings soon. Those who want more information on the meetings can email her directly at email@example.com.
The hospital is also supporting efforts to expand awareness and compassion among its own staff – something Baras said was lacking years ago. Baras is co-chair of an employee group called PROUD, for Promoting Respect, Outreach, Understanding and Dignity, which has worked alongside other teams to ensure hospital policies are respectful of diverse populations. They have been reviewing everything from employee benefits to the rules regulating family visits to patients, to ensure LGBT individuals aren’t left out.
“Robert Wood Johnson is focusing on making sure we address the diverse needs of our employees,” Baras said. “We want any LGBT, like me, to be comfortable coming here.”