Family Tree Clinic

Report date
September 2016

What has been most instrumental to your progress?

Community outreach and collaboration, especially during the beginning of the project have been instrumental. Our work in partnership with community members and stakeholders has been central in guiding our program and model of care.
Our work in training our provider staff on the clinical aspects of trans hormone care has been extremely instrumental in the success of our program. Funding from the Bush Community Innovation Grant has allowed us to focus our efforts on training our providers really well and to take time away from patient care for education and case consultation. Because training around trans health is extremely minimal in nursing and medical education programs, it has been very important for us to incorporate training and education time into the program.
Flexibility and a willingness to be nimble and make changes to our plan as needed have been really important. Our project is very innovative with not a lot of models out there to guide us so we have had to become comfortable with knowing that there will be lots of adjustments made to the plan, and that it's actually a good thing.

Key lessons learned

In working closely with communities that many of our staff members are part of, we have learned a lot about navigating these relationships both professionally and personally. The staff members who are closely connected to this program have a lot of personal investment in the work and are often seen as the faces of Family Tree within their community of friends and family, which means they hold a large amount of perceived personal responsibility for the successes and challenges of the program. We are continuing to learn how to practice healthy boundary-making and self-care when it comes to this issue.
Progress and culture change take time. Building a culture of healthcare provision that is actively working to combat transphobia, racism and other forms of oppression requires a huge amount of thoughtfulness and unlearning, and there is a constant level of "upkeep" that needs to happen. Some of the work we have done this year has felt slow at times, but we have learned that a thoughtful approach is often key to being successful in the long run.

Reflections on the community innovation process

Collaboration was the most important element for us in completing our work during the grant period. We worked closely with our community and patients in many ways, which was key to our success in building an accessible and effective program. Collaboration was also necessary in terms of training and educating our medical providers to provide the clinical aspects hormone care. Our outreach and evaluation efforts were also very collaborative. Collaboration has been evident in every aspect of our program because it is very holistic in its design.

Progress toward an innovation

Since the beginning of the grant period we have designed, launched, and evaluated a successful and comprehensive transgender hormone program. We have served over 150 trans patients from Minnesota and the surrounding states by providing holistic, gender-affirming hormone care. Our program model has provided an innovative solution to a significant unmet need in our community. The model of care we designed during the grant period is community powered, patient-centered and adaptable. In addition to increasing access to informed consent hormone care in our community, we have also seen a huge increase in the number of LGBTQ individuals accessing other types of care at the clinic as well. In 2014, 14% of our patients identified as lesbian, gay, bisexual or queer and 4% identified as trans or gender non-conforming. In 2016, 29% identify as lesbian, gay, bisexual or queer and 13% of our patients identify on the trans spectrum of identities. Our trans hormone program has hugely impacted our community of patients and the way that we provide care.

What's next?

Our plans are to continue the program and to expand it so that we can provide health services to even more people. We would also like to explore the possibility of becoming a formal training center for new nurses, advanced practice nurses, physician assistants and doctors to provide LGBTQ-specific care, which we feel would make a huge impact on a local and national level. We are also exploring ways that Family Tree Clinic can better meet the full primary care needs of our patients and community.

If you could do it all over again...

Looking back at the beginning of the grant period I think the lesson we would give ourselves now is that authentic change takes time and that thoughtfulness and patience and very important to the process. Because we had such a clear vision of the program we wanted to create and the place we wanted to get ourselves, it was sometimes frustrating to exist in some of the sticking points we needed to work through in the process.

One last thought

Thank you for the opportunity! The flexibility and trusting support of the Bush Foundation have been invaluable throughout the project and have truly helped us to transform our organization and the healthcare we provide.