March 19, 2012
Our Runaway Youths: What Schools, Communities, and Parents Can Do To Protect LGBTQQ Children ~ The Sanctuary House
I wrote this proposal for a class. My mother opened up the first runaway shelter in Pennsylvania. It was called, “The Sanctuary House ” I dedicate my proposal to her.
To: Executive Director, The Threshold Foundation
From: Danelle Wolfe, Proposal Writer
Parents can do to protect LGBTQQ children ~
The Sanctuary House Project
Homeless and runaway children were seldom reported but, have existed as part of our history since the early settlement of the United States. In 2009, there was an estimated one to three million runaway and homeless youths in Americaat any point in time. Some of the reasons are: emotional or physical abuse, problems in school or home and even feeling of not fitting in. Within this group are the LGBTQQ (Lesbian, Gay, Bisexual, Queer and Questioning) individuals. Our society is based on the two gender concept and countless youths fall out side of the “norm.” As a result these children have experienced ridicule and discrimination possibly from friends and family resulting in running away or worse, taking their own life as they try to escape the hate and end up on the streets or dead. It is the lesbian, gay, bisexual, transgender, and queer, adolescents who are at a higher risk for abuse while living on the streets.
The Sanctuary House will represent a safe haven for those in need. The immediate goals for this preventive program are to save a child from living on the streets, give encouragement to be who they are, teach communication skills, and educate the community. It will be a twenty four, seven days a week shelter for teens in need of assistance with an open door policy. Once established in a secure setting these children ranging from ten to eighteen will be fed, housed, and counseled. The concept is to have communication reopened between a youth and their family. One long term goal is to reunite the family unit. The next stage would be to focus on establishing training for fifteen to eighteen year olds in connection with instituting employment opportunities within the community. The local Transportation Department working with the project, within a thirty mile radius is willing to create passes for the youths after establishing employment.
We as a team will participate in the construction, design and implementation of the project. I would like extra participation dealing with the context issues of the project. Many local businesses are willing to begin the process of contracting the necessary materials to begin work immediately. The planning proposal will be read by the internal staff members, decision makers within our organization and after approval it will be sent to Threshold Foundation: The Queer Youth Fund for a requested grant of $10,000.00 to begin the project. The research for the program will involve statistics on the suicide rate of the homeless youths as well as reviewing present programs similar to The Sanctuary House, and examining the high statistics of the LGBTQQ runaway youth problem of today. “One in every seven youth will run away from home by the age of 18 (The National Runaway Switchboard, 2001).” The statistics as of 2009 were clarified and reported as children between the ages of ten to eighteen run away.
Children whom reside in The Sanctuary House will attend school, live in a learning environment which will include weekly discussions on responsible and healthy behavioral activities that are necessary for personal relationships and daily family meetings with a child’s parents and/or other family members. Monthly speakers who are anticipating working with the project will discuss the trials and tribulations of the community through education of the current AIDS issues/other gender related problems, and incorporate community events for example, by participating in Pridefest. A local organization, Also Youth, has a drop-in center that will work with the project in referring adolescents in need of help. There will be four certified counselors (two female, two male) that will live on the premises alternating weekends with four part time counselors (two female, two male), also certified.
Something to keep in mind:
For every dollar invested in a child, there is a seven-dollar return for society…
Thank you for taking the time to read this proposal.
T. Danelle Wolfe
We Are Here 1432 Hope Street
Sarasota Florida 54321
(FX) 555 -987-4321
Our Runaway Youths: What Schools, Communities, and Parents Can Do To Protect LGBTQQ Children ~ The Sanctuary House
Prepared for: The Threshold Foundation
Written by Danelle Wolfe
Date of application: 3/19/2010
Name of organization: Threshold Foundation
Purpose of grant: WAH will utilize The Queer Youth Fund’s resources towards the project of a housing organization geared towards the LGBTQQ’s (Lesbian, Gay, Bisexual, Transgender, Queer and Questioning) runaway youths in our community.
Address of organization:PO Box 29903San Francisco,CA94129
Telephone number: (415) 561-6400
Contact person and title: Threshold Foundation, Director of Fundraising
Is your organization an IRS 501(c)(3) not-for-profit?(Yes or No):Yes
Grant request: $10,000.00
Check one: General support: N/A Project support: X
Dates covered by project budget (mo/day/year): April 2010 – March 2011
Project name: Our Runaway Youths: What Schools, Communities, and Parents can do to protect LGBTQQ children ~
The Sanctuary House Project
Table Of Contents
Project Description I……………………………………………………2
Project Goals and Objectives……………………………………..…….3
Plan for Measuring Results……………………………………………..12
Conclusion: The Success of The Sanctuary House…………………….14
We Are Here Inc. (WAH), a non profit 501 (c)(3) organization has been part of theSarasotaFloridacommunity since 2007. Our creed is to shelter the homeless youths (10-18 years old) in the LGBTQQ community, feed, counsel, reunite families and/or and train them for employment purposes, and provide medical care. We respect their individual sexual identity/gender and support these adolescents providing a tangible connection to available community relief systems.
Our Vision Statement
WAH aspires to be a valuable source of social services committed to enhancing the life and personal dignity of LGBTQQ youth’s.
Our mission is to offer community services intended to create a structured, compassionate, and safe atmosphere through which LGBTQQ youth and their families may obtain awareness, individual growth, encouragement, skills and personal success.
We Are Here Incorporated
Legal Form of Business
The Sanctuary House will be a 501(c)3 not–for–profit organization.
I. PROJECT DESCRIPTION
Statement of need
Our society is based on the two gender concept and countless youths fall out side of the “norm” and as a result these children, the LGBTQQ youths have experienced ridicule and discrimination possibly from friends/family resulting in running away or worse, taking their own life as they try to escape the hate and end up on the streets or dead.
