Tips for Those Who Serve Victims
Services for sexual assault victims may be segregated by gender (male/female), sexual orientation (LGB/straight), or any number of other demographic variables. Many services are for women only or, at best, are offered separately for men and women. In addition, many services and institutions that a victim may need or want to access are segregated by sex: social support groups; shelters; hospital rooms; substance abuse or drug treatment; OB/GYN and urologists' offices; gyms and health/wellness programs; religious facilities; community service groups; some hair salons and barber shops; mentoring programs; YMCAs; clothing banks; and sweat lodges and other spiritual healing retreats.
Gender-specific bathrooms are a source of stress for transgender people. More than 65 percent of over 1,000 transgender respondents to a 2011 FORGE study said that they viewed the availability of gender-neutral bathrooms as "important," "very important," or "extremely important" in deciding whether to access professional services.42
Many facilities have converted single-stall bathrooms to unisex bathrooms. This quick and low-cost change benefits a wide range of people, including non-transgender individuals who feel they must wait in a hallway for "their" bathroom to become availableeven if the one next door is unoccupied.
Your policies should clearly state who is or is not eligible for services based on gender, and your staff should understand the policies and be able to clearly state them to victims seeking services. For example, if services are only available to women who have a female gender designator on their driver's license or identification card, outline that in the eligibility requirements for that service. If a particular service requires a prescreening interview to determine if it is an appropriate match for a victim's healing needs, make this requirement clear.
Implications and Actions for ...
Health Care Providers
Some medical offices have public areas (e.g., waiting areas in x-ray departments) that are divided by gender. If a transgender patient needs a service that usually involves waiting in a gender-segregated space, consider the patient's safety and comfort. Offering to place a patient directly in an exam room without any other patients is a short-term solution. Facilities should address their policies and procedures of sex-segregated spaces and determine if there might be a more effective and comfortable practice for all patients.
If a transgender person requires inpatient medical care, you may play an important role in helping to minimize the additional layers of distress that person may feel. Four primary issues might be particularly distressing:
Each patient's needs are unique. Direct, sensitive communication, using inclusive and respectful language, can be a successful first step to collectively determining solutions that meet the facility's needs as well as the patient's.
Patients may need to enter transitional care facilities following hospitalization. Many of the same concerns will apply in other types of residential facilities.
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Whenever possible, consider alternatives to hospitalization or segregated housing, such as outpatient day surgery centers and hospitals with private rooms.
If referring the patient to a sex-segregated service and the patient's gender expression and gender identity align with the sex being served, that may be an appropriate referral. The patient may choose never to disclose gender history to the service provider or other people being served by that provider. If referring the patient to a sex-segregated residential service and the patient's gender identity, appearance, documentation, or genital status does not fit the service's eligibility policies, discuss options with the patient to determine the best course of action. Never disclose a patient's gender when referring that patient to another service provider or agency without overt permission.
In most situations, segregated services will not likely pose any issues for law enforcement officers. The exception would be if the victim is being arrested for a crime while reporting a crime committed against them (e.g., a person damages property during a bar fight but is also sexually assaulted).
When transgender individuals are incarcerated, they are typically housed according to their genital status, gender assigned at birth, or legal gendereven if this is a dangerous situation for the person. For example, a transgender woman who is housed with men may experience extensive harassment and possibly violence or sexual assault from other inmates. According to numerous agencies that work extensively on issues involving transgender individuals and incarceration,1 some incarcerated transgendered individuals are being placed in solitary confinement as a protective custody measure.
The Sylvia Rivera Law Project works extensively with low-income transgender people, who have higher rates of involvement in the criminal justice system as a result of engaging in the underground economy (e.g., involvement in the sex trade, drug dealing). It recommends that
Just Detention International, which seeks to end sexual violence in jails and prisons (including sexual violence against transgender inmates), provides national technical assistance and may be a useful resource for local police departments.
1. For example, National Center on Lesbian Rights, Transgender Law Center, Sylvia Rivera Law Project, Just Detention International, and National PREA Resource Center.
2. Letter from Dean Spade of the Sylvia Rivera Law Project to the National Prison Rape Elimination Commission on August 15, 2005.
Some sexual assault service providers—including therapists—only serve women. Before you refer victims to therapists or other service providers, you must know the attitudes, beliefs, and approaches they have about working with individuals who are male identified or transgender identified (or who have previously identified this way). Referring a victim to providers who are ignorant of transgender people, or who are prejudiced against them, could result in the victim being revictimized by the very people who are supposed to help them.
