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Support Trans Youth, Say Pediatricians

On Monday, the American Academy of Pediatrics (AAP) released a policy statement declaring that “The Academy stands against stigmatization and marginalization of [transgender and gender-diverse (TGD)] youths and emphasizes the need for their acceptance as members of our families, communities, and workforce. A new policy statement, Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescentsuses strengths-based concepts to outline the role of pediatricians in addressing the needs, challenges and resilience of TGD youths and their families.”

The AAP is the largest professional organization of pediatricians in North America, representing over 64,000 members in both primary care and related specialties.The AAP’s recommendations are:

“1. that youth who identify as TGD have access to comprehensive, gender-affirming, and developmentally appropriate health care that is provided in a safe and inclusive clinical space;

“2. that family-based therapy and support be available to recognize and respond to the emotional and mental health needs of parents, caregivers, and siblings of youth who identify as TGD;

“3. that electronic health records, billing systems, patient-centered notification systems, and clinical research be designed to respect the asserted gender identity of each patient while maintaining confidentiality and avoiding duplicate charts;

“4. that insurance plans offer coverage for health care that is specific to the needs of youth who identify as TGD, including coverage for medical, psychological, and, when indicated, surgical gender-affirming interventions;

“5. that provider education, including medical school, residency, and continuing education, integrate core competencies on the emotional and physical health needs and best practices for the care of youth who identify as TGD and their families;

“6. that pediatricians have a role in advocating for, educating, and developing liaison relationships with school districts and other community organizations to promote acceptance and inclusion of all children without fear of harassment, exclusion, or bullying because of gender expression;

“7. that pediatricians have a role in advocating for policies and laws that protect youth who identify as TGD from discrimination and violence;

“8. that the health care workforce protects diversity by offering equal employment opportunities and workplace protections, regardless of gender identity or expression; and

“9. that the medical field and federal government prioritize research that is dedicated to improving the quality of evidence-based care for youth who identify as TGD…”

This important statement comes at a time when fearmongering about the acceptance and accommodation of trans youth has reached a fever pitch in the Western world. In the US, fears raised about trans kids in public washrooms continue to constitute an unwarranted panic used to justify attacks on the public school system and teachers unions as much as the kids themselves. In the UK, tabloids have targeted a children’s charity with false claims and called medical access into question, while predominantly anti-trans websites have attempted to portray an increase in trans youth coming out of the closet as a “social contagion.” In Canada, acceptance of trans kids is typically rephrased as “transgender [or even “liberal”] ideology” (it makes it easier to generate alarm when the kids are erased entirely), and used as one of the main objections to age-appropriate sex education (the phrase “gender ideology” has been used by the Vatican for longer, and is also sometimes a dog whistle encompassing any combination of feminism, reproductive freedoms, sex education, and / or LGBTQAI2 rights). Much of this fearmongering has been made possible by flawed or distorted data, such as the often-cited statistic that 84% (or 90, because rounding up sounds better) of trans kids desist (that is, grow out of it, in much the same way people used to view being gay as “just a phase”) — a claim made possible by looking at studies that failed to distinguish kids who actually had a strong and persistent identification with the gender that does not match their birth assignment, from kids who simply experimented with gender (or were even just arbitrarily thought of as gender non-conforming by their parents or doctors).

The AAP statement also comes at a time when Canadian media are starting to jump on a study purporting to show a social contagion-style phenomenon that proponents call Rapid Onset Gender Dysphoria (ROGD). If anything clearly demonstrates why the AAP’s statement this week was necessary, it is the panic over ROGD.

Rapid Onset Gender Dysphoria is not recognized by any medical body, but is rather a theory generated by a group of trans-exclusionary feminists and parents who refuse to accept their kids’ admissions of experiencing gender dysphoria, and instead blame trans awareness and activism for making being trans seem trendy. It is essentially a retooling of the “gays recruit” myth, but it has proven so effective in UK tabloids that British Conservative politician and Equalities Minister Penny Mordaunt is launching an investigation into why the number of kids accessing the medical system has risen from 97 to 2,519 over the past eight years.