Homeless and runaway children were seldom reported but, have existed as part of our history since the early settlement of theUnited States. Presently, at this very minute, inFloridathere are 5,949 runaway youths that have been reported. In 2008, “The U.S Dept. of Health and Human Services estimates there was an estimated 1.6 to 2.8 million runaway and homeless youths in America at any point in time…Our analysis of the available research suggests that between 20 percent and 40 percent of all homeless youth identify as lesbian, gay, bisexual or transgender (LGBT). Given that between 3 percent and 5 percent of theU.S.population identifies as lesbian, gay, or bisexual, it is clear that LGBT youth experience homelessness at a disproportionate rate.”
Some reasons given are:
Emotional or physical abuse
Problems in school or home
To be with others people who are supportive and
encouraging of sexual identity/gender
To be within places that are distractions from
Feeling of not fitting in
These young people have been classified as, “Policy Focal Runaways…defined as minors who, along with fitting the broad scope definition of runaways, are also endangered due to not having a familiar, safe place to stay.”
It is the lesbian, gay, bisexual, transgender, queer, and questioning adolescents who are at a higher risk for abuse while living on the streets. It is these reasons that Reed explained, “The psychological effects of victimization, rejection and social stigma, resulting in feelings of isolation, experience by many gay and lesbian youth constitute what Meyer (1995) terms as ‘minority stress’. It is because of this stress and isolation, that lesbian and gay youth are at increased risk for other factors such as anxiety and depression, academic problems, substance abuse problems, sexual abuse, running away, homelessness and prostitution, HIV infection, and suicide. Identity development and family and peer rejection are the main contributing factors in isolating gay and lesbian youth.” In order to ensure suicide prevention, our organization will serve the LGBTQQ youths and will partner with theFlorida’s statewide suicide prevention agencies.
The Sanctuary House acknowledges the fact that our society is not perfect. It is crucial to study the negative aspects concerning this issue in order to better serve this community. “Travers and Paoletti (1999) conclude that an understanding of the effects of this social world is vital in understand the concerns, behaviors, and emotional needs of lesbian and gay youth. This understanding is paramount, in trying to help them avoid becoming street involved.”
We Are Here, Inc. (WAH) is requesting a grant for a preventive program to get youths off the streets, reinforce encouragement to be who they are, teach communication skills, offer training for employment, educate the community, and reunite families. Our mission statement guarantees the helping of hands up and not the helping of hand outs.
Project Goals and Objectives
Short Term Goals
Lao Tzu, a wise man, once stated, “The journey of a thousand miles begins with one step.” Our short term objectives are based on the immediate needs of the homeless youth. Whereas, the long term goals are to reunite families (if this is not plausible, because the adolescent is unwilling or the family circumstances is hazardous, foster care is an option), institute an employment program and incorporate community educational events. Through this project, as objectives are met, the confirmation of the success of the program will be certain. These are listed below.
Create a twenty four, seven days a week shelter for teens in need of assistance with an open door policy.
Develop a safe haven for those in need.
Provide food, donated clothing, shelter, medical assistance and toiletries.
Create and foster communication with family members, community members and academic members.
Provide counseling and educational materials.
Establish training for fifteen to eighteen year olds in connection with instituting employment opportunities within the community.
Implement training for all staff members to effectively serve LGBT youth
Create passes in a joint venture with the local Transportation Department working with the project: with in a thirty mile radius for the youths after establishing employment.
It is imperative to get these juvenile’s off the streets and supply a safe environment in which to concentrate on dilemmas and solutions within the walls of The Sanctuary House. They need time to focus on their future goals rather than struggling daily on the streets.
March 1, 2009 we constructed a committee for implementing and approving initial decisions regarding the program and begin contacting local establishments requesting participation in the program. With this in mind, we have successfully entered into a joint venture with the City ofSarasotaas of July 2010 to lease the property seen above. The eighteen units are fully operational and are on 1.11 acres on Sarasota’s North Trail. Within the office area is a two bedroom unit where employees will reside. The project manager will reside on the premises within the eighteenth unit.
Supplies for Shelter Participating Business Donations Item of donation
1. Cots or Sleeping MatsBerkeleySurplus Store Military Pads
2. Blankets/Linens Bed, bath & Beyond Blankets/Sheets
3. Bottled or Potable Water Culligan man Fresh Water/Containers
4. Medical Supplies SarasotaMemorialHospital Emergency Medical
5. Eating Utensils
6. Towels & Toiletries for
7. Sanitation and Cleaning Walmart Cleaning Materials
8. Cooking equipment
9. Communication Equip.
10. TDD Telephone
12 Foods items 7-eleven Corporation Various Food Sysco Food Products
13. Cleaning Laundry/linens Clean Step Living USA Services
Additional Donors and Sponsors
Gamma Mu Foundation
GreaterSarasotaChamber of Commerce
Sarasota County Department of Health
The shelter is in need of minor renovations and the City has recommended splitting the cost that will begin on September 2010 and will be completed for the opening on February 1, 2011.
Provision of food
Whether it is one or fifty youths residing in the program each one will require three square three meals a day. The project will implement a communal effort philosophy in meal preparation with donated items from local businesses such as 7-eleven and grant funds. Local churches and temples have agreed to donate lunches for the employed youths.
The conditions living on the street make it literally impossible to have clean clothes without holes. Arrangements have been confirmed with local businesses and charities such as Salvation Army and Good Will to donate clothing to the project on a bi-weekly basis.
Every child who enters the program must pass medical clearance by an in-house qualified General Practitioner and a Registered nurse. They test for contagious diseases and review the physical well being of the adolescent youth.
Once a youth has had their basic needs tended to the next step is to place them into counseling. It is critical to find an explanation of their actions in order to help in the long term plan of reestablishing contact with their family members and/or establishing a new life. If a young person is fifteen or older, counseling is first and foremost then training for employment.
During this stage, in October 2010 we will begin the hiring process and identify complications and solutions.
Each youth will receive counseling from a licensed psychologist. Counseling sessions will begin the day after a youth enters the program and will continue weekly. Upon participating in the project educational material is distributed and they are notified that certain topics will arise during discussion time.
Youths whom reside in The Sanctuary House will live in a learning environment which will include weekly discussions on responsible and healthy behavioral activities that are necessary for personal relationships and daily family meetings with a child’s parents and/or other family members.
