title: Screening for Spiritual Struggle in an Adolescent Transgender Clinic: Feasibility and Acceptability.
abstract: Spiritual struggles are associated with poorer health outcomes, including depression, which has higher prevalence among transgender individuals than the general population. This study's objective was to improve the quality of care in an outpatient transgender clinic by screening patients and caregivers for spiritual struggle and future intervention. The quality improvement questions addressed were whether screening for spiritual struggle was feasible and acceptable; and whether the sensitivity and specificity of the Rush Protocol were acceptable. Revision of the screening was based on cognitive interviews with the 115 adolescents and caregivers who were screened. Prevalence of spiritual struggle was 38-47%. Compared to the Negative R-COPE, the Rush Protocol screener had sensitivities of 44-80% and specificities of 60-74%. The Rush Protocol was acceptable to adolescents seen in a transgender clinic, caregivers, and clinic staff; was feasible to deliver during outpatient clinic visits, and offers a straightforward means of identifying transgender persons and caregivers experiencing spiritual struggle.
authors.affiliation: a Division of Pulmonary Medicine , Cincinnati Children's Hospital Medical Center , Cincinnati , Ohio , USA.
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Grossoehme
authors.affiliation: a Division of Pulmonary Medicine , Cincinnati Children's Hospital Medical Center , Cincinnati , Ohio , USA.
authors.forename: Alexis
authors.initials: A
authors.lastname: Teeters
authors.affiliation: b Department of Pastoral Care , Cincinnati Children's Hospital Medical Center , Cincinnati , Ohio , USA.
authors.forename: Sue
authors.initials: S
authors.lastname: Jelinek
authors.affiliation: a Division of Pulmonary Medicine , Cincinnati Children's Hospital Medical Center , Cincinnati , Ohio , USA.
authors.forename: Sophia M
authors.initials: SM
authors.lastname: Dimitriou
authors.affiliation: c Division of Adolescent and Transition Medicine , Cincinnati Children's Hospital Medical Center , Cincinnati , Ohio , USA.
authors.forename: Lee Ann E
authors.initials: LA
authors.lastname: Conard
mesh_terms: D000293:Adolescent; D000554:Ambulatory Care Facilities; D001291:Attitude of Health Personnel; D003220:Conflict, Psychological; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening; D008503:Medical Staff / Q000523:psychology; D010290:Parents / Q000523:psychology*; D010342:Patient Acceptance of Health Care / Q000523:psychology; D012680:Sensitivity and Specificity; D029181:Spirituality; D063106:Transgender Persons / Q000523:psychology* / Q000706:statistics & numerical data
keywords: Adolescent; parent; screening method; spiritual struggle; transgender