Creating Accessible Environments for Gender Diverse People...Trans Care BC - PHSA Accessiblce Care Assessment Tool for Care Services i Beta version Creating Accessible Environments

Trans Care BC - PHSA Accessiblce Care Assessment Tool for Care Services i

Beta version

Creating Accessible Environments for Gender Diverse People

Organizational Assessment Tool for Health Care & Support Services

March 2020

DescriptionThis assessment tool is for organizations interested in developing a multi-pronged approach to offering accessible care for gender diverse individuals, including transgender, non-binary, and Two-Spirit people seeking gender-affirming care.

This tool can be used on its own or in combination with the Service Provider Reflection Tool for Individual Service Providers & Support Staff which is designed for individuals seeking learning opportunities that explore their knowledge and attitudes towards gender diversity.

Feedback welcomedWe believe your feedback is one of the best ways to improve our educational resources. Therefore, we have released this beta version with the hope that you will consider using it, reviewing it, and letting us know your ideas for improving it. If you have any questions, comments, or suggested revisions, please email us at [email protected].

http://www.transcarebc.ca

http://www.phsa.ca/transcarebc/Documents/HealthProf/Service_Provider_Reflection_Tool_Beta.pdf

http://www.phsa.ca/transcarebc/Documents/HealthProf/Service_Provider_Reflection_Tool_Beta.pdf

mailto:[email protected]

Trans Care BC - PHSAOrganizational Assessment Toolii

Directions

Select relevant strategies in each

category.

Then, consider the following questions:

Where are we currently at? (level)

What would enable us to score

1+ level higher? (action Items)

Who could help us make these

changes? (supports)

When could we take these steps?

(target dates)

Terminology

Gender Diverse refers to individuals who do not identify as the sex they were assigned at birth. This includes, but is not limited to, transgender, non-binary, and Two-Spirit people seeking gender-affirming care.

Client refers to all clients, patients, residents, and service users accessing care unless otherwise specified.

Staff refers to anyone employed by your organization unless otherwise specified. This may also include contractors and volunteers.

People refers to anyone who may be present in your service, including staff, volunteers, contractors, clients, family members, advocates, and all others who access the service or space.

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Insert Trans Care BC logo

# Strategy(select the relevant strategies) Re

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WHAT(action items)

WHO(supports)

WHEN(target dates)

1 Leadership team has taken gender diversitycompetency training in the past 3 years

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2 Clinical staff have taken gender diversitycompetency training in the past 3 years

YN 0 1 2 3 4

3Support staff have taken gender diversitycompetency training in past 3 years, includingreception, pay roll, information technology, etc

YN 0 1 2 3 4

4 On-call staff and contractors have takengender diversity competency training

YN 0 1 2 3 4

5 Volunteers have taken gender diversitycompetency training

YN 0 1 2 3 4

6External educators are used for gender diversitycompetency trainings (ie. not relying on gender diversestaff to educate coworkers)

YN 0 1 2 3 4

7 Orientation packages for new staff and volunteersinclude your gender-affirming policies and procedures

YN 0 1 2 3 4

8Orientation for new staff and volunteers includesmandatory gender diversity cultural competencytraining

YN 0 1 2 3 4

9Existing staff and volunteers are trained ongender-affirming intake procedures, client placements,and addressing conflict

YN 0 1 2 3 4

10Clients frequently served or in long-term housinghave opportunities to learn about gender diversityand your organization's policies

YN 0 1 2 3 4

1) Select the strategies from each section that are relevant to your service. Then, consider the following questions:2) Where are we at currently? (level)3) What would enable us to score 1+ level higher? (action items)4) Who could help us make these changes? (supports)5) When could we take these steps? (target dates)

Education

Accessible Care Assessment Tool for Care Services

Directions:

This assessment tool is for services interested in developing a multi-pronged approach to offering accessible care for gender diverse individuals, including transgender, non-binary, and Two-Spirit people seeking gender-affirming care.

