Using a Co-Design Approach to Support Aged Care Workers to Understand and Respond to the Needs of Transgender and Gender Diverse People

Rosemarie Draper


rdraper@boltonclarke.com.au I Boston Clarke 

Key Learnings: 

The importance of:

  1. Using a co-design approach with consumers and people who have a lived experience 
  2. Developing tailored, culturally sensitive training resources that using co-design processes to develop resources can also lead to organisational improvements in policy and practice

Authors
Michael, J. Walsh, L. Goldner, S. Healy, T. Draper, R. Elder, K. McLeod, K. Radermacher, H.

Introduction
The need for accessible health and support services for older Transgender and Gender Diverse (TGD) Australians is well documented, and reveals the long term impacts of discrimination and stigma . Many older TGD people are reluctant to seek aged care services because of past life events, and fear of being treated with further discrimination . With appropriate training and education, and a supportive organisational culture, aged care workers have a critical role to play in achieving equity and justice within health care . 

Background 
Bolton Clarke (BC) is a large national provider of At Home Support, Retirement Living and Residential Aged Care services. In 2014 BC undertook a Lesbian, Gay, Bisexual, Transgender and Intersex (LGBTI) Inclusive Practice Self-Assessment, using standards developed by Gay and Lesbian Health Victoria. This was conducted to assess the extent to which inclusive and equitable services were currently being provided to LGBTI consumers. In total, 50 items of evidence identified areas of good practice, and 19 recommendations for improvement were made. This informed a BC LGBTI action plan 2016-2020.
An area of improvement implemented by BC as part of the LGBTI action plan was a Transgender and Gender Diverse Project. A co-design approach was used with a focus on partnering with consumers. The Partnering with consumers for diversity model received a 2017 Better Practice Award from the Australian Aged Care Quality Agency.

Objective
To develop and evaluate resources (Digital Diversity Story) to support aged care workers to meet the needs of trans and gender diverse clients/residents using a co-design approach.

Methods
This project comprised a literature review, working groups, in-depth interviews and a questionnaire. The Working Group comprised of specialist diversity and clinical employees from Bolton Clarke, representatives from Transgender Victoria, Gender Diversity Australia, The Shed (formerly FTM Shed), as well as three people who identified as transgender.
Results 
A Client/Resident Digital Diversity Story with a transgender focus was co-designed, implemented and evaluated. As part of orientation, employees were given the Diversity Conceptual Model (DCM) and asked to listen to the digital diversity story to identify all the diversity characteristics of the client/resident. Of the 29 new employees who completed a questionnaire 93% said the story was easy to understand, and 72% said it was very good at providing knowledge about how to better understand and respond to the needs of TGD clients/residents. Participants reported back that the digital diversity story highlighted for them: the importance of correct documentation of gender; and fear of discrimination, stigma, illness and mental health issues being important to consider when working with TGD clients/residents.

Conclusion
The diversity story is a potentially useful resource for aged care workers to more effectively understand and respond to the needs of TGD clients. The multi-method and participatory process, which included TGD representatives, not only enhanced the usefulness of the resources, but sent a clear message across the organisation that equity of
access was important. The Digital Diversity Stories will be available free on the Bolton Clarke website www.boltonclarke.com.au in April 2018. 

References:
1. Fredriksen-Goldsen KI, Cook-Daniels L, Kim H-J, Erosheva EA, Charles A. Emlet CA, Hoy-Ellis CP, et al. Physical and Mental Health of Transgender Older Adults: An At-Risk and Undeserved Population. The Gerontologist. 2014;54(3):488-500.
2. Crameri P, Barrett C, Latham JR, Whyte C. It is more than sex and clothes: Culturally safe services for older lesbian, gay, bisexual, transgender and intersex people. Australasian
3. Reynolds R, Edmonds S, Ansara YG. Silver Rainbows: Advances in Australian ageing and aged care. Australasian Journal on Ageing. 2015;34:5-7.
4. Lindroth M. Competent persons who can treat you with competence, as simple as that’ – an interview study with transgender people on their experiences of meeting healthcare professionals. Journal of Clinical Nursing. 2016;25(23/24):3511-21.
5. Michael, J. Diversity Conceptual Model for aged care: Person-centred and difference-oriented and connective with a focus on benefit, disadvantage and equity. Australasian Journal on Ageing. 2016:35: 210–215. doi:10.1111/ajag.12313