Monthly speakers who are anticipating working with the project will discuss the trials and tribulations of the community through education of the current AIDS issues/other gender related problems, and incorporate community events for example, by participating in Pridefest.
A local organization, Also Youth, has a drop-in center that will work with the project in referring adolescents in need of help starting on July 1, 2011. There will be four certified counselors (two female, two male) that will live on the premises alternating weekends with four part time counselors (two female, two male), also certified.
In December 2010, the coordinating committee will finalize the updates for the WAH website for the up and coming program of The Sanctuary House and begin preliminary meetings with the local school board. We will also participate with the Gay, Lesbian, and Straight Education Network’s (GLSEN) annual school climate report.
We will implement a training program for all staff members to successfully serve the LGBTQQ adolescents in January 2011.
Adolescent youths will be required to immediately enroll in school within our designated site. It is crucial that a young person doesn’t lose any educational benefits due to their circumstances. The Schoolhouse Link Program will be a partnership between the The Sanctuary House theSarasota County School Board. The program serves as a liaison and provides services to help families and youth that are homeless and in transition. The program’s goal is to ensure that students in transition are able to enroll, attend and succeed in school. Schoolhouse Link supports each student by helping create educational stability and by removing any barriers limiting their success.
At this stage, help will be given in preparing the older juveniles for employment. Daily general training will help in the transition from homeless to a confident employee resulting
in an independent individual. The creating of the bus pass program which will be implemented as a joint venture with the local Transportation Department working with the project: within a thirty mile radius for the youths after establishing employment.
Working with local businesses, the planning proposal will help create the unity of community actions. These establishments will contract youths for entry level positions within their companies.
We are all family
Annual Pridefest inSarasotais an occasion for the entire community to come together in acceptance. Not only will we have a booth promoting the program along with educational brochures but, our clientele will be on a waiting list to participate as volunteers.
Effects of Inaction
Consequences of inaction adversely affect the community in which we reside. Therefore, we can not sit by and watch our children jeopardize their lives. The LGBTQQ homeless adolescents have been reported at a greater risk of sexual exploitation when living on the streets compared to non-LGBTQQ individuals. The psychological issues, the medical issues and even spiritual issues of
our youth will continue to debilitate before our very eyes as they continue to live on the streets. Alone they have no voice. Our agency is about giving them the chance to be heard, to be safe and to continue living without fear. “Each year, there are approximately 2 million homeless and runaway youths in theUnited States.” If we do nothing, these statistics will only increase again.
Shannon Moriarty commented, “One study noted that of the youth engaging in survival sex, 48 percent reported exchanging sex for housing or food, 22 percent traded sex for drugs, and 82 percent traded sex for money. 40-60 percent of homeless youth have experienced physical abuse and 17-35 percent have experienced sexual abuse. These young people are much more vulnerable to survival sex, prostitution, and sexual exploitation.”
Submit Grant Proposal
Joint Venture contract signed with Sarasota City Notification
Notification Of Construction Bid
October – December 2010
Finalize Updates for Web Site/School Board Meetings
Training for Employees
Prepare Results Report
Key Staff (Resumes are attached)
Who’s on Board: Ficticious name. I made them up.
Melissa Leonard, LCSW
The executive director and one of The Sanctuary House founders,Sharon has worked for the past 15 years with low-income families and youth around the issues of poverty, abuse and neglect, substance abuse, mental illness and homelessness.
Iris Jackson, MA, M.Div.
A former social worker and mental health counselor, Iris is a career coach and life planning consultant with Bell Investment Advisors, Inc. She is the former board president of the Berkeley Ecumenical Chaplaincy to the Homeless.
Marie is the case manager and supervisor for The Sanctuary House.
Patrick Edwards, MSW
A writer, Patrick previously worked as a social worker with LGBTQQ homeless adults inNew York City.
Sarah Kaiser, MA
Photographer and long time volunteer with homeless youth in Sarasota, she is one of The Sanctuary House founders.
As Youth Services Coordinator, Heather is helping to create New Generation: the Future is Now for Trans. Formerly a supervisor in the The Sanctuary House shelter, she has been volunteering and organizing in solidarity with historically neglected communities for 10 years.
A teacher recently retired toBerkeley after 30 years of teaching around the world, she is a tutor in the local school system.
Kenneth is the shelter manager for The Sanctuary House. He serves in this position as a member of the Lutheran Volunteer Corps.
A Youth Counselor for The Sanctuary House , Peter holds a Master’s degree in counseling gender psychology and has been working in the field since 2000. He has worked as a mental health rehabilitation specialist and provided therapy to elementary school children living in theSarasota area.
The volunteer coordinator for The Sanctuary House.
II. PLAN FOR MEASURING RESULTS
We will have continuous reporting of the effects of our program regarding clients, schools and the community.
Survey present programs similar to The Sanctuary House, local organizations
Examine the behavior patterns of the LGBTQQ runaway
Monthly meetings with local business owners, religious organizations, and school districts
Assessment of achievement scores and grade levels
Analyze the visits of family members, amount of incoming/outgoing calls by youths, and surveys completed by parent’s
Quarterly reporting of local organizations and schools involved in the project
Weekly interviews with the youth clientele
Bi-Weekly meeting of employees including surveys
“One in every seven youth will run away from home by the age of 18 (The National Runaway Switchboard, 2001).” The statistics as of 2009 were updated and reported as children between the ages of ten to eighteen run away.
The purpose of this program is to assist the LGBTQQ youth in becoming productive members of society while increasing public awareness of the crisis which is plaguing our children. By creating and developing The Sanctuary House children between the ages of ten to eighteen will have a choice in their life, to begin a new journey. The final product will be saving a life.
We could not provide the services we do without foundations such as yours, private and public donor contributions to fund our programs. State, City and County provide what they can. Other resources are The Sarasota County commission which granted $30,000 in funding last year used for contract services. Many agencies formed the Project Initiate and established a prevention contract in which we are associated and we were granted $45,000. Within the past three years WAH has received tax payer funding in grants that were from $5,000 to $8,000 per grant.
|General Operating Support|
|Joint Venture Lease||8,000|
|Insurance & taxes||6,000|
|Consultants & professional fees||25,000|
|TOTAL OPERATING EXPENSE||$170,200|
For every dollar invested in a child, there is a seven-dollar return for society. (Annan, K., United Nations Secretary-General Address to the United Nations General Assembly Special Session on Children, May 2001).
