"The right to self-determination" – Exploring the experience of different stakeholders with models of trans health care in Andalusia

In Andalusia, Spain, access to state-funded trans health care was established in 1999, by means of the creation of a specialized Unit in the Public Hospital of Malaga.Over the last few years, the trans depathologization... [ view full abstract ]

In Andalusia, Spain, access to state-funded trans health care was established in 1999, by means of the creation of a specialized Unit in the Public Hospital of Malaga.

Over the last few years, the trans depathologization movement demanded the change of the trans health care model, from an assessment model towards an approach focused on information, optional counseling and informed consent, as well as a decentralization of trans health care.

In 2014, a law for protection from discrimination on grounds of gender identity was passed in Andalusia, based on a depathologization perspective and the “right to self-determination”. In the implementation process, a change in the organization of trans health care in Andalusia was introduced. Instead of a specialized Unit in Malaga, multidiscplinary teams were established in Hospitals of the eight Andalusian provinces, decentralizing the access to trans health care. Furthermore, a protocol for trans health care has developed, based on an informed consent approach.

The presentation summarizes the results of a qualitative research project that explores the experience of different stakeholders (adult trans people, gender diverse children and youth, their parents, as well as health professionals) with the process of modifying trans health care in Andalusia, Southern Spain.

• To explore the historical process of establishing state-funded trans health care in Andalusia and Spain.• To review the critiques of the depathologization movement regarding the assessment model applied in the trans... [ view full abstract ]

• To explore the historical process of establishing state-funded trans health care in Andalusia and Spain.
• To review the critiques of the depathologization movement regarding the assessment model applied in the trans health care provided in different Spanish autonomous regions.
• To review the experience of different stakeholders (adult trans people, gender diverse children and youth, their parents, as well as health professionals) with the model of trans health care applied over the last decades in Andalusia.
• To explore the experience of different stakeholders (adult trans people, gender diverse children and youth, their parents, as well as health professionals) with the recent changes in the trans health care model in Andalusia.
• To explore the experience with the process of health care and referral of trans adults and gender diverse children and adolescents in Primary Care and Community Mental Health Services in Andalusia.
• To explore proposals of improvement contributed by different stakeholders (adult trans people, gender diverse children and youth, their parents, as well as health professionals).

The presentation forms part of a qualitative research project that explores the perspectives of trans adults, gender diverse children and adolescents, their parents and health professionals regarding gender transition... [ view full abstract ]

The presentation forms part of a qualitative research project that explores the perspectives of trans adults, gender diverse children and adolescents, their parents and health professionals regarding gender transition processes, experiences of support and discrimination in the family, social, education and health care context in Andalusia, as well as proposals for improvement, by means of the following methodologies:
• Review of recent scientific literature on gender transition processes and trans health care.
• Review of the demands and proposals contributed by trans depathologization activism.
• Individual semistructured interviews with adult trans people, gender diverse children and youth, their parents, as well as health professionals in Andalusia.
• Transcription of the interviews.
• Analysis of the discourses of adult trans people, gender diverse children and youth, their parents, as well as health professionals.
• Result triangulation by different members of the research team.

As main outcome measures, the following items were established:• Conceptualization of gender transition processes and models of trans health care in the recent scientific literature. • Demands and proposals of trans... [ view full abstract ]

As main outcome measures, the following items were established:
• Conceptualization of gender transition processes and models of trans health care in the recent scientific literature.
• Demands and proposals of trans depathologization activism.
• Experiences of different stakeholders (adult trans people, gender diverse children and youth, their parents, as well as health professionals) with the trans health care model applied over the last decades in Andalusia.
• Experiences of different stakeholders (adult trans people, gender diverse children and youth, their parents, as well as health professionals) with recent changes in the trans health care model.
• Experiences of different stakeholders (adult trans people, gender diverse children and youth, their parents, as well as health professionals) with the process of health care and referral of trans and gender diverse people in Primary Care and Community Mental Health Services.
• Role of non binary gender expressions and identities in trans health care.
• Proposals for improvement contributed by the interviewed stakeholders.

As result of the literature review, the following aspects can be highlighted:• Existence of a broad scientific literature on gender transition processes and trans health care models. • Relative lack of research on the... [ view full abstract ]

As result of the literature review, the following aspects can be highlighted:
• Existence of a broad scientific literature on gender transition processes and trans health care models.
• Relative lack of research on the perspective of trans people with informed consent models.
• Questioning of the assessment model by trans depathologization activism and demand of introduction of an approach based on information, optional counseling and informed consent.

As results of the interview process with different stakeholders (adult trans people, gender diverse children and youth, their parents, as well as health professionals), the following aspects can be mentioned:
• Critique of the assessment model.
• Frequent lack of information and difficulties in the assistance and referral process in Primary Care and Community Mental Health Care.
• Complementary services provided by Social Services and psychologists in private practice.
• Expectations regarding the new trans health care model.
• Role of non binary gender expressions and identities in current trans health care.
• Needs and suggestions of professionals involved in the new multidisciplinary teams, as well as professionals in Primary Care and Community Mental Health Services.
• Proposals for improvement contributed by the interviewed stakeholders.

Trans activists and allied health professionals criticized the assessment model established in trans health care for not respecting the trans people’s right to self-determination and capacity for informed decision making.... [ view full abstract ]

Trans activists and allied health professionals criticized the assessment model established in trans health care for not respecting the trans people’s right to self-determination and capacity for informed decision making. The recent modification process of the trans health care model in Andalusia opens up the opportunity for establishing a Best Practice model based on a depathologization and human rights perspective in the Andalusian Public Health System. The interviewed stakeholders identify different areas for improvement in order to facilitate the implementation process of the new trans health care model and guarantee a fulfillment of the principles established in the legal framework.