Family Tree Clinic

Report date
November 2015

What has been most instrumental to your progress?

Community outreach and collaboration. Our work in partnership with community members and stakeholders, and particularly the two community convenings we organized in the first few months of the project and our ongoing relationship with MTHC, has been extremely vital in helping to guide our program and model of care. The energy and effort we put into making strong connections with key organizations and communities has continued to benefit our project and outcomes as we move through different phases. It has also been instrumental in building trust in the community for Family Tree Clinic and our staff.
Recruiting and hiring a Trans Health Advocate has been central to our progress in many aspects of the project. Creating this new position in our organization has allowed us to build a truly community-informed model of care for our trans hormone program. It has also created a pathway to incorporate more ongoing community feedback into our program, as well as providing a central non-clinical staff figure in our coordination of care. Our Trans Health Advocate, Damion Mendez, has already provided over 70 advocate visits with patients since he started in the spring.
Partnering with a medical expert in trans hormone care, Dr. Eric Meininger, has allowed us to significantly move forward in our program development and implementation. This relationship has been mutually beneficial as Dr. Meininger has provided our clinician team with an invaluable amount of guidance, education, and consultation, and Family Tree has provided a space for him to continue and expand his practice working with transgender youth.

Key lessons learned

Progress does not always need to be fast, and thoughtfulness is often preferable, even though it can sometimes feel frustrating. 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. For example, in the first year of our program we are limiting the number of new hormone patients that we will take on. This is challenging because there are so many patients in need. However, in order for us to provide the highest quality of care we have needed to build expertise and experience slowly so that we don’t become overwhelmed.
Community-centered work has its challenges! 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.

Reflections on inclusive, collaborative or resourceful problem-solving

Collaboration has probably been the most relevant community innovation process so far. Our main community partner, MTHC, has contributed so the program in all phases and has informed many of the decision points we have come to. Our relationship with MCTC has been invaluable, and we hope reciprocal. As a main touchpoint for many trans folks in the Twin Cities, MTHC has helped us be truly aligned with the patients we seek to serve.

Other key elements of Community Innovation

Patience and openness have also allowed us to make progress as a group. The trans hormone program involves many staff people in just about every area of the organization, and we’ve had to be patient with one another as we navigate a lot of new terrain. Because this is a project and a service that is so deeply connected to patient experience and navigation of a larger health care system, we have developed new ways of working together and new appreciations for our respective roles in the care of individual patients. Being open to seeing and understanding one another’s perspectives is vital for us to continue moving forward.

Understanding the problem

Our process has definitely led us to have more clarity and a better understanding of the need that we defined in our grant application. Since we started offering trans hormone services about 5 months ago we have been overwhelmed with the number of patients who want to seek care at Family Tree Clinic. Our medical providers and Trans Health Advocate have also been able to talk to many patients and learn more about the specific barriers that people have experienced in attempting to access hormone care. Because we approach health care in such a holistic way we are really able to have a detailed understanding of the multiple ways that our patients experience barriers in accessing health care, including hormone care.

If you could do it all over again...

Aim higher and be flexible! Although we set out to see just 20 trans-identified patients for hormone care in the first year, we quickly surpassed our goal. We went into the project knowing that there was a huge need for services, yet we set our goal much lower that we knew we could achieve. Looking back, we could have set a more realistic goal for ourselves and been more clear about how we would balance the huge need for services with our somewhat limited capacity in the first year.