Conclusion: The Success of The Sanctuary House
Clearly, thirty five million dollars are given every year by the government to address the homeless youth dilemma, but few of these funds reach the LGBTQQ adolescent community. Most support is through private grants, donations and fund raising.
These young people are in dire need of support through means of family, community, academic resources and social service programs such as ours. As we address the emotional, physical and spiritual effects of our children living on the streets and the results come to light. We are fighting for the healthy development of these LGBTQQ youths within safe environments and we need your help.
Flowers, R.B. (2001). Runaway Kids and Teenage Prostitution : America’s Lost, Abandoned, and Sexually Exploited Children. Retrieved April 2, 2010, from http://site.ebrary.com.library.esc.edu/lib/empire/docDetail.action?docID=10004890&p00=teenage%20runaway
Meyer, I.H. (1995). Minority stress and mental health in gay men. Journal of Health and Social Behavior, (36), 38-56.
National Runaway Switchboard. (2010). Retrieved April 2, 2010, from http://www.nrscrisisline.org/
Podschun, G.D. (1993). Teen Peer Outreach-Street Work Project: HIV Prevention Education for Runaway and Homeless Youth. Public
Health Reports, (108) 2, 150-155. Retrieved March 30, 2010, from http://www.jstor.org/stable/4597319
Reed, M. (2009). : Issues and Social Stigmas which Cause Gay and Lesbian Youth to be at increased Risk for Becoming Street Involved. Retrieved March 31, 2010, from http://www.sfu.ca/pridehouse/documents/pridehouseappx3.pdf
Statistics – Runaway and Homeless Youth. (2010). Retrieved April 3, 2010, from http://1736familycrisiscenter.org/quotes1a2.htm
Travers, R., and Paoletti, D. (1999). The lesbian, gay & bisexual youth program (LGBYP): A model for common communities seeking to improve the quality of life for lesbian, gay & bisexual youth. The Canadian Journal of Human Sexuality, (8) (i4) 293. Retrieved April 1, 2010, from http://www.questia.com/googleScholar.qst;jsessionid=L2ML3h 3CMWPpLdbpKB0JL2y62FQTSMDpJLj2dVypLzZjpq4xGjL2!-348092591!948790962?docId=5001896464
#1 in Commercial Real Estate Online. (2010). Retrieved April 2, 2010, from http://www.loopnet.com/Listing/14948076/2413-N-Tamiami-Trail-Sarasota-FL/
I wrote this proposal for a class.
One Call Doc Project: The United Diversity Clinic ~ Trans Health And Wellness for Today‘s Community
To: Fund Director, Third Wave Foundation
From: Danelle Wolfe, Proposal Writer
Re: Memo on: One Call Doc Project: The United Diversity Clinic
This proposal is written to acknowledge a very special and significant group within every community, every country, every large city and small, a group called transgenders and the immediate need to improve health care access for these individuals. The United Diversity Clinic , a medical unit built on the health and wellness of the transgender community will offer services to the Sarasota area and outer ally counties. Transgenders are of all colors, races, ages and walks of life. They are our brothers and sisters who were born in the wrong body.
The population is growing every year as individuals find the courage to be true to themselves. With this increase also comes social inequality connected with poor health status. The Human Rights Campaign mentioned, “There has been dramatic increases in the visibility of transgender people and the understanding of transgender issues in the past several years. Focus groups and national polls show that Americans know who transgender people are, and believe that our nation’s laws should treat transgender people fairly.” (http://www.hrc.org/documents/Transgender_handbook.pdf).
These individuals are at a higher risk of medical threats due to lack of access of primary medical care, lack of compassionate physicians and lack of acceptance associated with the fear of repercussions. Moreover, some have no choice but to purchase illegal hormones to continue in their transition with out a physicians guidance.
While there is little statistics regarding the health inequalities of the transgender community, more information will be compiled through in house surveys and researching similar programs. Further research will be conducted on the lack of insurance available to these individuals, alternative funding for surgeries and the transgenders risk of HIV/AIDS.
This planning proposal will be used as a recommendation to take action. Are you, as a member of society, willing to take the necessary steps to take our medical unit to the next level? Can you visualize the incorporation of a humanitarian medical clinic for those in need. The United Diversity Clinic has the potential to offer medical services to the transgender community while politically and economically producing a positive outcome. We are requesting $30,000 from your foundation to save lives, one person at a time.
Thank you for the opportunity to write a pre-proposal for The One Call Doc Project. We look forward to working with you in the future.
Danelle Wolfe, Proposal Writer
Table Of Contents
History and the Problems of Today……………………………………8
Our Plan For a Successful Program…………………………………… 9
Appendix A: Access to Health………………………………………………………..23
The UDC is a community health medical unit that will offer primary care, mental health and counseling for the transgender community. We will provide hormone treatments to transgender patients as a part of their overall primary care. Our harm reduction policy is focused around the patient and we will be developing and implementing treatment programs to suit their physical needs.
Founded in 2009 by a group of medical physicians and transgender health advocates, our clinic will provide the essential options for the transgender community while offering services that are desperately needed.
The United Diversity Clinic is committed to improving health care access while incorporating the quality of life long health care received by transgenders. We will provide personalized healthcare and support services to a community who lack access to quality care because of their sexual or gender identity. We are dedicated to serving the transgender individuals of the Sarasota area and surrounding counties and its allies by medical, educational, diverse programs, support, and cultural consciousness in a open, compassionate, welcoming, and safe environment.
The definitions below may be helpful when reading about transgenderism and transgender health issues and shall mean the following when used in this proposal:
Gender identity means the internal experience of one’s gender.
Gender presentation means how a person demonstrates her or his experience of gender, often through attire, including hair or make-up, and mannerisms.
Transgender individual means a person whose gender identity is different than her or his birth sex.
Transgender woman means a male to female or MTF individual.
Transgender man means a female too male or FTM individual.
