A Mixed Methods Examination of Transgender Women's Help Seeking and Attainment Following Interpersonal Victimization

Background and purpose: While transgender women experience high rates of interpersonal victimization, they also experience numerous barriers to seeking and attaining effective help, including discrimination and bias. Much of the existing research focuses on transgender women’s exclusion from IPV-related services, with fewer studies examining other formal providers, including child abuse services and substance use treatment services. The present study fills this gap by examining specific barriers to seeking and accessing help to identify the availability, cultural relevance, and accessibility of existing services.

Methods: The present study utilized an exploratory sequential mixed-methods design to examine transgender women’s help-seeking and attainment across the life course. Using a life history calendar (LHC) adapted for this study, we recruited 103 transgender women (ages 18-35, in Chicago and Milwaukee) to complete an interviewer-administered LHC. In addition to documenting forms of victimization across the life course, the LHC interview included questions assessing help-attainment behavior, including accessing survivor, legal, child abuse, health care, substance use, and mental health services. For each service accessed, participants were asked if these were helpful and if they felt welcomed. Building upon these findings, we conducted in-depth qualitative follow-up interviews with a sub-sample of 25 participants. Participants were asked about barriers to accessing services and what resources they wished they had. Participants who had accessed services were asked about their perceptions of these services. Lastly, participants shared other ways they were able to survive and heal in the absence of formal services. Transcripts were coded and analyzed using a thematic analysis approach.

Findings: Findings from the initial, quantitative phase indicate low levels of help-attainment. In childhood, a small number (19%) accessed child abuse services. In adulthood, 20% of participants accessed survivor services and 24% accessed legal services. However, participants reported high rates of accessing mental health care not specific to victimization, with 30% accessing services when they were under 18 and 82% when they were over 18. Analysis of qualitative findings indicated that many participants did not feel comfortable accessing survivor or legal services for fear of gender-based discrimination and bias. Some also stated that calling the police did not align with their political or personal values. Those who accessed survivor, legal, and child abuse services reported a range of encounters, from helpful and welcoming to unhelpful and further traumatizing. Some participants accessed anti-violence services through LGBTQIA+ organizations and found this to be helpful and affirming, yet others expressed that they were unable to find such services. Several expressed frustration with the need to cobble together services from multiple organizations. For example, one participant discussed traveling to a group for military sexual trauma survivors, a transgender support group, and individual therapy every week.

Conclusion and implications: Despite high levels of interpersonal victimization and violence, transgender women in this study experienced numerous barriers to accessing survivor services. Findings indicate the importance of ensuring that existing services are inclusive and welcoming of transgender survivors as well as designing new programs specific to transgender women.