BETA Version (feedback welcomed)

2018-09-12 DRAFT: Self-assessment tool for care provision services 1


Trans Care BC - PHSAOrganizational Assessment Tooliv4



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WHAT(action items)

WHO(supports)

WHEN(target dates)

1Your website demonstrates that your services arewelcoming of gender diverse people, and explainswhy and how

YN

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2 Your brochures and pamphlets identify your servicesare welcoming of gender diverse people

YN 0 1 2 3 4

3Your gender-inclusive material is offered in multiple languages, based on the cultural communitiesfrequently served

YN 0 1 2 3 4

4Your gender diversity inclusion policy and/or position statement is easily visible to all staff, volunteers,and clients

YN 0 1 2 3 4

5When relevant, advance-messaging and signs informclients that gendered programs and spaces aretrans-inclusive (circumventing conflict)

YN 0 1 2 3 4

6 Safe Space / Positive Space signs are present andculturally competent staff are identifiable and available

YN 0 1 2 3 4

7 Posters, handouts, and health promotion materialsreflect diversity, including gender diverse individuals

YN 0 1 2 3 4

8 Your organization has gender diverse staff whowork with clients

YN 0 1 2 3 4


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WHAT(action items)

WHO(supports)

WHEN(target dates)

1 Programs, services, and health care are based onclient-need, not gender (optimal strategy)

YN

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1A Programs and services offered are gender-segregated,but trans-inclusive (alternative strategy)

YN 0 1 2 3 4

1BIf programming is gender-segregated, clientscan choose their group based on gender identity,safety, and/or confidentiality needs

YN 0 1 2 3 4

2Gender-diverse clients have the same ease ofaccess as cisgender clients to programming,services, and care

YN 0 1 2 3 4

3 Written resources for programing usegender-inclusive language

YN 0 1 2 3 4

Visibility and Outreach Materials

Programming



Trans Care BC - PHSA Organizational Assessment Tool v5


Forms / Charts / EMRs# Strategy

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WHAT(action items)

WHO(supports)

WHEN(target dates)

1 Legal name not required and removed fromforms, sign-in sheet, chart, EMR, wristband, etc

YN

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2 Legal name required and there is an additionalfield added to write Name Used

YN 0 1 2 3 4

3 All forms, charts, EMRs, and wristbands visiblyprioritize Name Used

YN 0 1 2 3 4

4 Legal names are recorded in a separate sectionof the form or chart, such as Notes Field

YN 0 1 2 3 4

5Sex marker not required and removed fromform, application, sign-in sheet, chart, EMR,wristband, etc

YN

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6Sex marker required and there is an additionalfree-text field to write Gender Identity(optimal strategy when sex marker required)

YN 0 1 2 3 4

6AGender Identity field is limited to predeterminedoptions and can 'choose all that apply'(alternative strategy when sex marker required)

YN 0 1 2 3 4

6BPre-existing boxes include: ‘female’, ‘male’, ‘intersex’, ’transfeminine’, ‘transmasculine’, ‘non-binary’,‘decline to state’, and 'unknown'

YN 0 1 2 3 4

7 There is a free-text field to indicate Pronouns(optimal strategy)

YN

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7A Pronoun field is limited to pre-existing options and can 'choose all that apply' (alternative strategy)

YN 0 1 2 3 4

7BPre-existing boxes include a minimum of:'she', 'he', 'they', 'none', 'decline to state',and 'unknown'

YN 0 1 2 3 4

Name Used and Legal Name

Gender Identity and Sex Marker

Pronouns



Trans Care BC - PHSAOrganizational Assessment Toolvi6


Forms / Charts / EMRs (continued)# Strategy

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WHAT(action items)

WHO(supports)

WHEN(target dates)

8 Honorifics are not used on forms(optimal strategy)

YN

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8AHonorifics are used on forms, but are always optional;the gender-neutral title 'Mx' is added as an option(alternative strategy)

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8BHonorifics are required; the gender-neutraltitle 'Mx' is added as an option(alternative strategy, less desirable)

