Outreach: Connecting to the Transgender Community
Consider the Transgender Perspective
More than 50 percent of transgender people experience sexual violence at some point in their lives.1 This is more profound when coupled with the fact that transgender victims of sexual assault are even less likely to seek help than are other types of sexual assault victims. Why is this the case?
On the one hand, transgender people who have had (or have heard of others having) negative experiences with health care professionals, service providers, and law enforcement may decide not even to ask for help. Sexual assault service providers, on the other hand, often have limited experience with transgender victims and little to no training on their special needs. These two factors all too often discourage providers from reaching out to this underserved population and from creating services that are targeted for transgender victims.
Before they enter the doors of a program, transgender people must see evidence that the program has taken proactive steps to learn how to appropriately serve transgender people. Likewise, before sexual assault service providers can effectively reach out to the transgender community, they have to feel confident that they are aware of the unique needs transgender people have and how they can appropriately meet those needs.
It is important to note that many (if not most) transgender people are not active in transgender organizations. Although outreach efforts must be made to organized transgender groups, targeted outreach to these groups alone is not enough. Mainstream outreach efforts must also include explicit mention of transgender and other marginalized groups your agency is committed to serving because someone who would never read a brochure that has "transgender" in the title might pick up one for "sexual violence survivors."
In 20112012, FORGE, with support from an OVC grant, extensively worked with four demonstration sites to identify barriers, build collaboration teams, and heighten communication between sexual assault service providers and the transgender community. The four sitesIowa City, Iowa; Boulder, Colorado; Boston, Massachusetts; and the State of Mainedeveloped goals, priorities, and a work plan on how to improve services and healing for transgender survivors. These communities continue to collaborate and expand on their original goals. We encourage other communities to work together formally or informally to increase access to respectful services for transgender survivors of sexual assault.
Assess Your Readiness
Before you make formal outreach efforts to the transgender community, you may need to assess your agency's readiness and capacity. Although many steps in this section can be taken with minimal financial, staff, or other capacity, broader scale outreach may require an internal review of staff attitudes, your agency's ability to fund a potential influx of new clients and to adapt its internal policies and procedures for these clients as needed, and a willingness to follow through with outreach efforts.
Find the Transgender Community
The first step in reaching transgender people in your community is to locate meeting and communication venues. If your locale is large enough, there will probably be transgender-specific organizations and events. In smaller places and rural areas, transgender people may not be "out" as transgender, might be found in mixed LGBT spaces, or may be active members of the town's community (e.g., attending church, playing bridge with neighbors, participating in their child's Parent-Teacher Organization).
There are many places you can start:
In addition to LGBT press, communities may have alternative press newspapers that cater to people who are young, concerned about health or environmental issues, or committed to the arts or that are neighborhood specific. Transgender individuals who are not part of an organized transgender community may read these rather than LGBT newspapers.
Some churches in smaller towns produce regular newsletters that list activities hosted at their church and around the community. More liberal churches and other religious venues host meetings, which may include groups like PFLAG (Parents, Families and Friends of Lesbians and Gays).
Take the First Step
After determining where transgender people congregate and find support, contact these organizations either in person or by letter, phone, or e-mail. You could simply add an organization or business contact to your mailing list, but that tactic is much less effective than contacting the organization directly and may even be viewed as impolite. At a minimum, call or e-mail the transgender contacts you have found and tell them your agency is interested in serving the transgender community. Ask if you can add them to your mailing list and send them periodic news about events and programs. Better yet, ask to meet someone for coffee so you can get to know them and their organization and they can start developing trust in you.
Asking transgender contacts for a brief face-to-face meeting has many benefits. Perhaps most important is that your willingness to leave your officeto go to themshows your genuine interest in serving this population. Do note, however, that some transgender people are so aware of the potential for anti-transgender violence or discrimination that they may be reluctant to discuss transgender topics in public places. Similarly, some transgender individuals simply prefer more privacy regarding their transgender status or history. (Remember, too, that the person you meet may not be transgender themselves, but may be a vibrant part of the transgender community or a service provider who has an established involvement with the community.) Have a backup venue in mind, such as your office or a private study room at the library. Meeting in person also puts a face to a name, which may encourage transgender contacts to pay attention to future mail you send or may encourage them to refer someone in the transgender community to you for services.
Ask contacts to bring a copy of any information they may have about their organization, events, or community so you can learn more about their organization. When introduced, use the name the person gives you. If you are unsure about which pronoun they prefer, ask. Consistently using their name and their preferred pronoun will help build a stronger relationship.
