Beginning from within: Promoting the health of trans, Two-Spirit and/or gender-diverse youth
Dr. Julie James is a female-identified, cis-gendered, white assistant professor at Ryerson University in the School of Child and Youth Care.
In this framework description, she discusses the importance of engaging with, and following the lead of, trans and gender-diverse youth. Dr. James presents a framework her team developed that can be used to guide public health action to shift personal and organizational knowledge, attitudes and approaches; it can also be used to provide competent services to trans, Two-Spirit and/or gender diverse youth.
The post includes a link to a survey for service providers to help shape the future of this work.
Working with transgender (trans), Two-Spirit and/or gender-diverse youth (T2SGDY) has been wonderful and a process of learning/unlearning that I greatly value. For over 20 years, I have worked with young people as their social worker, elementary school teacher and advocate in healthcare, education and social and community service settings.
In each of these contexts, I tried to centre the voices of young people and to follow their lead in detailing the healthcare, the social services and the educational pathways that best serve them. Building on this experience, my focus as an academic is to see how I can use my privileged position as a white, cis-gendered professor and researcher to broker resources for T2SGDY — centrally, I am interested in helping to construct youth-led models of care.
I try to do this work in ways that accesses resources for, follows the direction of and does not interfere with the creativity or analysis of the trans and gender-diverse research team. Outside of this work, I try to challenge the larger systems of oppression of white supremacy, transphobia, classism, ableism, sexism and heteronormativity that I gain privileges from but that also cause widespread suffering. I do this work imperfectly, often failing and feeling regret for these failures, and hopefully learning through each attempt.
The need for T2SGDY-led models
Research shows that trans youth face extraordinarily high rates of discrimination [1,2,3] and receive no or minimal professional support for these experiences.  Studies also overwhelmingly conclude that affirming a young person’s gender — combined with the presence of supportive adults — has striking positive impacts on well-being. [4,5,6,7]
A key gap within current academic literature is the absence of T2SGDY voices to inform the creation of service delivery models. Given these findings, it is urgent and vital that T2SGDY are listened to and enabled to lead in cultivating services that meet their needs.
Engaging with T2SGDY communities
Since May of 2019, I have been engaged in helping to organize a T2SGDY-led conference that took place in June of 2019, a national study that my team started data collection for in May of 2020 (ongoing at the time of writing) and a podcast series that was released in July 2020.
Organizing for these projects included consultations with young people in communities across Canada of various gender identities and various experiences of disability/ability, as well as a range of racial identities and diverse ethnicities. Throughout all this work, the youth were adamant that the most marginalized amongst them are to be centered in making decisions about services provided to them. They talked about how the sparse but emerging services for gender-diverse youth meet the needs of the most privileged among this group (white, middle and upper socioeconomic status, able-bodied) to the exclusion of T2SGDY dealing with racism, poverty, lack of family support and/or disability.
This group reinforced that T2SGDY inclusion and competency needs to start with decolonization, anti-racist and disability-inclusive work. It was also asserted that all our work should focus on creating tools so that services can be truly gender inclusive and meet the needs of all gender-diverse young people. By providing insight into their experiences, these young people are making an invaluable contribution to improving the delivery of health and social services to T2SGDY.
Developing the framework
Pree is an incredibly talented contributor to these projects who agreed to continue working with me at Ryerson University in Toronto. Pree brings the perspective of a racialized, disabled, non-binary person who also happens to be a researcher. Together, we drew from the findings of the above-mentioned study, the themes that emerged from the podcast series and the priorities that surfaced through the conference. We also examined recent studies on T2SGDY well-being and the results of several youth symposiums, including the MHCC Rainbow Health Symposium and a Trans Care BC symposium — two events where T2SGDY were centered as decision-makers and authorities of their own bodies.
Additionally, Pree conducted a series of community consultations with racialized T2SGDY and the racialized service providers who support them. Pree and I also consulted with Joel Baum from Gender Spectrum — an organization in the U.S. that is devoted to teaching businesses and educational and medical institutions about trans and gender-diverse competency.
Together, we developed the ARDC (Act, Resurgence, Dynamic, Congruence) framework of action that can be applied to a variety of services offered to T2SGDY. The applicable services include but are not limited to public health, healthcare, education, social services and community supports. This work led to the construction of an internal report for the Mental Health Commission of Canada (MHCC) on how to competently serve all T2SGDY titled Beginning from within: Deploying the ARDC principles to develop better practices for trans, Two-Spirit, and/or gender diverse youth.  At the time of writing, the report has been drafted and is in its final stages of editing and graphic design.
The Act, Resurgence, Dynamic, Congruence framework
The ARDC framework centers decolonization, anti-racism and resurgence practices as the basis for the approach that when the needs of those who are most marginalized are met, the needs of everyone are met.