[Of course, the answer to that should be obvious. Eight years ago, trans-affirming treatment existed only at major metropolitan centres, few doctors would help trans kids, and finding those who did was hit-and-miss. Eight years ago, human rights protections were tenuous for adults, let alone youth who had much less legal autonomy, and schools were unprepared for accommodating them. Eight years ago, awareness, support options and the assurance of being accepted were much less, but the certainty of opposition was overwhelmingly intimidating. Eight years ago, parents could even have custody of their children taken away if they affirmed and supported them. As the stigma decreased and acceptance increased, people simply started coming out earlier in life. Which means that only now is society beginning to realize the real prevalence of trans* people.]

“Parents have described clusters of gender dysphoria outbreaks…”– the Littman study

But ROGD was given a veneer of legitimacy by a recent “study” that media outlets everywhere eagerly jumped on. I put study in quotation marks, because its methodology was a total mess. It was published in a journal that speeds papers to publication, and then lets you “peer review” them. The study itself acknowledged that its methodology was to take a voluntary survey of visitors to three websites (4thwavenow, Transgender Trend and youthtranscriticalprofessionals, which I will not link to directly), a cursory glance at which would be more than enough to ascertain exist only to discredit trans youth anecdotally and demonize their supporters. The survey didn’t talk to trans kids at all, but rather asked parents if their child’s coming out was sudden (i.e. it can seem to be “rapid onset” when one doesn’t live with it and is unaware of it for years), without prior signs (any trans person can tell you that before coming out, they sometimes go to great lengths to hide it), and were received with any sort of peer or educational support (from which they are assumed to have contracted transgenderism, I guess). The methodology was so flawed that PLOS ONE decided to conduct a “post-publication re-review,” and the researcher’s university withdrew its support almost as quickly as it was published:

“As a research institution, we feel we must ensure that work that is featured on the University website conforms to the highest academic standards. Given the concerns raised about research design and methods, the most responsible course of action was to stop publicizing the work published in this particular instance.  We would have done this regardless of the topic of the article…”

In the end, the only thing that was “rapid onset” was the process from fearmongering to theory (the few months in which the aforementioned three websites grew) and from published “study” to media event (which can be measured in days). National Post and The Globe and Mail should be embarrassed.

In fact, attempts to pass off transphobia and homophobia as science are not new: a discredited 2012 study attempting to prove that parenting by same-sex couples harmed their kids touched off a new wave of anti-LGBTQAI2 junk research, and an astroturf organization calling itself the American College of Pediatricians (identified as a hate group by the Southern Poverty Law Center) has repeatedly tried to pose as an authoritative pediatrics organization in order to fight LGBTQIA2 equality and reproductive rights. But the speed with which ROGD was heralded shows that there is a real appetite for misinformation about trans youth.

So this week’s policy statement by the American Academy of Pediatrics is vital. After years of ongoing research and evidence, the AAP has put its support behind the Gender-Affirmative Care Model (GACM):

“The GACM is best facilitated through the integration of medical, mental health, and social services, including specific resources and supports for parents and families.24 Providers work together to destigmatize gender variance, promote the child’s self-worth, facilitate access to care, educate families, and advocate for safer community spaces where children are free to develop and explore their gender.5 A specialized gender-affirmative therapist, when available, may be an asset in helping children and their families build skills for dealing with gender-based stigma, address symptoms of anxiety or depression, and reinforce the child’s overall resiliency.34,35 There is a limited but growing body of evidence that suggests that using an integrated affirmative model results in young people having fewer mental health concerns whether they ultimately identify as transgender.24,36,37

I have written before about medical accommodations for trans youth, and what is involved:

“It’s important to recognize that the process for trans youth that I’m speaking of is not “sex change” and surgery.  This is often the conclusion that people jump to, but the reality is that newer treatments merely delay puberty until it is certain whether further changes like hormone therapy must be undertaken… typically after age 14…

“Youth transition does not start simply because a child wants to crossdress on occasion or because they like dolls or trucks.  It happens when there is a strong and persistent identification that clearly indicates that there is something deeper than the usual experimentation phase which most kids go through…”

Dr. Norman Spack, who pioneered affirmative treatments, has a TED Talk on how they are scaled to be age-appropriate, and why he came to develop his course of care.  (It should be acknowledged that the policy statement does not specifically embrace Dr. Spack’s treatment, but does stand behind gender-affirmative care, of which his medical process is an example.)

