Centering Gender Affirming Resources in Education (CARE): Pilot Feasibility Trial to Increase College Health and Counseling Support for Trans and Gender Diverse Students

Background and Purpose:

Transgender and gender diverse college and university students (TGDS) experience sexual violence (SV) at rates substantially higher than their cisgender peers. College health and counseling centers (CHCs) are a source of confidential support for all students on campus; however, TGDS often do not find them accessible, even for basic medical care. To address this gap, we outline the creation of a community developed intervention to increase CHC provider/staff comfort and competence supporting TGDS. We then share the results of a feasibility trial in which we implement the intervention in CHCs across the country.

Methods:

With a collaborative of TGDS, CHC providers, and community practitioners, we used Human-Centered Design activities and the Intervention Mapping approach (Bartholomew et al., 2016) to build Centering gender Affirming Resources in Education (CARE). CARE is a three-module e-leaning training for CHC providers focused on: 1) affirming diverse gender identities in clinical settings, 2) understanding the broader context of TGD communities and the medical system, and 3) engaging SV and substance use supports for TGDS. Fifteen CHCs were invited, with 11 participating across five U.S. states. Participating CHCs were from large (n=5 ,>3,000 students) and small (n=6, <3,000); urban (n=3), suburban (n=7), and rural (n=1); private (n=5) and public (n=6); and religious (n=3) and secular (n=8) campuses. All providers and student-facing staff were invited to participate.

Participants completed a baseline survey, brief surveys after each module, and an end of training survey assessing CARE’s acceptability, usability, appropriateness, and feasibility, with >4 out of 5 serving as a benchmark of success for these measures.

Findings:

Of the campuses invited to participate, four did not due to their states’ sociopolitical climate. Fifty-two participants initiated CARE and completed baseline, with 37 completing all modules. Participants were – nurse practitioners (n=10), physicians (n=5), registered nurses (n=17), medical assistants (n=2), licensed professional counselors (n=2), clinical directors (n=1), social workers (n=2), doctoral/graduate students (n=1), other (n=7), and chose not to respond (n=5). Participants worked at their CHC - less than 5 years (n=22), 5-10 years (n=9), more than 10 years (n=15). Participants were aged 20-39 (n=15), 40-59 (n=23,), and 60 years or older (n=7). Most participants identified as cisgender women (n=42), straight (n=41), and white (n=37).

Participants found CARE acceptable (M= 4.26, SD=0.04), appropriate (M= 4.35, SD=0.06), feasible (M=4.21, SD=0.15), and usable (M= 4.13, SD=0.16). Most participants (n=29) who completed the training liked it.

Conclusion and Implications:

Co-creating an intervention with our community collaborative highlighted CHCs’ need for training in affirming TGDS before students could trust them with trauma-related needs. In our pilot trial, the intervention met acceptability, usability, appropriateness, and feasibility benchmarks with diverse CHC providers and clinic staff. We did note; however, that hostile sociopoliticial environment was a barrier to implementation at the CHC-level despite provider/staff level success in implementation. Future intervention testing includes examining the intervention’s impact with a larger CHC sample. As TGD identity becomes increasingly weaponized in the US, building CHC’s capacity to meet TGDS’ health needs is critical to supporting students and addressing violence.