Hotez Emily, Yang Bridgette, Chua Kristine J, Smith Andrew M, Lee Cameron, Delgado Daniela, Weimer Amy
General Internal Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, USA.
Community Health Sciences, University of California Los Angeles Fielding School of Public Health, Los Angeles, USA.
Cureus. 2023 Aug 23;15(8):e43983. doi: 10.7759/cureus.43983. eCollection 2023 Aug.
Transgender and gender diverse (TGD) individuals, comprised of those whose gender identity does not correspond with the sex they were assigned at birth, represent approximately 1.4 million people in the U.S., with a higher prevalence among those 18-24 years old. TGD individuals experience high levels of intimate partner violence (IPV), which leads to disproportionately negative mental and physical health outcomes for this population. As a result, there is a resounding need to connect TGD populations to health-promoting services, supports and resources. Med-Peds and Family Medicine clinics may be particularly well-positioned to support these efforts due to physicians' focus on transitional-aged youth and young adults under 30.
The current manuscript reports on processes and outcomes related to a quality improvement (QI) initiative that aimed to test the feasibility and acceptability of implementing IPV screening within both a Med-Peds and a Family Medicine specialty clinic serving TGD populations in Los Angeles, CA. This QI initiative included screeners that capture IPV in cisgender/non-TGD populations (Humiliation, Afraid, Rape, Kick [HARK]) as well as in TGD populations specifically (IPV-T). We utilized a mixed-methods approach to both quantify and qualify responses to existing IPV screening as well as informal feedback from clinic "champions" in each clinic.
Quantitative and qualitative findings from this QI initiative, featuring both general and TGD-specific IPV screening measures with 140 TGD individuals, elucidated several important processes that can support effective IPV screening and referral to supports and services. These include the importance of interdisciplinary teams, the utility of an iterative approach to screener roll-out, and the essential role of solidifying a referral process in these efforts. This project additionally shed light on the potential utility and challenges of implementing both general and TGD-specific IPV screening measures. Our pilot test did not support the necessity of a TGD-specific IPV screener for identifying and responding to IPV in this population, yet additional data is critical to generate more conclusive recommendations.
We recommend larger-scale data collection efforts to evaluate the utility of integrating general and TGD-specific screeners into clinic workflows to ensure optimal health promotion for the TGD population in Med-Peds and Family Medicine clinics.
跨性别和性别多样化（TGD）个体，即那些性别认同与出生时被指定的性别不符的人，在美国约有140万，在18至24岁人群中的患病率更高。TGD个体遭受高水平的亲密伴侣暴力（IPV），这给该人群带来了不成比例的负面身心健康后果。因此，迫切需要将TGD人群与促进健康的服务、支持和资源联系起来。由于医生关注过渡年龄的青少年和30岁以下的年轻人，医学-儿科学和家庭医学诊所可能特别适合支持这些努力。
本手稿报告了一项质量改进（QI）倡议的过程和结果，该倡议旨在测试在加利福尼亚州洛杉矶为TGD人群服务的医学-儿科学和家庭医学专科诊所内实施IPV筛查的可行性和可接受性。这项QI倡议包括筛查工具，用于捕捉顺性别/非TGD人群中的IPV（羞辱、恐惧、强奸、踢打[HARK]）以及TGD人群中的IPV（IPV-T）。我们采用混合方法来量化和定性对现有IPV筛查的反应以及每个诊所中诊所“倡导者”的非正式反馈。
这项QI倡议的定量和定性结果，以针对140名TGD个体的一般和特定于TGD的IPV筛查措施为特色，阐明了几个可以支持有效IPV筛查以及转介到支持和服务的重要过程。这些包括跨学科团队的重要性、筛查工具推出的迭代方法的效用以及在这些努力中巩固转介过程的关键作用。该项目还揭示了实施一般和特定于TGD的IPV筛查措施的潜在效用和挑战。我们的试点测试不支持使用特定于TGD的IPV筛查工具来识别和应对该人群中的IPV的必要性，但更多数据对于得出更具决定性的建议至关重要。
我们建议进行更大规模的数据收集工作，以评估将一般和特定于TGD的筛查工具整合到诊所工作流程中的效用，以确保医学-儿科学和家庭医学诊所中的TGD人群获得最佳的健康促进。