If referring the victim to a sex-segregated service and the victim's gender expression and gender identity align with the sex being served, that may be an appropriate referral. The victim may choose never to disclose gender history to the service provider or other people being served by that provider. If referring the victim to a sex-segregated residential service and the victim's gender identity, appearance, documentation, or genital status does not fit the service's eligibility policies, discuss options with the victim to determine the best course of action. Never disclose a victim's gender when referring that victim to another service provider or agency without overt permission.
Your advertising must accurately represent the populations you actually serve. For example, if you specialize in working with lesbian and bisexual women, be clear that you only serve women. Only use the acronym “LGBT” when serving all members of the lesbian, gay, bisexual, and transgender community.
If referring your client to a sex-segregated service (e.g., support group, single-gender retreat, spiritual gathering) and the client’s gender expression and gender identity align with the sex being served, that may be an appropriate referral. A client’s choice not to disclose gender history to the service provider or other clients must be respected and held confidential. If referring your client to a sex-segregated residential service and the client’s gender identity, appearance, documentation, or genital status does not fit the service's eligibility policies, discuss options with the client to determine the best course of action. Never disclose a client’s gender when referring that client to another service provider or agency without overt permission.
If your client requires inpatient psychiatric care, you can play an important role in helping to minimize the additional layers of distress that client may feel. Four primary issues might be particularly distressing:
Each client's needs are unique. Direct, sensitive communication, using inclusive and respectful language, can be a successful first step to collectively determining solutions that meet the facility's needs as well as the client's.
Clients who have been hospitalized for mental health reasons may move to transitional housing at some point during their treatment. The majority of transitional housing is segregated by sex. Similar types of advocacy may be necessary if transitional housing is recommended.
Whenever possible, consider alternatives to hospitalization or segregated housing. All-day mental health programs, housing with friends or family, or combining multiple types of services may yield the same results as being hospitalized or living in shelter or transitional housing.
Support Group Facilitators
Support groups for survivors are often segregated by gender, sexual orientation, or another demographic variable. Most are for women only and very few are for men or for people of all genders. These groups may not accept a male-to-female (MTF) survivor, particularly if they are told she is transgender or if she is visibly gender non-conforming. Female-to-male (FTM) survivors would not be welcome either, unless they presented as female and did not discuss their masculine identity. According to one FORGE survey respondent:1
Having clear, well-thought-out written policies and procedures in place for eligibility requirements is an excellent place to begin. If your support group has gender-based restrictions, be clear about the entrance requirements. The clearer the policy, the better clientsboth transgender and non-transgenderwill be served. Some support groups that are segregated by gender determine entrance eligibility by factors such as legal gender (e.g., M or F on a driver's license), surgical/genital status (which would not be asked of non-transgender clients or clients not perceived to be transgender), or even hormone status. These screening protocols are discriminatory. Policies related to eligibility requirements should be carefully constructed, clear, and as unbiased as possible and uniformly applied to all potential group participants.
If no policy exists, consider developing a work group to outline the implications of various policy choices. After the policy is finalized, make sure that all staff are fluent in its meaning and application and make the policy available to any potential group member who wishes to see it.
If transgender individuals are eligible for your group, can they openly discuss their whole lives, including their gender histories and gendered bodies, in ways that are similar to what non-transgender individuals can share? Or are they restricted from broaching certain topics, as was the case with one FTM survivor, who was told by a facilitator that he could attend the male sexual assault survivors group "if I did not talk about my vaginal rape"?2
If unsure whether group members will be receptive to a transgender member, create a plan with the transgender client about their preferences regarding your response, while assuring them that they are not the problem. Some transgender participants may want to be "out" in the group while others may not want to disclose. Do not assume that a particular transgender person prefers a group of a specific gender. If possible, allow participants to select which group they would like to attend. In working with an all-LGBTQ survivor's group, it is considered best practice to integrate all genders.
If a prospective client is ineligible for your services, make sure you have appropriate referrals on hand so that the survivor can receive services elsewhere. Develop strong connections with local transgender groups, LGBT community centers, or providers who extensively work with transgender clients so that you can better refer clients who do not meet your eligibility requirements.
For the long term, consider revising your policies so that all survivors, including transgender survivors, are eligible to participate.
1. FORGE, 2005, Sexual Violence in the Transgender Community Survey, quotation from narrative response, unpublished data.