Are RHO training sessions approved for Continuing Medical Education (CME) Credits?

Several of Rainbow Health Ontario’s (RHO) training sessions have been approved by the College of Family Physicians of Canada for MainPro+* Credits.  The Transition-Related Hormone Therapy in Primary Care Course is worth 5.0 Mainpro-MI credits – Ontario only.

The fourth edition of Sherbourne Health’s Guidelines for gender-affirming primary care with trans and non-binary patients was just released in December 2019.  This edition, like its predecessor, was authored by Dr. Amy Bourns, a family physician on Sherbourne’s LGBT2SQ Health Team. Rainbow Health Ontario is also in the process of updating the Trans Primary Care Guide, the online interactive tool based on the Guidelines.

Is there a need to improve our capacity for gender diverse health care in Northeastern Ontario? 

Northern Ontario Needs to Increase its Capacity

While LGBTQ2S+ people have many of the same health concerns as the general population, these health needs are affected by a number of issues that are specific to LGBTQ2S+ communities, and LGBTQ2S+ people face several barriers to accessing health care. Rainbow Health Ontario (RHO) provides training to assist health care and social service providers in their understanding of these issues and to improve their skills in providing equitable and comprehensive services to LGBTQ2S+ people. When it comes to trans and gender-diverse care, primary health care, such as hormone treatment, is not currently a part of the standard medical education curriculum, and many clinicians have never seen (or believe they have never seen) gender-diverse people in their practice. Trans and gender-diverse people are often referred elsewhere, even when their health needs are routine. (Adapted from RHO Trainings).

The need for transition-related services in Northern Ontario is only growing. Over the last three years, the North Bay Parry Sound District Health Unit’s Sexual Health Clinic has seen a substantial increase in the number of clients seeking transition-related referrals, and specialists are challenged to keep up with the demands of these referrals on their busy practices. The referrals to specialists can mean extensive wait times, additional costs to the client and barriers such as transportation to other communities to access needed care. This training places responsibility and access with HCPs. They are the experts on their patients, and if they are following their client’s journey, they are more qualified to diagnose and support.

There is currently strong and diverse leadership for gender-diverse folks in communities across the province, and RHO supports through mentorship and networking. However, many regions of the province still lack services, and RHO is working to improve that, in part through training.

What Local Voices Are Saying

In 2018, a research study was performed in North Bay called A Place for Us: North Bay Positive Spaces Research Project*. The purpose was to understand the experiences of LGBTQ2S+ identified residents regarding services, programs, and supports in North Bay. One hundred and forty people who live in North Bay or access services and/or attend events in North Bay and self identify as LGBTQ2S+ were surveyed.  Six additional interviews and three focus groups were also conducted. 

Participants were asked about their access to, use of and experience with services and supports; their sense of belonging and what they need from their community.

Research Highlights:

• 28% of respondents indicated that they avoided health care services, and 26% avoided mental health services because they felt unsafe (meaning at risk for experiencing harm, harassment, exclusion, danger, etc.)
• When asked “Do you think that current service providers in North Bay are safe for LGBTQ2S+ people to use?”, 16% of respondents answered ‘yes’, while 50% answered ‘some but not all’. Stated one respondent: “Staff using the wrong pronouns, not asking for pronouns, lack of safe washrooms or change rooms.  Filling out forms that only have binary options.”
• When asked “What might discourage and/or prevent you from accessing services in North Bay?”, respondents reported the following:
  • 51% reported hearing offensive/harmful language used
  • 45% said staff are not experienced and/or skilled working with LGBTQ2S+ people
  • 43% reported staff have no positive space training
  • 37% said there aren’t any LGBTQ2S+ resources available
  • 32% said intake/registration forms do not include a space to identify pronouns, gender identity, and/or preferred name, etc.
  • 31% said staff do not ask clients/patients what their pronouns are and/or use the correct pronouns
  • When asked “Do you feel that healthcare providers in North Bay understand the unique health experiences/needs of LGBTQ2S+ folks?”, 40% of respondents were ‘unsure’ and 38% answered ‘no’. 
  • When asked about what would make them feel safer and/or more welcome accessing services in North Bay, respondents identified the following:
  • 76% said it would be better if “staff are experienced and have skills in working with LGBTQ2S+ people”
  • 66% said it would be better with “use of inclusive language”
  • 61% said it would be better if “staff have positive space training”
  • 53% cited it would be better if “confidentiality is discussed and it (is) clear that staff will not “out” me/share my identify with others”
  • 51% said it would help if “there is a positive/safer space policy posted”
  • 48% said it would help if “Intake forms ask about my pronouns, gender identity, preferred name, etc.”

