title: Improving Transgender Healthcare in the New York City Correctional System.
abstract: OBJECTIVE
  Correctional settings create unique challenges for patients with special needs, including transgender patients, who have an increased rate of overall discrimination, sexual abuse, healthcare disparities, and improper housing. As part of our correctional health quality improvement process, we sought to review and evaluate the adequacy of care for transgender patients in the New York City jail system.
  
  
  METHODS
  Using correctional pharmacy records, transgender patients receiving hormonal treatment were identified. A brief in-person survey was conducted to evaluate their care in the community before incarceration, medical care in jail, and experience in the jail environment.
  
  
  RESULTS
  Survey findings and analysis of transgender patient healthcare-related complaints revealed opportunities for improvements in the provision of care and staff understanding of this population. Utilizing these findings, we conducted lesbian, gay, bisexual, and transgender (LGBT) trainings in all 12 jail clinics for medical, nursing, and mental health staff. Three months after LGBT training, patient complaints dropped by over 50%. After the development and implementation of a newly revised transgender healthcare policy, complaints dropped to zero within 6 months.
  
  
  CONCLUSIONS
  Our efforts to assess the quality of care provided to transgender patients revealed significant areas for improvement. Although we have made important gains in providing quality care through the implementation of policies and procedures rooted in community standards and the express wishes of our patients, we continue to engage this patient population to identify other issues that impact their health and well-being in the jail environment.
authors.affiliation: Bureau of Correctional Health Services , New York City Department of Health and Mental Hygiene, Queens, New York.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Jaffer
authors.affiliation: Bureau of Correctional Health Services , New York City Department of Health and Mental Hygiene, Queens, New York.
authors.forename: John
authors.initials: J
authors.lastname: Ayad
authors.affiliation: Bureau of Correctional Health Services , New York City Department of Health and Mental Hygiene, Queens, New York.
authors.forename: Jose Gabriel
authors.initials: JG
authors.lastname: Tungol
authors.affiliation: Bureau of Correctional Health Services , New York City Department of Health and Mental Hygiene, Queens, New York.
authors.forename: Ross
authors.initials: R
authors.lastname: MacDonald
authors.affiliation: Bureau of Correctional Health Services , New York City Department of Health and Mental Hygiene, Queens, New York.
authors.forename: Nathaniel
authors.initials: N
authors.lastname: Dickey
authors.affiliation: Bureau of Correctional Health Services , New York City Department of Health and Mental Hygiene, Queens, New York.
authors.forename: Homer
authors.initials: H
authors.lastname: Venters
mesh_terms: D057237:Criminals / Q000523:psychology; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000193:education / Q000523:psychology; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D009519:New York City; D011330:Prisons; D011785:Quality Assurance, Health Care; D057829:Gender-Affirming Procedures; D063106:Transgender Persons / Q000523:psychology; D014189:Transsexualism / Q000523:psychology / Q000628:therapy
keywords: correctional health; health policy development; quality improvement; transgender health