"What's the right thing to do?" Correctional healthcare providers' knowledge, attitudes and experiences caring for transgender inmates. (November 2017)

• Record Type: Journal Article
• Authors: Clark, Kirsty A.; White Hughto, Jaclyn M.; Pachankis, John E.
• Is Part Of: Social science & medicine. Volume 193(2017)
• Page Start: 80
• Page End: 89
• Publication Date: 2017-11
• Subjects: Transgender -- Incarceration -- Healthcare -- Prisons and jails -- Corrections; Social medicine -- Periodicals; Medical anthropology -- Periodicals; Public health -- Periodicals; Psychology -- Periodicals; Medicine -- Periodicals; Medicine -- Periodicals; Médecine sociale -- Périodiques; Anthropologie médicale -- Périodiques; Santé publique -- Périodiques; Psychologie -- Périodiques; Médecine -- Périodiques; Electronic journals; 362.105
• DOI: 10.1016/j.socscimed.2017.09.052
• Languages: English
• ISSNs: 0277-9536

Abstract

Abstract: Rational: Incarcerated transgender individuals may need to access physical and mental health services to meet their general and gender-affirming (e.g., hormones, surgery) medical needs while incarcerated. Objective: This study sought to examine correctional healthcare providers' knowledge of, attitudes toward, and experiences providing care to transgender inmates. Method: In 2016, 20 correctional healthcare providers (e.g., physicians, social workers, psychologists, mental health counselors) from New England participated in in-depth, semi-structured interviews examining their experiences caring for transgender inmates. The interview guide drew on healthcare-related interviews with recently incarcerated transgender women and key informant interviews with correctional healthcare providers and administrators. Data were analyzed using a modified grounded theory framework and thematic analysis. Results: Findings revealed that transgender inmates do not consistently receive adequate or gender-affirming care while incarcerated. Factors at the structural level (i.e., lack of training, restrictive healthcare policies, limited budget, and an unsupportive prison culture); interpersonal level (i.e., custody staff bias); and individual level (i.e., lack of transgender cultural and clinical competence) impede correctional healthcare providers' ability to provide gender-affirming care to transgender patients. These factors result in negative health consequences for incarcerated transgender patients. Conclusions: Results call for transgender-specific healthcare policy changes and the implementation of transgender competency trainings for both correctional healthcare providers and custody staff (e.g., officers, lieutenants, wardens). Highlights: The paper tests a conceptual model of healthcare provision to transgender inmates. Incarcerated transgender individuals often receive inadequate healthcare in prison. Correctional healthcare providers infrequently provide gender-affirming care. Transgender-specific healthcare policies in prison are necessary. Cultural and clinical competency trainings for healthcare providers are essential.