The AAP statement also condemns reparative (or conversion) therapy:

“In contrast, “conversion” or “reparative” treatment models are used to prevent children and adolescents from identifying as transgender or to dissuade them from exhibiting gender-diverse expressions. The Substance Abuse and Mental Health Services Administration has concluded that any therapeutic intervention with the goal of changing a youth’s gender expression or identity is inappropriate.33 Reparative approaches have been proven to be not only unsuccessful38 but also deleterious and are considered outside the mainstream of traditional medical practice.29,3942 The AAP described reparative approaches as “unfair and deceptive.”43 At the time of this writing,* conversion therapy was banned by executive regulation in New York and by legislative statutes in 9 other states as well as the District of Columbia.44

Ontario banned reparative therapy for youth in 2015, noting that kids are often coerced or forced into the treatment by unaccepting parents and churches. This year, reparative therapy for all ages has been coming into question, with legislation being proposed in Nova Scotia, considered in Alberta, passed in the City of Vancouver, and being lobbied for nationwide.

The AAP’s statement mirrors guidelines issued earlier this year by The Canadian Paediatric Society, and are informed by a growing body of evidence that accepting, affirming and supporting trans children and youth leads to better long-term outcomes:

“Many kids who are transgender have chosen a name that is different than the one that they were given at birth,” said author Stephen T. Russell, professor and chair of human development and family science. “We showed that the more contexts or settings where they were able to use their preferred name, the stronger their mental health was…. I’ve been doing research on LGBT youth for almost 20 years now, and even I was surprised by how clear that link was…”

Whether or not the rhetoric subsides, the science is clear.

(Crossposted to Rabble.ca)

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Opponents of Social Progress (In The Bedrooms of the Nation II)

Update:

Due to a moderation queue flooded with mind-numbing racist, Islamophobic and homophobic freeps as well as a reasonable question about singling people out, this post is withdrawn for the moment, until I can decide how I should address that question and also re-examine my moderation policy.

I’m normally not that big on censorship, but apparently, I’m going to have to make exceptions.

This post will be back, although perhaps tweaked.

Vote on Monday May 2nd.

I’m getting back to trans issues for this post, and will resume the “In The Bedrooms of the Nation” series shortly.

Firstly, I’m not going to tell you how to vote.  If you care about trans issues, however, I might be able to help you narrow it down a little.  Trans human rights are only one of several issues, but it’s certainly reasonable to want to choose among candidates that are trans-positive.  But the bottom line is this: vote! Continue reading Vote on Monday May 2nd.

Distinctions Are Important in Fired Trans Teacher’s Dispute

Watch the interview on CTV

It’s not unusual for parties in a legal dispute to seek a non-disclosure agreement, in which the dollar amount or specific terms of an agreement are not for discussion.  That kind of non-disclosure agreement was not what the Greater St. Albert Catholic Regional Division (GSACRD) sought when making an offer to Jan Lukas Buterman, the substitute teacher in the Edmonton area who was fired because he was undergoing a transition to male.

Under the terms that GSACRD sought, Buterman would not be able to acknowledge that the discrimination ever happened, and could be held in violation of the terms of the settlement if it were perceived that he spoke about the incident at all — it’s not clear what this might mean if portions of old interviews surfaced.  During the months that have transpired since his complaint was first filed, Buterman found that despite his own silence, he really had no control over how or when his firing was brought up.  After all, it is relevant in his work as the current Chair of the Trans Equality Society of Alberta (TESA), an advocacy organization that involves itself in issues that include employment rights.  (Full disclosure: this writer is also a board member of TESA). From the Canadian Press:

For months he spoke out in favour of federal Bill C-389, which would have amended the Canadian Human Rights Act to prohibit discrimination on the basis of gender identity or gender expression. The bill passed third reading in Parliament earlier this year, but died in the Senate last month when the federal election was called.

Buterman says he has a right to speak out about the discrimination he faced.

“People like us have all experienced job harassment, job discrimination, job loss — it is a common theme in the community,” he says. “The only difference between me and everyone else is that I got mine in writing. I have no interest in pretending it didn’t happen.”

