It was a big day — the start of my clinical internship as an occupational therapy student. I had landed a unique opportunity to work with people in recovery from substance abuse at Philadelphia's Morris Home, a one-of-a-kind center for individuals who identify as transgender and gender variant individuals who do not match the larger society's ideas of male and female.

I couldn't wait to get started, so I arrived 10 minutes early. But right away, I knew something was wrong. The people I was so eager to help were clearly tense and anxious around me. Several of the members  — as Morris Home calls its clients  — left the room even before I could introduce myself.

I met with the director of Morris Home, who explained that many trans people have experienced so little understanding from medical providers, they preferred not to even engage. Perhaps, she suggested, they thought an occupational therapy student would be like all the others who insisted on addressing them by the wrong pronoun, or made them fill out forms with the wrong gender box, or made assumptions about what it means to be transgender.

This kind of discrimination confronts my clients not just in health settings, but as they seek education, jobs and housing. Little wonder that this population is more at risk for poor health, homelessness, incarceration, abuse and even early death.

The next time I went back to Morris Home, I tried a different approach. Rather than meeting in a group setting, I spoke with members one-on-one to hear their stories and identify their needs. We talked about what their lives would be like when they left Morris, and how they would remain sober. They  voiced several common themes including not knowing what to do with their time and often experiencing boredom.

Occupational therapists have an important role to play in recovery. A person who is addicted to drugs, for instance, often spends all their time and money to get the drug. An occupational therapist can help clients to develop a new way of living, or find a way back to the roles they lost due to addiction, such as parent, partner, worker, student. Working together, therapist and client can identify triggers for substance use and develop positive coping strategies, healthy habits and routines that take consider the client's environment, health and overall wellness.

Putting together what the Morris Home members told me with what I have learned in my occupational health studies, I designed and implemented a group session focused on structuring one's day to support sobriety and promote healthy routines. I played music that members had told me they liked, and started the session by asking everyone to introduce themselves by name and preferred pronouns. For me, it was, "Hi, my name is Nuriya and I go by she/her/hers."   This set the tone for the session, in which everyone created a time management clip board with weekly goals, a "to-do" list and positive affirmations, and talked about using the clip board to reach those goals.

Over the three months of my internship at Morris Home, we all continued to learn from each other. The director was thrilled to share that the occupational therapy interventions had a measurable impact, helping members achieve higher rates of self-esteem, socialization skills and the ability to cope with stress.

I saw first-hand that the health care system has work to do when it comes to improving care for the LGBTQ population. Today's occupational therapy students should not be entering the field without comprehensive education on caring for LGBTQ patients and clients in a competent, affirming manner. Occupational therapy is fundamentally client-centered, and if we don't understand the diversity of our clients' experiences, we cannot deliver the best care possible. I believe occupational therapists are uniquely positioned to address the needs of the LGBTQ community and be leaders on interdisciplinary teams advocating for clients.

Starting Thursday, the American Occupational Therapy Association is gathering for its Centennial Conference right here in Philadelphia. My hope is that OT leaders tasked with accrediting educational programs will further define and require this vital education for students, clinicians and educators.

At Thomas Jefferson University, the faculty understand the importance of this education and are in the process of developing comprehensive cultural competency education and training to integrate LGBTQ health. JeffLGBTQ, the student group, has taken on a number of projects to support LGBTQ health, including designing Pride Pins, which health care providers can wear to show they are allies with their patients.

The Pride Pins are distributed with information on best practices for supporting LGBTQ health care; all proceeds will go to Morris Home.

Accrediting bodies should require a system-wide approach so that these best practices are delivered to all health care students – now, before one more transgender or gender variant person delays care or treatment.

What does it mean to be a gender affirming health care provider?

  • It means you call your patients by their preferred name, using their preferred pronouns.

  • It means asking non-judgmental questions and obtaining a complete history.

  • It means asking, not guessing or assuming.

  • What can occupational therapy programs do to educate students?

  • Seek out online training and resources focused on LGBTQ health in order to learn key terms like cisgender, gender non-conforming, and queer. (Check out The Fenway Institute and Mazzoni  Center .)

  • Use same sex couples or transgender clients in training to teach open-ended interviewing.

  • Incorporate transgender and gender variant individuals in test questions.

  • Role play situations where students practice greeting and establishing rapport with LGBTQ clients.

  • Empower students to evaluate their own perceptions and test their ability to view clients with a lens of inclusion and nondiscrimination.

Nuriya Neumann is working toward her master's degree in Occupational Therapy at Jefferson College of Health Professions.

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