YN 0 1 2 3 4

9 Gender-inclusive language is used on assessment formsYN

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10 Procedures are in place to update records to prioritizeName Used, Gender Identity and Pronouns

YN 0 1 2 3 4

11Procedures are in place to prioritize Name Used,Gender Identity and Pronouns on wristbands andother visible identifiers

YN 0 1 2 3 4

12If gender-affirming fields are limited or non-existent,a confidential alert system is used to notify staff ofclient’s Name Used and Pronouns

YN 0 1 2 3 4

13Staff are trained to respond affirmingly to requests toupdate records and visible identifiers, irrespective ofclient's previous level of access to gender-affirming care

YN 0 1 2 3 4

Honorifics (Dr, Mx, Ms, Mrs, Mr)

General Recommendations



Trans Care BC - PHSA Organizational Assessment Tool vii7



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1 Clients are referred to by Name Used(unless directed otherwise by the client)

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2 Clients are referred to by the Pronouns they identified(unless directed otherwise by the client)

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3When discrepancies around name, gender orpronouns arise, direction by the client is prioritized

YN 0 1 2 3 4

4When discrepancies around name, gender orpronouns arise, there is a procedure to clarifyinformation in a confidential manner

YN 0 1 2 3 4

5Anti-discrimination policy, position statement oninclusion, and/or safe space signs are visible fromwaiting room

YN 0 1 2 3 4

6 Posters reflect diversity, including gender diverseindividuals

YN 0 1 2 3 4

7 Pamphlets, handouts and health promotion materialinclude services for gender diverse people

YN 0 1 2 3 4

8 Universal (or trans-inclusive) washroom or directionsare visible from waiting room

YN 0 1 2 3 4


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WHAT(action items)

WHO(supports)

WHEN(target dates)

1 Organizations we refer to have accessible and affirming services for gender diverse people

YN

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2We have contacted organizations we refer to andassessed how accessible and affirming they are forgender diverse people

YN 0 1 2 3 4

3Staff know where to find updated information onservices that are accessible to gender diverse people(ie: Trans Care BC)

YN 0 1 2 3 4

4 We maintain partnerships with organizations thatoffer gender-affirming care and/or services

YN 0 1 2 3 4

5We have the contact information readily availablefor the gender affirming service(s) we primarily contactwhen we need support (ie. Trans Care BC)

YN 0 1 2 3 4

6 We have pamphlets and handouts from organizationsthat support gender diverse people and their families

YN 0 1 2 3 4

Waiting Room / Reception

Referral Services and Resources



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1 Signs use function-based icons instead of gender-based icons

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2 Signs designate all single-stalls as universal (for all genders)

YN 0 1 2 3 4

3 Signs designate all multi-stall gendered washrooms as trans-inclusive

YN 0 1 2 3 4

4 1+ multi-stall washroom has signs designatingthe washroom as universal

YN 0 1 2 3 4

5 There are signs in the building to help people to locate the universal/trans-inclusive washrooms

YN 0 1 2 3 4

6 Locks visibly indicate 'occupied' or 'vacant' onall single-stalls

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7 Locks visibly indicate 'occupied' or 'vacant' onall doors in multi-stall washrooms

YN 0 1 2 3 4

8Stall doors in multi-stall washrooms have minimal gaps (privacy), except small gap on bottom forsound transfer and staff monitoring (safety)

YN 0 1 2 3 4

9 Stall walls in multi-stall washrooms have minimal gaps, including above and below (privacy)

YN 0 1 2 3 4

10Building has a minimum of one universal access, single-stall washroom that is easily accessible by all people

YN

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11 At least one universal or trans-inclusive washroom is in the sightline of a staff-frequented area

YN 0 1 2 3 4

12Open (doorless) entrances to universal multi-stallwashrooms that increase sightline / sound monitoringby staff, as well as wheelchair and stroller access

YN 0 1 2 3 4

Washrooms

Signage

Amenities

Floor Plan



Trans Care BC - PHSA Organizational Assessment Tool ix9



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1 Signs use function-based icons instead ofgender-based icons

