PROJECT SUMMARY
This proposal aims to improve the care of specific populations included in the special emphasis notice (NOT-
HS-21-014) to advance health equity by increasing health services research involving transgender and gender
diverse youth, youth who identify as Black, Indigenous, or People of Color (BIPOC), and youth living in rural
communities. Gender diverse youth (GDY) who identify BIPOC, as well as those living in rural communities,
are more likely to experience depression and anxiety than their peers.1-5 Additionally, BIPOC and rural GDY
are disproportionately underrepresented in pediatric gender clinics,6-8 limiting their access to pediatric gender-
affirming care, which has been shown to improve mental health outcomes.9,10 One proposed solution for
improving access to gender-affirming care, which is currently provided in large academic medical centers, is
facilitating its delivery in the community setting. Prior research suggests both GDY and community pediatric
providers are interested in community-based care delivery models, especially those that incorporate
technology-based support from gender specialists;11,12 however, additional stakeholder-engaged research is
needed to ensure interventions meet the needs of GDY and their families. Given few providers have received
training in this area13-15 and most lack opportunities to consult with transgender specialists, telehealth
modalities like telemedicine and electronic consultation show great potential in facilitating the provision of
community-based gender-affirming care. Unfortunately, little is known about whether existing models provide
necessary psychosocial support to GDY and their families. In this K08 proposal, Dr. Sequeira will build on her
existing research with GDY, their families, and community pediatric providers to: 1) identify existing barriers
BIPOC and rural GDY experience to receiving gender-affirming care and explore design and implementation
considerations for facilitating access to care via telehealth, 2) develop a Technology-based Enhanced Gender
Support (TEGS) platform to facilitate comprehensive gender-affirming care provision in the community
pediatric setting, and 3) conduct a pilot study to determine the feasibility and acceptability of TEGS platform
use in the community setting. In addition, this K08 award will provide the necessary skills and preliminary data
to inform the development and submission of a future R01 proposal to conduct a randomized trial to evaluate
the efficacy of TEGS platform use on GDY’s mental health and perceived care needs as well as community
provider knowledge and behavior.