Consider bringing one of FORGE's "It's never too late..." brochures to your meeting. (You may want to have a stack of them in your office, as well.) Transgender people may not realize how prevalent sexual assault is in the transgender community, so bringing such documentation will help establish why you are interested in this population and will give them a place to start if they want to learn more. In addition, bringing materials developed by a transgender organization will give you some credibility in their eyes. They will know you have done your homework and are not looking for them to educate you. Then, go over the services offered by your agency (and elsewhere in the community, if possible), noting that you would like the information to be passed along to anyone who needs it. Answer any questions about your agency or how sexual assault survivors are served in your agency or community.
Explicitly ask if you can add their name to your mailing or e-mail lists, and whether it would be okay if you or someone from your agency contacted them again should an issue about a transgender survivor come up. Let them know if mailings from your agency are in plain or marked envelopes (since it may be of concern to some people). Also make sure to ask if they need a specific (different) name on mailings to them, as some transgender people use one name in some venues and another name for mailings and official business. Many transgender leaders do not have official offices and run groups or events out of their homes. Find out, too, if your agency needs to use discretion when calling; make a note of their answers and make sure you follow the directions they give you. Finally, don't end without asking if they know of other transgender groups in the area or other transgender leaders they think you ought to contact. Some larger urban areas have multiple transgender groups, some of which are not listed in resource guides. You may also want to ask if any local bars cater to transgender people, as those may be good places to conduct in-person outreach or to place a flier or brochure, if the owner consents.
How much you want to ask them about their organization depends a lot on what else you are considering doing. Their organizations may have formal or informal speakers bureaus comprising individuals who volunteer to share their personal stories and answer questions to help educate the public. Some are proactive in their educational efforts and have a formal "Transgender 101" training they could offer your agency. Others may have enough interest and expertise to make them excellent candidates for some of the ongoing projects discussed later in this section.
Remember, first meetings can be awkward for everyone. People may feel a bit hesitant to share and open up immediately. Knowing that it is normal for the first meeting (or first several meetings) to feel a bit clumsy may help ease overall feelings of discomfort and overcome any resistance to pursuing a working relationship. Be patient and know it can get better.
Follow up with a thank you note, which should include a confirmation of whether you've added the individual, or the organization they represent, to your mailing list and an open invitation to contact you if they have any additional questions or concerns. Include at least one of your business cards.
Get Visible: Their Turf
Several of the following suggestions refer to "LGBT" rather than just "T." Because the transgender community can be so small, and because some transgender people and their partners just feel more comfortable in "LGBT space," you will often find as many or more transgender people in LGBT groups as you will in transgender-specific groups.
Come One and All events. Although there has been a slow and steady increase, business and mainstream agencies' interest in and participation at LGBT events is still so rare in most places that their presence at an LGBT event gets a lot of notice. Does your community host a pride event in June, or are there special events such as health or street fairs? Consider staffing a booth there. A small investment of time and money can really pay off.
Extra! Extra! Read all about it! Advertising. Local LGBT community centers or other agencies may maintain referral lists, which could be publicly available (on a Web site, for instance) or could be for internal use only. Make sure you are listed in any such guides, with a note that you specifically serve transgender clients.
Consider placing a small, regular advertisement in local LGBT newspapers or Web sites. Definitely place classifieds when you have job openings, which tells the community you are not only willing to serve them but are willing to be their coworker as well.
Tack it up: Bulletin boards. Does the local LGBT community center (or other LGBT gathering place) have a bulletin board or an area where brochures are displayed? If so, see if you may display your materials there. While you're there, look at what else is posted, taking note of those organizations that hold events or produce publications with many sponsors or cosponsors. Let those groups know that your agency might be willing to cosponsor future events (often all a transgender or LGBT organization wants is the agency's name; no money or staff attendance is required).
Give a little! Contribute. Think about whether you or your agency has a service you could offer to encourage people to walk in your door, such as a free massage or holistic service.
Talk about it! Guest speakers. Find out if you can be a guest speaker at upcoming events. Possible topics follow:
You may also want to propose being part of a panel of guest speakers, made up of professionals who serve the transgender community.
Stay in touch: Mailing lists. Ask to be put on local transgender groups' mailing and e-mail lists and watch for public events. Showing up at a transgender event will get you noticed and get people talking … exactly what you want.
Be a peacock: Fliers. A very worthwhile and inexpensive investment is a flier specifically for transgender or LGBT sexual assault survivors. It is not necessary to have a slick, full-color brochure. The goal of letting transgender people know you want to serve them can as easily be met by black print on a sheet of colored or regular copy paper. Once prepared, keep a small supply available to take with you whenever you do public outreach.
