title: Improving transgender health by building safe clinical environments that promote existing resilience: Results from a qualitative analysis of providers.
abstract: BACKGROUND
  Transgender (TG) individuals experience discordance between their sex at birth and their gender identity. To better understand the health care needs and characteristics of TG youth that contribute to resilience, we conducted a qualitative study with clinical and non-clinical providers.
  
  
  METHODS
  In-depth interviews were conducted of providers (n = 11) of TG youth (ages 13-21). Convenience and purposive sampling were used to recruit participants in the Boston area. All interviews were audio-recorded and transcribed verbatim. An interview guide of 14 open-ended questions was used to guide the discussion. A grounded theory approach was utilized to code and analyze the data, including double-coding to address issues of inter-rater reliability.
  
  
  RESULTS
  Five primary themes emerged: 1) resilience of TG youth 2) lack of access to services that influence health, 3) the critical role of social support, 4) challenges in navigating the health care system, and 5) the need for trans-affirming competency training for providers and frontline staff.
  
  
  CONCLUSIONS
  The findings of this study show that providers recognize multiple barriers and challenges in the care of TG youth. However, they also identify the resilience exhibited by many youth. We propose that providers can further enhance the resilience of TG youth and help them flourish by offering them necessary resources via the creation of safe and welcoming clinical environments.
authors.affiliation: Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Carlos G
authors.initials: CG
authors.lastname: Torres
authors.affiliation: Partners HealthCare, Boston, Massachusetts, USA.
authors.forename: Megan
authors.initials: M
authors.lastname: Renfrew
authors.affiliation: Massachusetts General Hospital, Boston, Massachusetts, USA.|Disparities Solutions Center, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Karey
authors.initials: K
authors.lastname: Kenst
authors.affiliation: Massachusetts General Hospital, Boston, Massachusetts, USA.|Disparities Solutions Center, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Aswita
authors.initials: A
authors.lastname: Tan-McGrory
authors.affiliation: Harvard Medical School, Boston, Massachusetts, USA.|Partners HealthCare, Boston, Massachusetts, USA.|Massachusetts General Hospital, Boston, Massachusetts, USA.|Disparities Solutions Center, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Betancourt
authors.affiliation: Harvard Medical School, Boston, Massachusetts, USA. lopezlenny77@gmail.com.|Partners HealthCare, Boston, Massachusetts, USA. lopezlenny77@gmail.com.|Massachusetts General Hospital, Boston, Massachusetts, USA. lopezlenny77@gmail.com.|Disparities Solutions Center, Massachusetts General Hospital, Boston, Massachusetts, USA. lopezlenny77@gmail.com.|Mongan Institute for Health Policy, Massachusetts General Hospital, 50 Staniford St, Suite 901, Boston, Massachusetts, 02114, USA. lopezlenny77@gmail.com.
authors.forename: Lenny
authors.initials: L
authors.lastname: López
mesh_terms: D000293:Adolescent; D001900:Boston; D005260:Female; D005783:Gender Identity; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel; D062985:Health Services for Transgender Persons / Q000592:standards*; D054625:Healthcare Disparities / Q000592:standards*; D006801:Humans; D008297:Male; D011369:Professional-Patient Relations; D036301:Qualitative Research; D015203:Reproducibility of Results; D012944:Social Support; D063106:Transgender Persons / Q000523:psychology*; D055815:Young Adult