It’s an important distinction, and one that one could reasonably speculate that the GSACRD does not want people to make, as it has become known that Buterman has declined a cash settlement.  In fact, a string of distinctions has already enabled the school district to sway favour from people who don’t realize the details:

1. Separate, But Yes, Still Equal

While the Greater St. Albert Catholic Regional Division is a Catholic school district, in the Province of Alberta Catholic school districts are publicly funded and are therefore subject to the same laws and requirements as public school districts, including non-discrimination regulations.

2. The Only Game In Town

In the majority of its region, there is no corresponding public school district, so GSACRD oversees the area’s public schools, and is the only public employer in that region.  This is an ongoing issue that parents in the region have been raising, including a delegation that spoke to GSACRD last December after one parent found that a public school was teaching her daughter Catholic perspectives on creation:

“They are breaking the rights of the children under the Human Rights Act of Canada, and they are breaking the rights of the children under the Alberta School Act, where they have the right to a secular education from their public school system,” [another parent Dave] Redman said. “This is a public school system. If they wish to be a separate school system, that’s wonderful. I’m happy if they wish to teach Catholicism every day and in every way to the children that attend the school as a separate school.”

Because there is no secular option, students are allowed to opt out of the Religion class and take a health and wellness class instead.  Having attended a Catholic school back when that class was called “Catechism” and faith was ever-pervasive far beyond that one class, I’d be skeptical that that option would make much difference.  And sure enough, blogs one former student in the district, at the prominent Canadian blog, Daveberta:

My personal experience attending these schools makes me keenly aware of how thin the “public” line of the system actually was. I chose not to attend Religion classes in high school, like most of my graduating cohort, yet we still had to start classes with morning and afternoon prayers. A student could avoid some of the more pervasive official religious education inside the classroom, but there was no mistake that the schools themselves existed in a religious environment.

This issue is continuing even now.  MorinvilleNews Editor Stephen Dafoe made a short film documenting the different sides of the dispute.

3.  It’s Not As Easy As “Just Find Another Job.”

Based on responses when I’d previously written on this, U.S. -based readers are unaware of the way substitute teachers are handled in Alberta, and how that differs from south of the border.  Here, they complete their degree before entering the classroom to teach.  By the time they become substitute teachers, they’ve already invested heavily in making education their career.  It is also a requirement for teachers to put in a minimum number of hours before being able to become a permanently-placed instructor, so the dismissal, lack of other employers in the region and unavailable hours are actually a significant career obstacle.

The Question Now

So now, the question becomes twofold: 1) whether the GSACRD discriminated against Buterman when they fired him, and 2) whether the money and conditions offered constitute a fair and equitable settlement.  On the first point, there’s not a lot of doubt, considering they put it in writing:

In a letter, Steve Bayus, deputy superintendent of schools for Greater St. Albert, wrote that in discussions with the archbishop of the Edmonton diocese, it was their view that “the teaching of the Catholic Church is that persons cannot change their gender. One’s gender is considered what God created us to be…. Since you made a personal choice to change your gender, which is contrary to Catholic teachings, we have had to remove you from the substitute teacher list,” Bayus wrote.

4. Silence, Or Total Erasure?

Much of the coverage right now is focusing on whether the $78,000 cash offer constitutes a fair and reasonable settlement.  But it is not the only question.  Is total erasure and even a requirement to participate in erasing the fact that discrimination ever occurred a reasonable requirement when the community concerned is in desparate need of advocative voices, and is nearly invisible in human rights discussions in Canada?  The Conservative party largely took the position that human rights protections for trans people were unnecessary and (with a few exceptions) opposed them at every juncture when Bill C-389 proceeded through Parliament.  There are few “out” trans people who can speak to this issue.