Get Visible: Your Turf
Make a good first impression. When approaching a new agency for the first time, transgender people may carefully scope it out to get a feel for how the staff will treat someone who is transgender or gender non-conforming. First impressions are critical and will determine whether a potential client becomes a served client, or if they will simply turn around and walk out the door.
A study of lesbian, gay, and bisexual peoplea population with concerns about a service provider's bias that often mirror the concerns of transgender peoplefound that 95 percent "reported studying their provider's behavior for cues of acceptance, and 85 percent assessed the environment of the office for signs of lifestyle affirmation."2 Reflecting this finding, a guide for those who want to serve LGBT clients advises that
Put on a public face: Web sites and beyond. Make sure your Web site explicitly says you serve LGBT people, transgender people, and both male and female survivors. You may want it to also address common fears by noting that clients can choose what they want to disclose or withhold and whether or how much they undress (if you provide physical examinations). Images and decorations used on your Web site, printed materials, and in your waiting room should always be checked for the subconscious messages they convey. If people are pictured, are they all white? All women? All in heterosexual pairs? Make sure you are not accidentally sending a message that "these are the only kinds of people we serve."
A prominently placed statement of nondiscrimination (or a routine handout to clients) that also includes gender identity/expression and sexual orientation is a good idea.4 More "coded" signals of LGBT friendliness are rainbow flags and symbols, pink triangles, and certain organizations' logos, such as one from your local LGBT organization. If your waiting room displays brochures on health issues and local support or information programs, make sure you include a brochure or two that explicitly has transgender in its title. (Similarly, you may want to add some transgender-specific resources to your Web site.) You may also want to subscribe to your local LGBT newspaper (which will help you track what's happening locally and connect with LGBT-friendly referral sources), and leave a copy in the waiting room. Otherwise, if local publications or brochures are not available, consider subscribing to national LGBT publications.
Knowledge is power: Empower your staff. Staff training is a critical part of making your agency or practice welcoming to transgender clients. One off-hand remark from a receptionist can literally send a transgender client out the door, never to return. (That off-hand comment may also send away non-transgender clients as well, if they perceive the agency's overall attitude to be dismissive, discriminatory, or prejudiced.) Staff training is important not only for the clients you serve, but for your staff as well. Training "may also relieve anxiety and confusion among employees who are unfamiliar with and do not feel prepared to serve" transgender clients.5 A physician who is himself FTM (female-to-male) advises other health care professionals, "The unfamiliar and unknown seem odd and even sometimes threatening to all of us. Providing even a small amount of familiarity with transgender medicine may therefore significantly impact the way patients are treated...."6
Where to go?: Bathrooms. Although having a unisex restroom won't automatically brand your office "trans-friendly," it will significantly reduce some transgender clients' anxiety levels. A Virginia study found that 11 percent of transgender participants marked "lack of appropriate restroom facilities" as a barrier to receiving health care.7 An added bonus to having gender-neutral bathrooms is the benefit to parents with small children, people with disabilities, older adults, individuals who have care assistants, or those who are naturally shy and prefer a bit more privacy.
It's all in the paperwork: Forms, policies, and confidentiality. Intake forms are critical. They help clients see who you are while also getting information from your clients. If you ask "gender" and give a line to be filled in, or include a "transgender" or "other" option, transgender people will know you know they exist. Asking "gender/gender identity" with a blank line signals that you may be familiar with terms they write down. Keep in mind that when new clients fill out intake forms, they are still forming an opinion of you and your agency and may well hold back some critical information. It may help to give clients a clearly worded, detailed statement about your agency's confidentiality procedures before you give them the intake form. (Placing your confidentiality policy online might help convince a Web-surfing potential client to come in).
Think like Michelangelo: Creativity goes a long way. Do you have underused meeting rooms? A local transgender group might jump at the offer of free meeting space. Can you offer any in-kind services such as limited photocopying or free safer sex supplies such as dental dams and condoms? Can you invest in inexpensive items like pens or magnets with your agency's name on them and ask your transgender contacts to hand them out at various gatherings if you are not attending yourself? Could you hold an open house and invite community members—including your transgender contacts—to come see your space and meet your staff? Don't forget to provide (and advertise) food . . . everyone agrees that food is a great way to boost attendance.
Get Visible: Someone Else's Turf
Show off your diversity. Transgender people attend the same range of public events as anyone else. If you have a table or booth or speak at a "mainstream" event, make sure that you bring along any of your population-specific materials (e.g., transgender or LGBT) and prominently display them. Take this opportunity to review your mainstream materials, too. Are all the pictures of women? Does your "all are welcome" statement need to be supplemented by something that more explicitly welcomes all genders and sexual orientations?
