Prison settings are not known for providing state-of-the-science care. Court decisions challenging the adequacy of care inside prisons and jails are rightly focused on outlining minimum necessary standards in order to be declared constitutional. Although Western society has begun to accept and appreciate those who do not identify with the male/female gender binary, transgender health care in corrections is split between facilities that have created new standards and procedures and others that continue to use antiquated systems.
Where does that leave correctional workers who aim to provide high-quality gender-affirming care, rather than the minimum? Psychologists Sarah Miller, Robyn Hodges, and Lindsey Wilner take a systems-oriented approach to this question. Their article in Psychological Services outlined guidance for correctional institutions in using a model of care that addresses individual and institutional needs.
The authors address the unique circumstances that arise in corrections. They start with the framework outlined by major transgender health organizations, such as the World Professional Association for Transgender Health. These frameworks are then applied to prison settings by adding detail to some of the commonly encountered gray areas for individuals in custody.
The authors describe building a multidisciplinary team—including behavioral health, medical, program/unit team, administration, security, Prison Rape Elimination Act monitors, and legal experts—to review requests for clinical interventions as well as nonclinical accommodations, such as alternate underwear selections and different housing options. Through a series of case examples, the authors highlight considerations for policy and procedure, essential components of the psychological assessment, and decision points for the team to address during treatment and case planning.
Transgender care is a litigation-prone area for corrections. Rather than focusing on risk aversion, the authors emphasize the need for teams to address the whole person, regardless of the person’s gender identity or potential for a diagnosis of gender dysphoria.
Psychologists play a particularly important role in promoting gender-affirming care and being change agents within correctional systems. Psychologists maintain many roles within corrections, from conducting clinical assessments to providing meaningful feedback to administrators, educating staff (many of whom are inexperienced in working with LGBTQ+ populations) on transgender care, developing or influencing policy and procedure, and promoting appropriate treatment and nonclinical services. The authors call on psychologists to assume a role in promoting and facilitating better care for incarcerated transgender populations.
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