Transsexual means a transgender individual who describes herself or himself as transsexual, particularly if she or he has altered her or his body with hormones and/or surgery.
Birth sex or biological sex means one’s physical body at birth, often categorized as male, female, or intersexed.
Intersexed means a combination of male and female genitalia and/or reproductive anatomy. 
Lower surgery means surgical alteration of one’s genitals.
Upper surgery means surgical alteration of one’s chest/breast.
Gender identity disorder Gender identity disorder is a rare, complex condition in which individuals of unambiguous genotype and phenotype identify with the opposite gender. One in 54,000 individuals are estimated to have GID. 75% are biologic males desiring reassignment to female gender (MTF) 25% are females desiring to be male (FTM). It means a conflict between a person’s actual physical gender and the one they actually identify him or herself as. For example, a person identified as a boy may actually feel and act like a girl.
 Here’s what we do know: If you ask experts at medical centers how often a child is born so noticeably atypical in terms of genitalia that a specialist in sex differentiation is called in, the number comes out to about 1 in 1500 to 1 in 2000 births. But a lot more people than that are born with subtler forms of sex anatomy variations, some of which won’t show up until later in life. http://www.isna.org/faq/frequency – Intersexed Society of North America.
 Laden M, Walinder J, Lundstrom B. (1996). Prevalence, incidence and sex ratio of transsexualism. Acta Psychiatr Scand, 93(4), 221–3. Retrieved April 15, 2010, from http://www.jfponline.com/Pages.asp?AID=4784
 Gender identity disorder is characterized by a strong, persistent cross-gender identification; people believe they are victims of a biologic accident and are cruelly imprisoned in a body incompatible with their subjective gender identity. Those with the most extreme form of gender identity disorder are called transsexuals. These disorders are considered mental disorders because the body does not match the person’s psychologic (felt) gender. http://www.merck.com/mmpe/sec15/ch203/ch203b.html
The United Diversity Clinic understands that many transgenders question whether to get healthcare when they perceive they’re not welcome by a physician. A clinical update in the Journal of the Gay and Lesbian Medical Association stated, “…that transsexual patients often have difficulty finding care because many physicians are not comfortable prescribing appropriate hormone regimens.” (http://php.ucsf.edu/PatientEd/MedicalCareofTransexualpts.pdf). Patients will drive for seven hours each way in order to find a compassionate doctor. Some individuals don’t even try. This places their lives in jeopardy. Others will dangerously take matters into their own hands and self medicate by purchasing illegal and untested hormones. Today’s world is constantly changing, and it’s up to us in the medical field to progress with the times.
Every year more and more individuals are coming out of their closet and declaring their individuality. With the increase of medical knowledge pertaining to gender and sexuality the necessity to assist these individuals is the main reason for this proposal. There are several ways in which a transition can occur in an FTM (female to male) or MTF (male to female). They range from individuals taking testosterone or estrogen to those who have had surgeries and those who have not.
Our medical unit has made arrangements with Sarasota Memorial Hospital to co-manage our facility. A medical building that was vacated last year owned by the hospital had been suggested as an option for our intended clinic. It is in need of minimal renovations. Our employees are projected to be salaried staff and professionals in private practice (psychiatrists, psychologists, plastic surgeons, gynecologists, endocrinologists, and speech pathologists) who will operate out of the clinic. These services are geared for transsexuals who need to have their mind match their bodies.
In this grant proposal, we will address the current issues of the need for funding to make this medical unit a reality. It will incorporate all the medical needs of the transgender community “under one roof.”
The requirements to begin the transitional process starts with The Harry Benjamin International Gender Dysphoria Association Standards Of Care For Gender Identity Disorders (Table A). These laws, SOC are intended to provide flexible directions for the treatment of persons with gender identity disorders.
Table A: Standards of Care for Gender Identity Disorders: Eligibility and Readiness Criteria for Hormonal Therapy in Adults – Eligibility Criteria
1. 18 years of age
2. Knowledge of what hormones medically can and cannot do, social benefits and risks
3. Either documented real-life experience for at least 3 months prior to hormones or
4. Psychotherapy of a duration specified by the mental health professional (usually 3 months)
5. Under no circumstances should a person be provided hormones who has fulfilled neither criteria 3 or 4
1. Further consolidation of gender identity during the real-life experience or psychotherapy
2. Progress in mastering problems leading to improving or continued stable mental health
3. Hormones likely to be taken in responsible manner.
Hormones can be given to those who do not desire surgery or real-life experience.
Here is our design of action:
Phase One: We will identify the health needs of the local community, the resources that are available, and the state of current programs. Also identifying existing organizations that offer transgender related programs can facilitate the development of collaborative partnerships necessary for supporting community participation in the delivery of pertinent health and social services.
Phase Two: We will coordinate agreements with fifteen to twenty primary practices that serve clinic clients.
Phase Three: We will develop new guidelines for the training of new and in place employees to ensure that a nondiscriminatory and welcoming environment is provided. We recommend that ongoing training about emerging issues within the transgender environment be part of regular staff education.
CASE EXAMPLE There are Transgender Law Center workshops for providers and offers tips for working with transgender Individuals to help organizations and business create a transgender positive environment.
People who transition from one sex to another face severe challenges. In most states, they can be fired from employment positions, abandoned/rejected by family members/spouses, and have the potential of losing custody of their children if they separate from a spouse or partner. Another major issue is that transgender people are often denied medical care or mistreated by health care providers who are biased or who don’t understand transgender issues.
The advantages of our plan are to intertwine the caring medical community with the transgender community. To break down the barriers of societies misconceptions and to lend a healing hand without discrimination.
History and the Problems of Today
Throughout history and dating back to the early 1400’s there were indications of transgender behavior within various cultures such as Asian (eunuchs), Indian, Pakistan (Hijras), and Native American (Two Spirit). Our culture created the word “Transgender” in the 70’s and was incorporated into our society’s language. The definition of a transgender is someone who was “born in the wrong body.” Their mind doesn’t match their body at birth (birth sex).
