An Ecological Systems Approach to Developing, Sustaining, and Expanding a Rural-Based Gender Healthcare Center

Claudia S.P. Fernandez

A chapter in From Clinical Practice to Public Health Applications - The Successful, Sustainable and Scalable Outcomes of the Clinical Scholars Program from IntechOpen

Abstract: Rural transgender and gender-diverse people face enormous challenges while attempting to access gender-affirming healthcare. Barriers to care emerge within the nesting ecological systems described by Urie Bronfenbrenner, impacting the individual's development and their ability to access medically necessary care. This chapter recounts our clinical team's efforts to increase access to equitable healthcare for transgender and gender-diverse people from within a rural-based family practice in upstate New York by embedding an interdisciplinary Gender Wellness Center in the practice. Implementation of this project occurred over a six-year period (2016-2022). During the first 3 years, while participating in equity-centered leadership training through the Robert Wood Johnson Foundation-sponsored Clinical Scholars program, created by experts at the University of North Carolina at Chapel Hill, our team transformed a vision for affirming healthcare into a strategic plan and completed measurable benchmarks. During the subsequent 3 years--a socio-politically turbulent time--our team sustained and expanded the Gender Wellness Center in both planned and organic ways. This chapter describes the success of our rural-based Gender Wellness Center around the provision of medical, mental health, surgical care, and legal advocacy for transgender and gender-diverse people and training and community-based research opportunities for healthcare professional students and clinicians. While creating our center, our team also faced challenges in and from the ecological systems that impact our patients. Systemic change that began within our center rippled throughout our network and region as we developed transformational partnerships with others involved in this work.

Keywords: gender-affirming care; LGBT health; ecological systems; rural-based transgender healthcare; equity-oriented primary care; interdisciplinary care; transgender health; equity-centered leadership; LGBT barriers to healthcare; Clinical Scholars (search for similar items in EconPapers)
JEL-codes: I11 (search for similar items in EconPapers)
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Persistent link: https://EconPapers.repec.org/RePEc:ito:pchaps:330924

DOI: 10.5772/intechopen.115589

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