TransECHO: A National Tele-Education Program for Expanding Transgender and Gender Diverse Health Care.

Purpose: Few clinicians have received training to provide comprehensive primary care for transgender and gender diverse (TGD) people. This article describes the program design and evaluation outcomes of TransECHO, a national professional development program for training primary care teams on the provision of affirming integrated medical and behavioral health care for TGD people. TransECHO is based on Project ECHO (Extension for Community Healthcare Outcomes), a tele-education model that aims to reduce health disparities and increase access to specialty care in underserved areas. Methods: Between 2016 and 2020, TransECHO conducted 7 year-long cycles of monthly training sessions facilitated by expert faculty through videoconference technology. Primary care teams of medical and behavioral health providers from federally qualified health centers (HCs) and other community HCs across the United States engaged in didactic, case-based, and peer-to-peer learning. Participants completed monthly postsession satisfaction surveys and pre-post TransECHO surveys. Results: TransECHO trained 464 providers from 129 HCs in 35 U.S. states, Washington DC, and Puerto Rico. On satisfaction surveys, participants provided high scores for all items, including those related to enhanced knowledge, effectiveness of teaching methods, and intentions to apply knowledge and change practice. Compared with pre-ECHO survey responses, post-ECHO responses averaged higher self-efficacy and lower perceived barriers to providing TGD care. Conclusions: As the first Project ECHO on TGD care for U.S. HCs, TransECHO has helped to fill the gap in training on comprehensive primary care for TGD people.

Gender-Affirming Mental Health Care Access and Utilization Among Rural Transgender and Gender Diverse Adults in Five Northeastern U.S. States.

Purpose: Transgender and gender diverse (TGD) populations are burdened by substantial mental health disparities. The mental health needs of TGD people in rural areas remain largely unknown. This study sought to characterize gender-affirming mental health service access and utilization in a sample of TGD adults from predominantly rural areas in the northeastern United States. Methods: A nonprobability sample of 241 TGD adults was recruited from 25 counties across Connecticut, Massachusetts, New Hampshire, New York, and Vermont. Participants completed a cross-sectional computer-administered survey, including self-reported mental health and mental health care needs. Bivariate and multivariable models were fit to examine the association of mental health service utilization with: sociodemographics; health insurance coverage; name and gender marker change; mental health symptoms; perceived stigma; mental health, substance use disorder, and somatic diagnoses; and violence victimization. Primary outcomes were utilizing either psychotherapy or psychopharmacology, both, or neither service. Results: Around 68.9% of the sample resided in rural areas. Fifty-one percent of respondents currently utilized at least one gender-affirming mental health service (48.5% psychotherapy, 18.7% psychopharmacology, 16.2% both services). Common barriers to gender-affirming mental health services were lack of trained providers, lack of mental health integration with primary care, financial costs, difficulty scheduling, distances that were too far, and transportation issues. Factors most important in choosing a mental health care provider were health insurance, gender-affirming care, rapport, and availability. Conclusion: Access to and utilization of gender-affirming mental health services was suboptimal in this sample. Achieving mental health equity will require addressing barriers experienced by TGD people in rural areas.