In the past decade, the LGBTQQ (Lesbian, Gay, Bisexual, Transgender, Queer, and Questioning) community consisting of an estimate of 8.8 million people has made great strides in educating society and some headway has taken place regarding their equal rights. But, many people still fall by the waste side within this group. The medical establishment for years had fought against transgenders stating they had a mental illness and in 1930 the first physician considered and actually completed a sexual reassignment surgery. It is the transgender that is in need of medical assistance today. It is difficult for an FTM or MTF to either locate the medical support within the medical community that will encourage the transition of these individuals or avoid being denied medical care. As Marks stated, “Denial of the recognition of human rights for any group of individuals is a denial of their humanity, which has a pro-found impact on health.”
Discrimination against transgender people is rooted in fear of difference, ignorance about who transgender people really are, and sexist stereotypes. This discrimination is intensified by various forms of negative representations of transgender people in the cinematic movies such as Psycho or Silence of the Lambs, which had shown transgenders as sexual deviants and even serial killers.
Most have to travel far distances to seek a doctor who is not only willing but, also accepting of the concept of gender identity disorder. The list of medical professionals usually consists of: Endocrinologists (hormonal therapy), Certified Psychologists, Psychiatrists, General Practitioners, Gynecologists, Plastic Surgeons (sex reassignment surgeries), and Speech Therapists.
Today, the numbers are growing within the transgender community and it has become necessary to provide a medical unit that will not only enhance the lives of the transgender community but, also begin the process of educating the diverse cultural community in which they live. The United Diversity Clinic will provide health services for eighteen to fifty plus year old individuals in a secure environment, offering the necessary physicians (several physician’s have been contacted and are willing to participate in the project) to begin or continue their transitional journey. This will include connections with local social services such as local gay churches and temples for religious insight.
The Human Rights Campaign in 2010 commented, “Although the American Psychiatric Association has noted that “…data from small countries in Europe with access to total population statistics and referrals suggest that roughly one per 30,000 adult males and one per 100,000 adult females seek sex reassignment surgery,” this statistic is not an accurate way of predicting the number of transgender people living in the United States. Studies like this one tend to dramatically undercount the population of transgender people because they only include transsexuals who have completed or are in the process of completing sex reassignment surgery…Only one thing is certain: little is known about how many transgender individuals live in the United States, but it is probably much higher than many have believed.”
Our Plan For a Successful Clinic
Our research has proven that this project addresses the needs of this community. To provide a safe zone for medical treatment where transgenders can be seen and treated with respect.
Primary medical care – Comprehensive primary care services emphasizing prevention and wellness, delivered by providers with extensive expertise in transgender health concerns. Without medical care for example, the gynecologic cancer risks in FTM’s is profound.
The American Cancer Society reported: Ovarian Cancer
- FTM transgendered and transsexual individuals are at a higher risk of ovarian cancer because of the amount of testosterone ingested. Excess testosterone can be converted into estrogen, contributing to an elevated risk for ovarian cancer.
- Due to discomfort with revealing transgenderism, transsexuals may not undergo screening procedures essential for detecting gynecological cancers, including ovarian cancer.
The American Cancer Society reported: Prostate Cancer
- Reduced levels of testosterone may put an MTF individual at an increased risk for prostate cancer.
Breast Cancer Prevention – Sarasota Memorial Hospital Cancer Prevention Services will offer free screening and diagnostic testing for individuals.
The HIV Clinic – Comprehensive, state of the art HIV/AIDS medical care and support services in an integrated model of care, including Care Coordination, HIV Medication Education & Support, and Mental Health services.
An In-house Pharmacy – Offering the medical drugs and supplies at a discounted rate to our clientele.
Staff: Clinic – Fifteen doctors visit the clinic on a rotational basis. Four Psychologist/ two Psychiatrists will visit five days, gynecologist/endocrinologist four days a week, and surgeons twice a week. twelve nurses, two pharmacists and three lab technicians, and six medical assistants.
Transgender health services – Comprehensive, transgender sensitive primary care, breast/chest cancer screening, sexual health services, as well as counseling and education, hormone therapy.
Hormonal therapy – Hormone therapy is for life whether it be through injections, oral medication or creams. It has been shown to profoundly increase the quality of life for transgender individuals. For many transgender people, hormonal therapy is a way to bring the body into greater congruence with gender identity. Integral components of hormonal therapy include assessing the patient’s health status, needs, and values as well as prescribing appropriate hormones and monitoring any potential side effects. Hormonal therapy, such as estrogen, anti-androgens, and testosterone, is often a significant part of gender transition.
Counseling services – Support Groups: offers support groups for patients of transgender experience, family interaction and individuals living with HIV/AIDS. (Appendix A). Everyone has a gender identity. Gender is a fundamental aspect of human identity. It is a deeply rooted element of how we see ourselves and how others see us. People should be able to express the gender that feels right to them and not be forced to conform to other people’s expectations, in the same way that we don’t try to force people to be straight. Transgender people are deeply harmed by efforts to change or hide their true gender.
Education – Providing health information, training, and education to communities to help ensure that transgender people receive safe and supportive health care services.
CASE EXAMPLE The United Diversity program will provide pamphlets and literature to their clients, as well as posting flyers describing community services and upcoming events. Also the clinic has made provisions to develop a library that will be staffed by volunteers presenting nonfiction as well as fiction books on gender related topics.
Effects of Inaction
Our society is in a healthcare crisis, but the transgender community is in a healthcare access crisis. It’s quite simple, by doing nothing lives will be lost. They are fighting a battle not only medically, socially, but also discriminated against through insurance companies, as none of the hormonal treatments or surgeries are covered.
As more focus is placed on individual health and its association for the overall general community health we can see the positive affects of cultural beliefs and attitudes of those living in the community. Therefore, with this in mind, the clinic will provide health benefits creating a healthier environment for all to live.
Finally, due to the lack of research information based on transgender people, there is a lack of funding available for transgender health care that often prevents effective public health services. Implementing the recommendations listed will give transgender people equal access to health care, ultimately saving lives.