The ARDC framework has four underlying principles:
- Professional Responsibility to Act,
- Decolonization, Anti-racism and Resurgence,
- Gender and Cultural Dynamic
- Gender Congruence
Figure 1.  The Act, Resurgence, Dynamic, Congruence (ARDC) framework
Professional responsibility to Act refers to acting and providing services immediately and efficiently to T2SDGYto halt and repair harm being done to them. The first step is for practitioners to educate themselves about colonization, racism, and gender diversity (see Related Resources listed below).
For professionals working with T2SDGY, immediate actions can include actively listening to T2SDGY they serve, using their chosen name and pronouns and offering kindness and respect.
Resurgence refers to the revitalizing of practices, culture, art, knowledge, identities and ways of interacting that have been erased or eroded through colonization.  Many young people are revitalizing practices that support gender diversity and are also engaging in art as a way to explore gender identities.
Professionals can support this type of resurgence work by listening and encouraging young people, while understanding that these youth are trying to discover who they are with histories and practices that have largely been erased. They have few histories, historical figures and known storylines to draw from — therefore, they need to engage in revitalizing what remains and creating/recreating what their identities and lives can look like.
Professionals can also work to find existing stories and draw on them in their work with young people.
3. Gender and Cultural Dynamic
Gender and Cultural Dynamic involves embracing gender and cultural diversity and how these elements interact. It requires an understanding that there are multiple ways in which gender diversity and gender identities unfold, are expressed and are experienced.
As young people explore their gender  and recognize the wide range of ways in which cultures embrace, interact with and/or discriminate against gender diversity, professionals must follow their lead. Moreover, professionals cannot assume how a young person’s family, community and/or culture engages with gender diversity and how that young person connects (or not) to their backgrounds.
It is also important for professionals to become active learners in both understanding a young person’s gender identity/identities and how young people relate to their communities, families and cultures.
4. Gender Congruence
Finally, Gender Congruence involves creating a sense of harmony with one’s gender — an internal balance that requires a triangulation of one’s body, identity and social gender.  For a full definition and explanation of gender congruence, please visit the Gender Spectrum website.
Checklist of action items for public health professionals
The ARDC principles provide a guide for public health practitioners and organizations to address inequities experienced by T2SGDY through interpersonal and institutional practices.
Consider the following actions to shift personal and organizational knowledge, attitudes and approaches.
Reflect on your own gender and what informs your gender congruence (body, identity, social expression), culture, traditions, ceremonies, religion, diaspora and education.
Seek out trans art, read trans-centred books, watch T2SGDY YouTubers, engage in gender forums and Reddit pages, read articles and blogs written by trans people and engage with the work of trans folks within your community.
Interrupt binary notions of gender in everyday conversations. For example, speak up when only male or female pronouns or terminology are used or when it is asserted that all ‘men’ or all ‘women’ are a certain way, since such practices overgeneralize and exclude gender-diverse people.
Be public in your efforts and work to be a role model for gender-inclusive and anti-racist practice.
Actively engage with trans and gender-diverse youth.
Work to understand and help facilitate gender congruence in trans youth.
Shift language and communication to gender-inclusive language that embraces gender diversity.
Engage with at least three colleagues and your direct supervisor in this work. Encourage them to engage with the internal point of care
Provide funding for and offer gender-inclusivity, anti-racist and trauma-informed training for staff and community
Develop organizational policies that are gender-inclusive and anti-racist
Develop programs specific to racialized trans youth, Indigenous trans youth, disabled trans youth and homeless trans youth.
Facilitate access to Indigenous cultures, languages and Elders for T2SGDY, as well as the whole community.
T2SGDY know what they need to be healthy and included in society. Addressing health inequities for trans and gender diverse youth must include learning about gender diversity and unlearning binary notions of gender, engaging with and listening to these young people and acting to do this work as soon as possible.
By shifting interpersonal and organizational practices and engaging directly with trans, T2SGD communities, public health can work to stop the harm being done. In addition, public health practitioners can become gender inclusive and can positively impact the lives and well-being of these young people.
We need your feedback!
Complete this survey as part of a research study on what service providers need to better serve gender-diverse youth, which will inform the potential development of a tool for public health practitioners working in this area. If you have any questions about this step, please contact Dr. James.
Get in touch with the Trans Youth Canada team with thoughts about this list of public health actions, and also to propose other ways that public health can use the ARDC framework.
And please stay tuned to www.transyouthcanada.com for the final study reports, an updated checklist tool, and profession-specific checklist tools (Child and Youth Care, Social Work and Public Health) to be released in the winter of 2021!
More information from Trans Youth Canada:
- Five brief reports  from the national youth-led studies on healthcare, education and social/community service needs for T2SGDY. Vitally, these reports examine the impact of COVID-19 on these young people and their needs and experiences across sectors.
- A podcast series  featuring eight episodes led by T2SGDY. In these episodes, hosts discuss their stories and explore collaborations with each other, non-trans individuals and experts in the field; centering the voices of the most marginalized within T2SGDY.