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2 Signs designate all single-stalls as universal(for all genders)

YN 0 1 2 3 4

3 Signs designate all multi-stall / open gendered change rooms as trans-inclusive

YN 0 1 2 3 4

4 1+ multi-stall change room has signs designating the change room as universal

YN 0 1 2 3 4

5 There are signs in the building to help people to locate the universal/trans-inclusive change rooms

YN 0 1 2 3 4

6 Locks visibly indicate 'occupied' or 'vacant' on all single-stalls

YN

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7 Locks visibly indicate 'occupied' or 'vacant' on all doors in multi-stall/open change rooms

YN 0 1 2 3 4

8Stall doors in multi-stall change rooms have minimal gaps (privacy), except small gap on bottom for sound transfer and staff monitoring (safety)

YN 0 1 2 3 4

9 Stall walls in multi-stall change rooms have minimal gaps, including above and below (privacy)

YN 0 1 2 3 4

10 Standalone, single stall change rooms are designated as universal access

YN

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11Building has a minimum of one universal access, single-stall change room that is easily accessible by all people

YN 0 1 2 3 4

12 All multi-user change room facilities have a minimum of one single-stall change area for privacy

YN 0 1 2 3 4

13Buildings requiring large public change rooms aredesigned to include a universal access, multi-stalledchange area

YN 0 1 2 3 4

14 At least one universal or trans-inclusive change room is in the sightline of a staff-frequented area

YN 0 1 2 3 4

15Open (doorless) entrances to universal multi-stallchange rooms that improve sightline / sound monitoringby staff, as well as wheelchair and stroller access

YN 0 1 2 3 4

Change Rooms

Signage

Amenities

Floor Plan



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WHAT(action items)

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1 Room assignements are not gendered(optimal strategy)

YN

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1ARooms are gender-segregated and clients can choosebased on gender-identity, safety, privacy andconfidentiality needs (alternative strategy)

YN 0 1 2 3 4

1BRooms are gender-segregated and assigned basedon gender-identity, safety, privacy and confidentialityneeds (alternative strategy, less desirable)

YN 0 1 2 3 4

2When heightened privacy needs are required toprotect safety and confidentiality, gender diverseclients are offered the choice of a private room

YN 0 1 2 3 4


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WHAT(action items)

WHO(supports)

WHEN(target dates)

1Dress code is applied universally and consistentlywith all staff / clients, regardless of their genderidentity and gender expression (optimal strategy)

YN

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1ADress code is gendered; all staff / clients have theright to dress in a manner consistent with their gender identity and gender expression (alternative strategy)

YN 0 1 2 3 4

2Dress code notes that non-binary staff / clients havethe right to dress in a manner consistent with theirgender identity and gender expression

YN 0 1 2 3 4


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WHAT(action items)

WHO(supports)

WHEN(target dates)

1Anonymous feedback options welcomed and madevisible and easily accessible at service site and onwebsite

YN

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2 Advisory groups includes gender diverse individualsYN 0 1 2 3 4

3Community advisory groups include gender diverse individuals who represent other marginalizedcommunities, offering an intersectional lens

YN 0 1 2 3 4

Room Assignments

Dress Codes

Feedback Opportunities



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WHAT(action items)

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1Job postings explicitly welcome diverse candidatesincluding gender diverse people; job postings usegender inclusive language

YN

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2Accessibility throughout the entire recruitmentprocess has been reviewed (ie. application,interview questions, required documents, etc)

YN 0 1 2 3 4

3 We currently have gender diverse staff, and we have/had gender diverse staff with strong retention

YN 0 1 2 3 4

4Access for gender diverse people is a standingitem on team meeting agendas (permanently oruntil goal reached)

YN 0 1 2 3 4

5LGBT2Q+ staff are present who can providecommunity perspective during leadership meetingson services' policies, programming, forms, etc

YN 0 1 2 3 4

6Each service provision site has 1+ staff designated asthe LGBT2Q+ point-person for providing additionalsupport and guidance as needed