As of 2009, Sarasota’s population was 52,488 people. Since 2000, it has had a population growth of 0.43 percent. Surrounding counties are averaging similar growth patterns. By reviewing the problems in our community, it has become important to increase the necessary medical physicians, implement new diversity programs, and increase the community events leading to educational information given by public speakers and presenters to enhance not only a transgenders well being and life but, to encourage others to become open minded in our ever changing world.
Medical Needs in Sarasota: Put Prevention Into Practice
Doctors who are ignorant of or hostile to transgender people may fail to ask the right questions when seeing a patient about medical issues seemingly unrelated to any treatment of transsexualism. Some physicians are unwilling to see transgender patients at all, expressing a fear that their presence in the waiting room may disturb other patients. Over the last decade, our society has begun the process of understanding the needs whether it be physical or psychological of the transgender community.
As the learning progresses so does the population of this group. Out of desperation, the purchasing of illegal hormones puts these individuals at a higher risk. Too often, transgender people, especially those with low incomes, obtain unprescribed hormones that may not have sufficient medical safeguards. Due to discrimination, both in health insurance and in access to basic care, it is difficult for many transgender people to get appropriate treatment. The discrimination that they face and traumatizing effects emotionally places them in a potential state of confusion and statistically prone to suicide. From Sarasota, the closest surgeons for sexual reassignment surgery is four hours away. There are a handful of therapists willing to work with transgenders. To locate an endocrinologist, the drive could be a minimum of an hour. Therefore, we believe our planning proposal to be a successful solution meeting these objectives:
Increase the awareness of the transgender community
Improve access to health care
Increase the promotion of living a healthy lifestyle
Promote preventive medicine within the transgender group
Increase patient/worker satisfaction
Increase quality and years of healthy life
Eliminate health disparities
Develop support groups
Phase One: Examining The Real Transgender Needs
1. Each patient will begin the program by filling out a form not only for the purpose of patient’s medical information but, also utilized as a survey. (Appendix B & C). The analyzing of this data will provide data of the needs of the transgender community. The results will open exploration of future programs. This stage will be an on going analysis.
2. Quarterly reporting:
Survey of staff reflecting the structure of the programs
Review the number of staff members educational updates
Explore improvements beginning and completed
Interview for patient/staff satisfaction
Report client cases and associated programs (on/off hormone or surgical/nonsurgical)
Teleconferencing with Sarasota Memorial Hospital’s director for future programming
Phase Two: Coordination of Care
This is the foundation of the clinic. During this four month period stage we will organize Physicians and Psychologists, Speech Therapists, Nurses and Administrative staff to join our team of benefiting the transgender community.
Phase Three: Designing Training Programs
The staff will be required to attend transgender sensitivity health educational training programs consisting of 5/8 hour classes and three hours through an internet HIV workshop. The more we know, the better to help our clients. Certification is mandated yearly. Lombardi (2001) commented, “Greater sensitivity and relevant information and services are required in dealing with transgender men and women. These individuals need their identities to be recognized as authentic, they need better access to health care resources, and they need education and prevention material appropriate to their experience.”
Who’s on Board:
These name are completely ficticious. I made them up.
Patricia Newman, MSW Director
Richard Stevens, Unit Manager
Rebecca Jason, MBA Fiscal Coordinator
Julie Montgomery, Director of Community Services
Stanley Goldman, Attorney P.A .
David Peterson, Director, HIV Health Services
Pamela Hartford, Administrative Analyst, HIV Health services
Timothy Johnson, Research Associate
Stacy Howards, Research Assistant
Joseph Cantinelli, M.D., Endocrinologist
Catherine Bontega, Ph.D., LMFT, Psychotherapist
Scott Friedman, M.D., F.A.C.E.P., Medical Management and Administration
Denise O’Brian, PharmD, BCPS, Clinical Pharmacist
Christopher Jones, C.P.E., C.C.E., Clinical Electrologist
Joanne Dickenson, D.O., F.A.C.O.G., Certified Gynecologist
Tammy Meyers, Certified Speech Therapist and Sign Language
Thomas Smith, ARNP, Nurse Practitioner
Terry Mathers, R.N, Registered Nurse
At this point in the proposal I’d like to address the alternative solutions to the limited access of medical care for the transgender community in Sarasota. Unfortunately, one does not come to mind. But, I can tell you of a moment in time when I drove four hours to Ft. Lauderdale to a surgeon so my (legal) transgender husband to be could have top surgery completed. The drive there had been full of scenery and joy. The surgery was completed on an out patient basis and he was released two hours after this major surgery. The trip home seemed longer as the miles past and his pain increased. Four hours on a highway seemed too long but, he had no choice. No surgeons who performed sex reassignment surgery were close to Sarasota.
By developing The United Diversity Clinic individuals will have the option of local sympathetic physicians with easier accessibility to healthcare regarding their transitions.
Dissemination and Implementation
Our main objective is to open the doors to other cities and states, to motivate community members in developing a medical services unit such as ours to offer a full service health care stressing primary and preventative care, health maintenance, disease prevention, counseling and education. We are optimistic regarding educational speakers and new pamphlets (and other educational materials) that will help in educating the community and clients.
We plan to disseminate our research results in both areas of academic, journal articles and scholarly trade publications. Serving as a resource to research projects concerning transgenders and medical practices, we will examine the possibility of publication of our own training materials within a medical trade journal. Our web site will be updated weekly and will provide pertinent information regarding the transgender community. We are also working on creating a link to provide our internet informational services in Spanish.
By improving the access of necessary clinical preventive services to our community, we will create stronger tools and resources in support of the transgender community while engaging our health care system.
The plans of the project will be modified as needed through an ongoing assessment of research involving surveys, questionnaires and interviews by the clients and staff. The results will be forwarded to city and state agencies.
What once may have seemed unthinkable now seems plausible…
ACCESS TO HEALTH
This medical information is completely confidential and is intended to help us understand the health care needs in the County of Sarasota, Florida.