- To read Pree’s blog post  written after attending a trans and gender-diverse youth–led conference, visit their website here: www.prehal.com/blog/restoring-the-circle
- Gender Spectrum 
- Gender Spectrum’s framework for gender-inclusive schools 
- Creative Kids 
- Trans PULSE project 
- Trans PULSE 
- Being safe, being me: Results of the National Trans Youth Health Survey 2015 
- Being safe, being me 2019: Results of the Canadian Trans and Nonbinary Health Survey 
- Trans Youth CAN! 
- Eve Tuck,  associate professor of critical race and Indigenous studies
Julie James is is an assistant professor in the School of Child and Youth Care at Ryerson University in Toronto, Ontario. For further information and contact information, visit her faculty page here.
We would like to thank Stephan Hardy, president of Collectif LGBTQ du Manitoba and communications officer for the National Collaborating Centre of Indigenous Health for his review and extremely valuable feedback.
[1.] The Trans PULSE Canada Team. Health and health care access for trans and non-binary people in Canada [Internet]. [location unknown]: Trans PULSE Canada; c2019 [cited 2020 Oct 7]. Available from: https://transpulsecanada.ca/results/report-1/
[2.] James J, Bauer G, Peck R, Brennan D, Nussbaum N. Legal problems facing trans people in Ontario: TRANSforming JUSTICE Summary Report 1 [Internet]. Toronto (ON): HIV & AIDS Legal Clinic Ontario; 2018 [cited 2020 Oct 7]. 17 p. Available from: https://www.halco.org/2018/news/transforming-justice-tfj
[3.] Veale J, Saewyc E, Frohard-Dourlent H, Dobson S, Clark B, The Canadian Trans Youth Health Survey Research Group. Being safe, being me: results of the Canadian trans youth health survey [Internet]. Vancouver (BC): SARAVYC e, School of Nursing, University of British Columbia; 2015 [cited 2020 Oct 7]. Available from: https://www.saravyc.ubc.ca/2018/05/06/trans-youth-health-survey/
[4.] Hill DB, Menvielle E, Sica KM, Johnson A. An affirmative intervention for families with gender variant children: parental ratings of child mental health and gender. J Sex Marital Ther. 2010;36(1):6-23. doi: 10.1080/00926230903375560
[6.] Sansfaçon AP, Hébert W, Oui Jim Lee M, Faddoul D, Bellot C. Digging beneath the surface: results from stage one of a qualitative analysis of factors influencing the well-being of trans youth in Quebec. Int J Transgend. 2018;19(2):184-202. doi: 10.1080/15532739.2018.1446066
[7.] Travers R, Bauer G, Pyne J, Bradley K, Gale L, Papadimitriou M. Impacts of strong parental support for trans youth [Internet]. Toronto (ON): Trans Pulse; 2012 [cited 2020 Oct 7]. 5 p. Available from: http://transpulseproject.ca/wp-content/uploads/2012/10/Impacts-of-Strong-Parental-Support-for-Trans-Youth-vFINAL.pdf
[8.] James J, Rehal P, Baum J. Beginning from within: Deploying the ARDC principles to develop better practices for trans, Two-Spirit, and/or gender diverse youth. Forthcoming 2020.
[9.] James J, Rehal P, Baum J. Beginning from within: Deploying the ARDC principles to develop better practices for trans, Two-Spirit, and/or gender diverse youth. Forthcoming 2020. Figure in development.
[10.] Corntassel J. Re-envisioning resurgence: Indigenous pathways to decolonization and sustainable self-determination. Decolonization: Indigeneity, Education & Society. 2012;1(1):86-101.
[11.] Ehrensraft D. The gender creative child: pathways for nurturing and supporting children who live outside gender boxes. New York (NY): The Experiment; 2016. 304 p.
[12.] Gender Spectrum. Understanding gender [Internet]. San Leandro (CA): Gender Spectrum; c2019 [cited 2020 Oct 7]. [about 14 screens]. Available from: https://genderspectrum.org/articles/understanding-gender
[14.] Trans Youth Canada. Restoring the circle podcast [recordings on the internet]. [location unknown]: Trans Youth Canada; 2020 [cited 2020 Oct 7]. Available from: https://transyouthcanada.com/rtc-podcast
[15.] Rehal P. Restoring the circle [blog on the internet]. [location unknown]: Priya Rehal; 2019 [cited 2020 Oct 7]. [about 4 screens]. Available from: https://www.prehal.com/blog/restoring-the-circle
[17.] Gender Spectrum. Framework for gender-inclusive schools [Internet]. San Leandro (CA): Gender Spectrum; c2019 [cited 2020 Oct 7]. [about 13 screens]. Available from: https://www.genderspectrum.org/articles/framework-for-gender-inclusive-schools
[21.] Taylor AB, Chan A, Hall SL, Saewyc EM, the Canadian Trans & Non-binary Youth Health Survey Research Group. Being safe, being me 2019: results of the Canadian trans and non-binary youth health survey [Internet]. Vancouver (BC): SARAVYC, University of British Columbia; 2020 [cited 2020 Oct 7]. 93 p. Available from: https://www.saravyc.ubc.ca/2020/03/18/being-safe-being-me-2019/