YN 0 1 2 3 4


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WHAT(action items)

WHO(supports)

WHEN(target dates)

1 Clients and staff are referred to by Name Used(unless they direct otherwise)

YN

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2 Clients and staff are referred to by the Pronounsthey identified (unless they direct otherwise)

YN 0 1 2 3 4

3When discrepancies arise regarding a gender diverseclient /staff's name, pronouns, and gender, directionby the client / staff is prioritized

YN 0 1 2 3 4

4When discrepancies arise with records, a standardized procedure is used to verify client information, while maintaining confidentiality

YN 0 1 2 3 4

5During client intakes, job interviews, etc, staff aretrained to offer their name and pronouns in advanceof asking personal information of others

YN 0 1 2 3 4

Staff-based Initiatives

Engagement with Gender Diverse Clients and Staff



Trans Care BC - PHSAOrganizational Assessment Toolxii12



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WHAT(action items)

WHO(supports)

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1 Anti-discrimination policy explicitly coversgender identity and gender expression

YN

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2 Anti-discrimination policy is visible to allstaff, volunteers, and clients

YN 1 2 3 4 5

3Steps and procedures are clearly defined to addresswhen anti-discrimination policy is violated, including disciplinary actions when required

YN 0 1 2 3 4

4 Steps and procedures are easily accessible for reviewby all people who access the space

YN 0 1 2 3 4

5 Steps for reporting a violation are easily accessible toall people who access the space

YN 0 1 2 3 4

6 Staff and volunteers must review and sign-off on theanti-discrimination policy and procedures

YN 1 2 3 4 5

7 Policy, position statement, and/or client’s bill of rights addressing equitable access for gender diverse clients

YN

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8 Policy and procedures outlining staff work practicessupporting gender diverse clients

YN 0 1 2 3 4

9 Policy and procedures addressing equitable access to employment for gender diverse staff

YN 0 1 2 3 4

10 Policy and procedures outlining staff work practicessupporting gender diverse coworkers

YN 0 1 2 3 4

Gender-affirming policies: general

Anti-discrimination policy

Policy


AcknowledgementsThe strategies in this resource are based on the work of countless international community members and care providers, who over the past decades have championed gender-affirming care. The assessment tool was inspired by resources from multiple organizations including the 519 Centre, Rainbow Health Ontario, the National LGBT Health Education Center, FORGE, and many more. Lastly, it was developed in collaboration with Ambit Gender Diversity Consulting, along with community members and care providers within British Columbia.


Trans Care BC - PHSA Organizational Assessment Tool xiii13

Remember, feedback is welcomed!We believe your feedback is one of the best ways to improve our educational resources. If you have any questions, comments, or suggested revisions to this assessment tool, please email us at [email protected].



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WHAT(action items)

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11Policy and procedures to support staff to maintaintrans-inclusion within gendered services,programming, and activities

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12Policy and procedures to support staff to maintaintrans-inclusion within gendered physical spaces(service areas)

YN 0 1 2 3 4

13Policy and procedures to support staff to maintaintrans-inclusion within gendered washrooms andchange rooms

YN 0 1 2 3 4

14Guidelines for staff intervening and de-escalatinggender-based discrimination (while maintaining confidentiality)

YN 0 1 2 3 4

15Procedures to follow up with staff that makediscriminatory comments or actions againstgender diverse people

YN 0 1 2 3 4

16 Policy addressing confidentiality of clients'gender identity, gender history, and gender expression

YN

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17 Policy addressing confidentiality of staff member'sgender identity, gender history, and gender expression

YN 0 1 2 3 4

18We involve gender diverse people in collaborative decision-making when addressing issues that effect their service access or employment

YN

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19We have procedures in place to revisit our mission,mandates, values, policies, and procedures on anongoing basis

YN 0 1 2 3 4

Gender-affirming policies: specific

Confidentiality

General recommendations

Policy (continued)



mailto:[email protected]

www.transcarebc.ca