(Crossposted to The Bilerico Project)

And There It Is

The NDP unveiled their platform today.  On page 18 (or 20, if you’re looking at the PDF), they vowed to reintroduce a trans rights bill:

5.13 Promoting Equality Rights in Canada

• We will ensure that gender identity and gender expression
are included as prohibited grounds of discrimination in the
Canadian Human Rights Act, amend the hate crimes and
sentencing provisions of the Criminal Code to ensure we are
providing explicit protection for transgender and transsexual
Canadians from discrimination in all areas of
federal jurisdiction;

• We will support gay, lesbian, bisexual, trans-gender and
transsexual equality internationally, as per the Montreal and
Jakarta Declaration on Human Rights;

The Liberal Party platform, which we watched leader Michael Ignatieff unveil a week ago, does not.  The Green Party platform also does not explicitly include a pledge to support trans rights.  Both leaders have supported trans rights in the past, and many of their candidates do as well.  Both party leaders could stand to clarify their positions.

In the meantime, my Canadian readers who are concerned about human rights for transsexual and transgender people have at least one choice to vote for on Monday, May 2, 2011. Readers are encouraged to ask candidates in their riding to also pledge their individual support.

Vote for Trans Rights Facebook Group

CBC Vote Compass

Her Own Payette Idaho Revisited

On Tuesday, Catherine Carlson’s trial begins.  She could potentially receive a life sentence for first degree arson, unlawful possession of a bomb or destructive device, using a hoax destructive device, and indecent exposure.  She could receive up to 35 years in prison, which would probably mean the rest of her life.

There seems to be frustratingly little will to talk about her story, and I’m concerned that it’s because people in our community often act like it’s “embarassing” or politically bad if someone lashes out.  Even if the reason for their lashing out appears to be a long legacy of struggling against transphobia, and an ongoing campaign of antagonism from the surrounding community and the authorities that govern it.  According to Boise Weekly:

… during traffic stops or identification checks by police, Carlson claimed her private information was broadcast over police scanners that she said “put a target” on her back in what she calls the small, conservative, religious community of Payette. Carlson’s efforts to have her male identity removed from Idaho records have been unsuccessful, leading her to what she considered her “breaking point” last July.

“You want to know why this mobile home went up in flames?” asked Carlson. “It went up in flames because they wouldn’t transfer it into my name, and the reason why is because I don’t have an ID. And I don’t have an ID because they are insisting that they keep that aka [Carlson’s previous male identity].”

The following has been reblogged from previous, but will be new to readers of The Bilerico Project, where I’ve crossposted.

Sunday, July 11, 2010, a mobile home and pickup truck were torched, fake pipe bombs found and a woman was arrested running naked down a county road carrying another fake pipe bomb. On that day, the Argus Observer reported:

When fire and police personnel arrived, they found what appeared to be four pipe bombs on the front porch of the residence and a propane tank between the bombs.“There was a note that said, ‘Do not enter. House booby-trapped. This is a bomb,’” Clark said.

Catherine Carlson was charged with arson, indecent exposure and making fake pipe bombs.  But the details of what drove Carlson to self-destruct and (my speculation, here) attempt suicide-by-cop paint a several-years-long shocking picture of inner death by misidentification.

The spark for this is said to have began back in December 2007, when she was given an $841 fine for driving with a suspended license.  Though her name was legally changed in the 1970s and she has not used the old male name since, authorities insisted on including her previous name from decades ago on the ticket as an “a.k.a.”  She refused to pay this ticket because of the court’s insistence on keeping that name on it, and has served jail time on at least four occasions, including a 5-day stretch in September 2008 and a 3-day stretch in October 2008.  Although post-operative since 1980, she was kept in segregation.  At that time, the Observer reported:

Carlson said, when she was in jail, she could hear men’s voices from her cell and said she was told the women’s cells were full. However, after communicating with nearby incarcerated women, she said she learned two of those bunks were empty when she was checked in and continued to be so.

Payette County Sheriff Chad Huff said the “3-man” cell Carlson was placed in was not specifically designated as either male or female.

He said Carlson was housed by herself in the cell because jail officials could not “confirm her gender.”

He also said the jail does not have any legal obligation to house her with the women, which he confirmed with the county’s legal department and the Idaho Counties Risk Management Program.

“We will never put her in with the females,” he said. “That’s just how it is.”

(When I first posted on this, a reader took me to task for pointing out that she was post-operative.  I do not believe that operative status should be the hinge upon which we should determine housing.  However, the fact that she is post-operative demonstrates with absolute clarity that her treatment as a “man” is motivated purely by irrational phobia, rather than some weak reliance on the assumption that anyone with a penis is a potential predator)

A bookkeeper in Redwood City, CA eventually paid the fine.  But the old name remains on record, and in fact likely came into use by Payette County officials after her mother revealed it to the court during a late 1990s dispute over a house.

