Centering Gender Affirming Resources in Education (CARE): Intervention Co-Design

Background and Purpose:

Transgender and gender diverse college and university students (TGDS) experience sexual violence (SV) at rates substantially higher than their cisgender peers. TGDS report that the health resources available to the general student population in the aftermath of SV are neither accessible nor trustworthy. College health and counseling centers (CHC) represent critical confidential medical and mental health support to students on campus, yet may be under resourced in meeting TGDS’ needs. This study engages TGDS’ and community practitioners’ perspectives in intervention co-design to inform CHCs in improving SV prevention and response for TGDS.

Methods:

Using human-centered design activities, we guided a community collaborative comprised of TGDS (n=5), CHC providers (n=4), and community practitioners (n=4) through a preliminary intervention mapping process of (1) establishing a detailed understanding of the problem, (2) describing the behavioral and environmental outcomes and change objectives, (3) reviewing theories of change, and (4) conceptualizing a context-specific program with implementation strategies. We met five times for 90-minute group-based online sessions using Zoom and MURAL (web-based workspace). Collaborative members received $100 per session. Sessions engaged participants in brainstorming and affinity clustering to arrive at behavioral outcomes and performance objectives to guide training development. We then engaged in outlining and critique to arrive at approaches we could use to build an intervention.

Findings:

Collaborative members identified eight behavioral outcomes necessary to increase CHC’s support of TGD students in the aftermath of SV: (1) interpersonally affirm TGDS’ identities; (2) procedurally affirm TGDS’ identities; (3) provide SV and substance use (SU) resources inclusive of TGDS; (4) promote the institution’s CHC as a safe space for TGDS; (5) advocate for the TGD community among CHC administration, staff, and non-TGDS; (6) provide patient-centered care; (7) maintain confidentiality of LGBTQ+ students; and (8) engage in conversations about SV and SU that recognize the unique factors that contribute to SV and SU in TGD communities. The collaborative prioritized behavioral outcomes appropriate for psychoeducation and those suited to quality assessment and improvement. We arrived at three training modules: (1) affirming diverse gender identities in clinical settings; (2) TGD communities and the medical system; and (3) engaging SV and SU supports for TGDS. The collaborative highlighted the importance of lived experiences and storytelling to build provider comfort and competence. We designed a quality assessment and improvement instrument to be completed with CHCs about the structural and administrative supports for TGDS.

Conclusion and Implications:

Co-creating an intervention with a community collaborative highlighted CHC’s need for foundational training in affirming and supporting TGDS before students could trust or engage with them on trauma-related topics. Two inter-related intervention components emerged: a clinician training and a quality improvement instrument so that we could address both the interpersonal and structural gaps that participants identified. The community collaborative encouraged storytelling and lived experience in the intervention to humanize the training, rather than relying only on factual information sharing. By employing interactive approaches to engage community voices, we were able to build an intervention that centered the specific gaps blocking TGDS service utilization.