PROJECT SUMMARY/ABSTRACT. Despite strides in social and political protections for transgender and nonbinary (i.e., transgender) people, transgender populations continue to face crisis-level rates of mental health concerns. Recent national surveys show that transgender people face also continue to face a burden of unmet need within healthcare systems, reporting elevated rates of mental healthcare avoidance of and exclusion from often life-saving services. This is often a result of discrimination from healthcare providers. Many hospital systems are unequipped to support transgender people seeking mental healthcare. As such, efforts to engage transgender individuals have not made significant dents in improving access to care and reducing psychological stress. One particular site of risk and opportunity for intervention is the Bronx, NY, a New York City borough containing the nation’s poorest congressional district and an epicenter of the ongoing health concerns for TNB people. The current project aims to data from a large group of patients at Montefiore Medical Center, a hospital system with over 3 million visits per year, to measure and address mental healthcare disparities. This study targets mental healthcare disparities using patients’ medical charts as well as interview data with transgender advocates and stakeholders. For Aim 1 (Year 1), we will analyze the extent to which transgender people receive fewer and/or worse quality mental health services at a large hospital site. We will do so by measuring differences between a large sample of 9,968 transgender adults with an even larger sample of 49,840 non-transgender adults. For Aim 2 (Year 2), we will meet with three groups of 36 stakeholders to contextualize why service disparities exist and strategies to address them. The first group will be composed of transgender people connected to mental health services. The second will be transgender people who are not connected to mental health services. The third will be hospital staff and administrators who specialize in transgender-affirming care. For Aim 3 (Years 3-4), we will integrate both types of data ( together and create a map to shift the ways mental health services are provided to improve transgender-affirming care. This award was developed with the goal of identifying barriers to and enablers of comprehensive TNB care, in order to measure and reduce mental healthcare disparities for diverse, resilient adult transgender populations.

PROJECT NARRATIVE Transgender and nonbinary people continue to face incredibly high rates of mental health concerns, due largely to minority stress and discrimination, as well as inadequate access to affirming mental health services at most major hospitals in the United States. By assessing a large database of almost 10,000 transgender adults in the Bronx, NY, this study will explore disparities between transgender and non-transgender people’s access to quality mental health care, and will incorporate conextual information from in-depth interviews with transgender patients and affirming providers. This research will contribute to our fundamental understanding of ways healthcare systems reinforce mental health care disparities for transgender and nonbinary people, and will generate solutions to improve access to quality, affirming services at any site.