Get listed. If your state sexual assault coalition or other group publishes a resource guide, see if you can add a comment that your agency welcomes transgender clients (as well as the rest of the LGBT community). If your staff is trained on LGBT issues, mention that.
Play well togethercreatively. You can also create events. In 2009, FORGE borrowed a concept developed by Kleenex and sponsored a "blue couch" at its local PrideFest. A blue couch is staffed by a skilled listener with a box of tissues. As people walk by they are invited to sit down and talk about whatever they'd like to talk about. At FORGE's event, the topics ranged from the very mundane ("I'm tired") to intimate (one person saw their past abuser at the event; another had been verbally attacked by another fairgoer). FORGE recruited licensed mental health professionals to be on call as emergency backups (they were not needed), and some also volunteered to staff the couch. Everyonevolunteers, staffers, and visitorsraved about the idea and was thrilled with the sense of caring and belonging that the couch helped to create. You could suggest this idea to your local groups and offer your staff as trainers for volunteer listeners or as volunteer listeners themselves.
FORGE also created a therapists' panel event. Because many transgender people are required to see a therapist before their doctors will prescribe hormones or perform surgery, the transgender community has a particularly high interest in "investing well" by learning about providers. At FORGE's event, six therapists who had moderate to extensive experience with transgender clients gave brief self-introductions and then answered questions from both the moderator and participants. The therapists were as thrilled with the event as the attendees were, because it gave them the rare opportunity to learn about each other and how they approached common issues. Cosponsoring an event such as this with a transgender group would allow your colleagues to learn more about area therapists—to whom they may be able to refer clients.
If you end up meeting transgender people with legal, accounting, fundraising, or other appropriate skills and an interest in serving sexual violence survivors, consider inviting them to be on your board of directors or community advisory council. It almost never works to recruit people just because they represent a marginalized group, but adding someone with skills as well as contacts and viewpoints can be extremely beneficial for everyone.
Consider making transgender groups aware of any volunteer or intern positions you may have. These can be particularly attractive to transgender people who may be experiencing employment discrimination and need to develop references and contacts. (It is also a great way to help reduce the loneliness and isolation that many transgender people experience.)
When you attend community coalition or task force meetings, ask yourself if the group might be of interest to local transgender leaders. FORGE's invitation to join a community health worker task force ended up leading to an ongoing partnership with a hospital and helped raise the consciousness of a whole range of local health-related agencies.
1 FORGE, 2005, Sexual Violence in the Transgender Community Survey, unpublished data; G. Kenagy, 2005, "The Health and Social Service Needs of Transgender People in Philadelphia," International Journal of Transgenderism 8(2/3):4956; G. Kenagy and W. Bostwick, 2005, "Health and Social Service Needs of Transgender People in Chicago," International Journal of Transgenderism 8(2/3):5766.
2 Using the term "lifestyle" when referring to people who are transgender, lesbian, gay, or bisexual is often viewed as pejorative; many say it erroneously equates core identities with much more superficial things like the colors someone has chosen for their walls. K. McGarry, M.R. Hebert, J. Kelleher, and J. Potter, 2008, "Taking a Comprehensive History and Providing Relevant Risk-Reduction Counseling," in H.J. Makadon, K.H. Mayer, J. Potter, and H. Goldhammer, eds., Fenway Guide to Lesbian, Gay, Bisexual and Transgender Health, Philadelphia, PA: American College of Physicians, 421.
3 Ibid., 420421.
4 Gay and Lesbian Medical Association, 2006, Guidelines for Care of Lesbian, Gay, Bisexual and Transgender Patients, Washington, DC: Gay and Lesbian Medical Association, 3.
5 J. Potter, H. Goldhammer, and H.J. Makadon, 2008, "Clinicians and the Care of Sexual Minorities," in H.J. Makadon, K.H. Mayer, J. Potter, and H. Goldhammer, eds., Fenway Guide to Lesbian, Gay, Bisexual and Transgender Health, Philadelphia, PA: American College of Physicians, 17.
6 R.N. Gorton, J. Buth, and D. Spade, 2005, Medical Therapy & Health Maintenance for Transgender Men: A Guide for Health Care Providers, San Francisco, CA: Lyon-Martin Women's Health Services, 75.
7 J. Xavier, J.A. Honnold, and J. Bradford, 2007, The Health, Health-Related Needs, and Lifecourse Experiences of Transgender Virginians, Richmond, VA: Community Health Research Initiative, Center for Public Policy, Virginia Commonwealth University, 12.