Assessment of Transgender/Gender-Expansive Accessibility in Inpatient Pediatric Mental Health Facilities

Purpose: This study surveyed a national sample of inpatient pediatric behavioral health facilities on policies related to care for transgender and gender-expansive (TGE) youth to assess adherence to best practices. Methods: Staff/providers at youth inpatient psychiatric facilities were recruited by phone or email. Participants completed an electronic survey on facilities' training policies, staff comfort related to gender diversity, and other policies related to caring for TGE youth. Results: Of 479 potential participating facilities, 124 surveys were initiated and 59 were completed. Measures to ensure accessibility to TGE patients are present in many facilities surveyed, with most reporting that their facility had nondiscrimination policies in place (86.2%) and required training on working with TGE patients (52.5%). A minority of participants (12.1%) reported that their facility roomed TGE youth based on sex assigned at birth, although only a small portion roomed based on gender identity alone (19.0%). Slightly more than two-thirds stated that their facility had individual restrooms available. Most participants (74.6%) stated that facility staff were comfortable discussing gender diversity in general, although this was less common for other topics related to TGE patient care. Conclusion: Our survey highlights efforts made by inpatient behavioral health facilities to ensure accessibility of services to TGE youth, although our results showed notable differences across facilities. Given inconsistent federal protections for TGE patients, there remains a need for efforts to ensure that TGE youth are receiving all possible support in these treatment settings, such as accessible restrooms and bedroom assignments, as well as the opportunity to room with peers.