2 - (IOP 12) Understanding Determinants to Gender-affirming School Practices: Insights from Educators and Transgender Youth

Background: Transgender youth experience significant mental health inequities compared to cisgender youth, which are largely attributable to school-based discrimination and victimization. Transgender youth supported by school staff experience better mental health compared to those without support. Few school staff know how to provide this support and anti-transgender policies limit the support they can provide. Collaborating with community partners to identify determinants of gender-affirming school practices (GASP) adoption is a vital first step in filling this gap.

Methods: Human-centered design (HCD) methods leveraging community partnerships were used to form a Community Advisory Board (CAB) of school staff (n=7) and a Youth Advisory Board (YAB) of transgender adolescents (n=7). Five focus groups were conducted using semi-structured interview protocols covering topics such as school administration guidance on GASP (CAB) and effective support provided by school staff (YAB). Rapid qualitative analysis was conducted iteratively between focus groups to refine the protocols. The data were later transcribed, coded, and analyzed via content analysis guided by the Health Equity Implementation Framework (HEIF).

Results: GASP adoption is influenced by determinants across the inner-setting, outer-setting, and individual domains. Six determinants were identified at the recipient level, 3 at the inner-setting level, and 1 at the outer-setting level. Recipient and outer-setting determinants were most often identified as facilitators (e.g., provider self-efficacy); whereas inner-setting determinants were most often identified as barriers (e.g., school climate). Nine of the 10 determinants were identified as both a barrier and facilitator, with 1 determinant (exposure to transgender people) being identified solely as a facilitator.

Conclusions: School staff adoption of GASP can mitigate the detrimental effects caused by victimization, discrimination, and legislative harm. Collaborating with educators and transgender adolescents provide important insight into the determinants of GASP, which can inform the development of implementation strategies to increase adoption.