Community-Driven Recommendations for Enhancing Transgender Youth’s Engagement in Mental Health Care

Introduction: Transgender and non-binary youth (TNBY) are significantly more likely to have serious mental health problems (e.g., anxiety, suicidality) compared to cisgender youth due to their greater exposure to discrimination - both within and outside of mental health care settings. Though TNBY may benefit from mental health treatment, most therapists are not trained in best practices with TNBY. As part of a larger project focused on developing a therapist training in best practices, we conducted focus groups with TNBY to identify provider behaviors associated with engaging treatment.Methods: Three virtual focus groups with TNBY (n=6; 18-23 years) representing multiple genders (n=2 transgender males, n=4 nonbinary youth) and races (n=2 Asian, n=1 Black/African American, n=2 White, n=1 multiracial). Participants were asked about provider behaviors and knowledge they viewed as critical to effectively supporting TNBY and about their historical experiences in therapy (e.g., what caused them to start, continue, or stop going to therapy). Results: Participants identified 5 practices associated with mental health treatment engagement. (1) Always ask for your clients’ affirmed names and pronouns, including where, when, and with whom you should use these names/pronouns, as the client may not be out in all spaces of their life. (2) Use your clients’ affirmed names and pronouns in all spaces when you have their permission (e.g., sessions, clinical team meetings, paperwork), regardless of their presence. Spend time practicing using your clients’ affirmed name pronouns correctly outside of sessions if needed. (3) Understand the amount of harm that can be caused by outing your client, and refrain from doing so intentionally or unintentionally. (4) Educate yourself about best practices in working with TNBY. Do not rely on your client to educate you unless they tell you that they find this process empowering. (5) Ask your TNBY clients for feedback, especially during the first several sessions, and respond non-defensively.Discussion: TNBY identified concrete therapist practices associated with treatment engagement. Findings underscore the need for therapists to be trained in best practices for engaging TNBY in therapy. With respect to research, findings highlight the importance of including TNBY and other minoritized populations in the identification of best practices in treatment engagement.