By December, 2008, Carlson was a mess, and her weight dropped to 105 pounds. The Olympian reported:

She used to wear pretty dresses, fix herself up. Now she only has a couple blouses and says she doesn’t want to attract attention to herself. She leaves her trailer about once every 10 days.

“You’re going to have to make me one of ‘We the People,'” Carlson said.

In April of 2009, MSNBC detailed her story, including the rocky relationship Carlson has had with her mother, such as an angry beating of the “awful mischievous child” with an electric cord.  Although her mother expressed some remorse, all was still not well:

Almost 29 years after Catherine’s operation, Bowman is still trying to reconcile her deeply held religious beliefs and her distress over this boy she gave life to and this woman she has so much trouble understanding.

“I do not approve of transsexuals, I believe the way the Lord created us is the way we should stay,” Bowman said. “But he was my child and I supported her.”

Following the self-destructive pipe bomb incident, KIVI-TV conducted a telephone interview with Catherine which is very telling:

Steve Bertel: “… but she tells me that the cause of all of her trouble is her frustration with how she’s treated as a transgender woman in Payette County. She tells me that agencies there refuse to use her female name, Catherine, and instead insist that she be called *****.”

Catherine Carlson (by phone): “Nobody ever refers to me by that name… except the State of Idaho.  And… I just… I just… cannot take it anymore.  They’re not going to allow me to have a life, then they’re going to have to take my life, because I cannot live my life with an a.k.a.  It puts a target on my back, it… it seriously endangers my welfare.”

When the desperation has escalated to attempted-suicide-by-cop, all because of stubborn insistence on maintaining a moniker that has long been irrelevant, something is very seriously wrong.  Let me count the ways:

1) For as little value as there is in noting a name that a person has not willingly used in decades, names gendered contrary to trans peoples’ presentation expose them to discrimination, isolation and sometimes violence.  When law enforcement agencies insist on documenting such names in places where the revelation can turn into violence, they are potentially culpable by incitement, and Carlson’s fear of the public would seem to indicate that county officials’ knowledge did not simply stay hidden in court record.  Although not as overt, this is certainly not without precedence.  We don’t know what whisper campaigns, conflicts and troubles have resulted in her everyday life, but it is clear from what has been reported so far that the name and history revelations have made Carlson terrified of going out into public, and that this has had serious physical and emotional consequences for her.

2) As much as media is aware and reporting that Catherine Carlson’s troubles and self-destruction are a result of ongoing misidentification and the creation of a target as a person with a known trans history, media outlets continue  to include in their report that she “used to be named *****.”  (At the time this was originally posted, it was overwhelming — since then, a number of publications, including Boise Weekly, have stopped publishing the old name.) At this point, of course, her current name and trans history are going to be widespread knowledge and the least of her problems, but the salt in the wound — or worse, challenging her core identity — is really not necessary.

3) Solitary confinement is a form of mental abuse and dehumanization that should really only be used when the person in question is causing trouble (which is not the same as when the person in question is the target of trouble).  It is the most extreme punishment that can be used on prisoners short of capital punishment, and has a toll on a person that means it should be used only for extreme circumstances — not prescribed for someone indefinitely simply because they’re trans or perceived as trans.  Although it’s said to help protect trans women against rape, it has occasionally happened where some would rather chance the rape than endure the isolation.  There needs to be a better system of including and protecting trans inmates with populations with which they identify.  But when you add this to the fact that Carlson is many years post-operative, the old, weak “she might be perceived as a danger to the other women” argument doesn’t even have a ghost of substance.

“We will never put her in with the females,” [Payette County Sheriff Chad Huff] said. “That’s just how it is.”

4) Payette County law enforcement’s bigotry is showing.  If that’s how they regard her, how have they addressed her and treated her?

“You’re going to have to make me one of ‘We the People,'” Carlson had said.

If she’s open to the idea, we could start by being a community for her, right now.

(crossposted to The Bilerico Project)  There are some comments on the original entry worth noting.