*We would like to acknowledge Cameron Ghent (Executive Assistant/Volunteer Coordinator at Amelia Rising Sexual Violence Support Centre) and Meg Ramore (Local Immigration Partnership Coordinator, North Bay and District Multicultural Centre) who facilitated the research and prepared this report as a project of the North Bay Local Immigration Partnership. We also what to recognize those who participated in this project and bravely and generously contributed their experiences, insights and stories.

What Provincial Voices Are Saying

The Trans Pulse Project (Ontario) was a community-based research (CBR) project that investigated the impact of the social determinants of health, social exclusion and discrimination on the health of trans people in Ontario between April 2009 – May 2010. Data collection was completed in October 2019 for Trans PULSE Canada, a community-based survey of the health and well-being of trans and non-binary people in Canada.

Research Highlights:

• One in ten trans people who accessed an emergency room presenting in their felt gender had been refused care or had care terminated prematurely , because they were trans
• One in four, or 25% of trans people had been belittled or ridiculed by an emergency care provider for being trans
• Approximately 40% of those with a family physician had experienced discriminatory behavior from their doctor at least once
• 21% had avoided the emergency department when they needed it, specifically due to being trans
• It is difficult for clients to start conversations about trans healthcare and to disclose to uninformed providers. 
• It is difficult to access gender affirming care.
• When a person has decided to access medical support to reach transition goals, but is unable or must delay, they are at high risk for suicide
• When trans people can access medical care to transition, the suicide rate goes down and is lowest once they have been able to reach their personal transition goals

What are the objectives and who should attend the Introduction to Gender Diversity session?  

SESSION: Introduction to Gender Diversity (Foundations for all health care providers working with trans, non-binary, and gender non-conforming adult clients)

Who this session is intended for:

This session is an introductory cultural humility module focused on gender diversity for all members of health and social service agencies who interact with clients.

By the end of this session, participants will:

• Be familiar with and use respectful, inclusive language and terminology
• Recognize the impacts of cisnormativity, heteronormativity and colonization
• Understand the intersection of diverse gender identities & the social determinants of health
• Recognize and address barriers to equitable health care for trans and non-binary clients
• Be prepared to make health care spaces safer and inclusive for trans and non-binary clients

What are the objectives and who should attend the Transition-Related Hormone Therapy in Primary Care session? 

SESSION: Transition-Related Hormone Therapy in Primary Care

Who this session is intended for:

This session is for Physicians, Nurse Practitioners, Registered Nurses, Physician’s Assistants and students of these disciplines – either those in a prescribing role or professionals like RNs who may be involved in preliminary assessment and discussions with clients.

By the end of this session, participants will be able to:

• Provide community-based gender-affirming services to trans and gender diverse clients
• Take a gender focused history, assess and diagnose gender dysphoria (WPATH SOC)
• Describe the informed consent process for initiating hormone therapy
• Initiate and monitor hormone therapy for trans and non-binary clients
• Utilize clinical guidelines to inform practice

What are the objectives and who should attend the Transition-Related Surgeries: Planning, Referral & Care session?  

SESSION: Transition-Related Surgeries: Planning, Referral & Care

Who this session is intended for:

This session is for Physicians, Nurse Practitioners, Registered Nurses, Registered Social Workers, Registered Psychologists, and students of these disciplines, because these are the five professions designated by the Ontario Ministry of Health to make referrals for transition-related surgeries.

By the end of this session, participants will be able to:

• Explain transition related surgeries
• Understand the provincial transition related surgery referral system and WPATH SOC criteria
• Conduct surgery planning visits and make referrals for transition-related surgeries
• Write a transition related surgery referral letter
• Complete the OHIP Prior Approval for Funding Request form