1. How did you learn about this clinic? Please select only one. □ Friends/family
□ newspaper □ Physician □ Community Health Program □ A colleague
□ Internet □ Phone book □ Other, please specify: ___________________________________________________________________
2. How do you identify your gender? Please select only one.
□ Female □ FTM (female-to-male) □ Male □ Gender Queer □ MTF (male-to-female)
□ Intersex □ Gender variant □ Questioning □ Transgender □ Decline to answer
□ Other, please specify: _______________________________________________________________
3. How do you identify your sexual orientation? Please select all that apply.
□ Queer □ Gay □ Questioning □ Lesbian □ Bisexual □ Decline to answer
□ Intersex □Other, please specify: _______________________________________________________________
4. How do you identify your ethnicity or race? Please select all that apply.
□ Asian or Asian American □ Pacific Islander □ Native American □ Black or African American □Latina(o)/Hispanic □ White/Caucasian □ Middle Eastern □ Decline to answer
□ Multiracial □ Other, please specify: _______________________________________________________________
5. What language do you speak most frequently at home? Please select all that apply.
□ English □ Spanish □ Other (specify): _________________
6. Are you Bilingual? □ Yes □ No
7. What is your age?
□ 20 to 29 years old □ 30 to 39 years old □40 to 49 years old □50 + years old □ Decline to answer
8. Which county do you live in?
□HillsboroughCounty □ Other (specify): _________________
EMPLOYMENT AND INSURANCE
9. What best describes your current job (work) situation? Please select one.
□ Employed full-time (33-40 hours/week)
□ Employed part-time (Less than 33 hours/week)
□ Working part-time and on disability
□ On disability – looking for work
□ Not working – on full disability
□ Not working – applied for disability
□ Not working – looking for work
□ Not working – student/homemaker/volunteer/other
□ Other, please specify: _______________________________________________________________
10. Do you have health insurance? □ Yes □ No (skip to question #11)
11. If YES, what kind of health insurance do you have? Please answer “yes” or “no” to each item below.
Health Insurance Yes No
|Insurance through work|
|COBRA or OBRA (insurance through my last employer)|
|Private insurance/HMO, not through work|
|Veteran’s Affairs (VA)|
HEALTH CARE SERVICES
12. When was your last visit with a doctor, nurse, or other health care provider?
□ Less than 6 months ago
□ Six to 12 months ago
□ More than a year ago
13. Where did you receive your medical care (doctor’s name or place)? ______________________________
14. Were you satisfied with the services you received?
□ Yes □ No
□ If NO, please explain:________________________________________________________
15. How much do you think each of the following factors could prevent you from seeing a doctor, nurse or other health care provider?
Please check the box beside the statement that most describes your experience.
1. Location of services/ transportation
2. Days and hours of operation
3. Having to disclose your gender identity
4. Concerns about confidentiality
5. Lack of health insurance/what services might cost
6. Feeling comfortable talking about health and sexuality
7. Length of waiting time to get an appointment or see someone
8. Not able to communicate or interact with the service provider in my
9. Sensitivity of the person or organization providing services
10. Feeling discriminated against by the service provider or the
organization providing services
11. Not getting along with the people providing services
12. Experience or expertise of the person providing services
13. Lack of professional support to help navigate the health care
16. Have you had any personal experiences with these or other barriers that you would like to share?
THOUGHTS ON HIV/AIDS
17. For each item below, please say if you believe there is a high, medium, low or no likelihood of occurring.
1 – Highly,
2 – Moderately
3 – Less Likely
4 – Not Likely
1. Using condoms will effectively reduce the likelihood of infecting someone with
2. A receptive partner in unprotected anal or vaginal sex can infect someone else
3. An insertive partner in unprotected anal or vaginal sex can infect someone
else with HIV.
4. One HIV+ person can re-infect another HIV+ person.
5. A person’s viral load can affect the transmission of HIV.
6. A person can be infected with HIV by having oral sex of any kind with
someone else who has the virus.
7. A person can be at risk for HIV when combining recreational drugs with sex
(i.e., party ‘n play, tweak ‘n freak).
18. Please mark whether or not each of the following statements is true for you.
1. Are you or anyone you know infected or affected by HIV/AIDS? _________
2. Do you know where you can get tested for HIV inSarasotaCounty? _________
3., Do you know where you can get health care services specializing in HIV inSarasotaCounty? _________
4. Do you know where you can get health care inSarasotaCountythat is accepting of your
sexual orientation and/or gender identity? _________
5. Do you know where you can get health care without having medical insurance? _________
6. Would you feel comfortable disclosing your sexual orientation or gender identity to your health
care provider? _________
7. Have you been sexually active in the last six months? _________
19. Do you have any other comments or stories about your access to health care services? You may use the back of this form if you need more room.
Human Rights Campaign. (2010). Retrieved April 10, 2010, from http://www.hrc.org/documents/Transgender_handbook.pdf
Lombardi, E. (2001). Enhancing transgender health care. Am J Public Health, 91(6), 869-72. Retrieved April 20, 2010, from http://ajph.aphapublications.org/cgi/reprint/91/6/869?view=long&pmid=11392924
Martin, K.A. (2007). Transsexualism: Clinical Guide To Gender Identity Disorder. Current Psychiatry, 6 (2), 1-11. Retrieved April 18, 2010, from http://www.changelingaspects.com/PDF/Transsexualism-Clinical%20Guide%20To%20Gender%20Identity%20Disorder.pdf
National Center for Transgender Equality. (2009) Retrieved April 5, 2010, from http://www.transequality.org/Issues/health.html
Oriel, K. A. (2000). Medical Care of Transsexual Patients. Journal of the Gay and Lesbian Medical Association, 4(4), 185-194. Retrieved April 17, 2010, from http://php.ucsf.edu/PatientEd/MedicalCareofTransexualpts.pdf
Transgender Law and Policy Institute (2010). Retrieved April 12, 2010, from http://www.transgenderlaw.org/
Marks, S.M. (2006). Global Recognition of Human Rights for Lesbian, Gay, Bisexual, and Transgender People. Health and Human Rights, 9(1), 33-42. Retrieved April 15, 2010, from http://www.jstor.org/stable/4065388
The American Property Group. (2010). Retrieved April 5, 2010, from http://www.americanpropertygroup.com/
The National Coalition for LGBT Health. (2010). Retrieved April 10, 2010, from http://www.lgbthealth.net/side_hp2010.shtml