Case Study: A 21-Year-Old Transgender Patient

“God doesn’t make mistakes.” A very deep argument, but a very flawed one. If God did not make mistakes, why are children born with an array of abnormalities? If God were perfect, why did he make us so imperfect? Aren’t we supposed to be made from his image? Or is this phrase a mere attempt to give a blind eye to a reality that faces us today? In Spanish, there is a saying that goes, “there is not worse blind man than the one that does not want to see,” and indeed this applies to many people. But we are not here to engage in an endless debate of who is right and who is wrong, the fact of the matter is that we have a problem at hand and we need to resolve it. We no longer are dealing with just grown men and women when it comes to transgenderism, and this puts us as a society, and more exclusively the parents of the kids, in a whole new playing field.

The article starts off defining the term transgender, and different circumstances where others attempted to ‘normalize’ the homosexual and transgender movements. The article states that transgender people “are deeply troubled individuals who need professional help, not societal approval or affirmation.” (Traditional Values Coalition 1). The article continues, showing instances where the transgender movement won “major political victor[ies]” (Traditional Values Coalition 2), such as California Student Safety and Violence Prevention Act of 2000 which protected transgender children at public schools. The coalition states that the media is helping the transgender movement by portraying transgender people as “misunderstood and persecuted” (Traditional

Regarding access to healthcare, transgender individuals often face the most obstructive barriers when attempting to receive care. Whether they are seeking access to hormones, therapy, general health services, reproductive healthcare, or specialty healthcare, transgender patients typically cannot get what they need without jumping through many hoops or hiding their identities. This occurs especially so in cases of intersecting identities -- where an individual is not just transgender, but is transgender and a person of color, disabled, gay, indigenous, undocumented, poor, etc. These intersecting identities interact in multifaceted ways to produce even more barriers for trans individuals seeking healthcare due to healthcare provider bias, insurance requirements, and doctors’ general unwillingness to help coupled with inaccessibility founded on racism, transphobia, homophobia, mental illness stigmatization, etc.

The patient is a transgender and has HIV. Our society has not fully accepted transgender as a societal norm, because of their gender identity and expressions are different to societal expectations of gender. The patient hardly has family support, which can possibly cause poor adherence due to isolation. HIV

Transgender is a metaphorical umbrella term that covers a person whose self-identification, anatomy, appearance, manner, and/or expression is different from the sex assigned to them at birth and does not fit with societies interpretation for the norm of gender roles. Included in the transgender umbrella are transsexual people, non-binary gender identities, and cross-dressing (LGBT Youth, 2017). Transgender individuals are often the target of discrimination, injustice and social stigma that can lead to negative health outcomes.

When people want to be theirself, doesn 't everyone deserve that chance at that much freedom? According to the national LGBTQ Task Force transgender people are not that lucky when it comes to the demographics of social media. On CNN website there 's an article that discusses how transgender people are twice as likely to be unemployed and four times more likely to live in poverty compared with the general population and these disparities are much greater for transgender black and latina woman said Emanuela Grinberg writer for CNN.

Presenting Problem: Pt is 16 y/o female who is currently at Tuckers Pavilion Acute facility. 8/7/16 Kelly refused to take her medication, and was generally noncompliant to staff directions. She communicated AWOL intent; she also broke a lightbulb to make a number of superficial cuts to her arm, but refused to turn in the glass an dstated that she had flushed it down the toilet. She refused first aid and refused to cooperate with staff directions. She also communicated that she was going to do worse things to herself, Intercept contacted crisis stabilization which transitioned the child to Tuckers Psychiatric at 6am. 8/12/16, Pt was upset to find out she was not getting discharged from Tuckers. Require hydroxyzine 50mg at 1530 medication

Adrian is a 24-year-old Caucasian male who presents to CRU from RRC-W. He is ACOT for non-compliance. He is SMI designated. La Frontera is the outpatient treatment agency for Adrian. He also receive DD services from AZ Dept of Development Disabilities. Per amendment letter, client was being aggressive towards group home staff, and admitted to stating that he wanted to jump into traffic. He denies AVH, and DTO. His BP is elevated 139/81, he has a hx of HTN and high cholesterol. He will benefit from meeting the provider to discuss medication

D-Met with the patient upon request. Upon meeting with the patient, the patient appeared upset and addressed her frustration in this writer's office. According to the patient, she's upset with her PCP forcing the patient to admit herself to the psych. ward to get on medication. Failure to do so, her PCP will complete the medication protection for her electricity. The patient owes over $3000 and with the protection, her light company cannot turn off her lights. Please note, the patient was pacing back and forth and getting emotional. This writer consolet he patient and validated her feelings. According to the patient, she reports that CMHA informed her that she in order to get into their clinic, an evaluation is needed whereas the evaluation can be completed at a hospital; however, the patient is worried about being admitted. Please note, the patient denies any suicidal or homocidal ideation when questioned.

Patient presented to the ED via EMS after a attempted suicide by driving his car into a tree. Patient reports braking up with his girlfriend a month ago and experiencing depressive symptoms. He reports that his girlfriend and him had a 7 year relationship, which he shared a with a 6 year old daughter from the relationship. Patient expresses that in the past he has been verbal aggressive towards her and she has recently moved into er mothers home. The patient reports since her leaving he has been having suicidal thought. He reports that he never attempted suicide, however has had a history of depression and a verbally abusive father. The patient express a poor appetite, sleep, and loss in usual pleasure, which is praying for change in his relationship.

Ronny is a 46-year-old white male who present to CRU from RRC-W on ACOT for PAD. He was amended by his OP clinic, Life Behavioral Wellness, for not complying with the terms of the order and treatment plan. Per collateral, Ronny has a hx of violent behavior including pulling knives on people and stabbing. According to his OP psychiatrist, Diana Havill, MD, Ronny pulled a knife on a pregnant woman. He also have a history of self-harm including attempted hanging. Patient is cooperative during admission, and answered all questions. He has a PMH of HTN, Asthma, TB, seizures, and Brain surgery (infant). His vital signs were WNLs. Patient will benefit from medication

D-The patient arrived to the clinic emotional and was advised to see this writer. According to the patient, she's upset about her DCF case, her supervised visit with her son that hasn't occurred yet, loss of employment, and owing $80. 00 for her rent. This writer provided support, validated the patient feelings, and encourages the patient to maintain contact with her attorney and to also, contact 211 for financial assistance. In addition, reach out to the court system to address the violation to her supervised visit as it is not being honored. During the remainder of the session, the patient provided an updated on her mental health provider whereas she is no longer going to Wheeler Clinic due to the travel distance. The patient signed an ROI

Mr. Flowers is a 41 year old male who presented to the ED via LEO under IVC from Daymark Recovery Services. TACT assisted ED staff with deescalating Mr. Flowers after being informed of Mr. Flowers was becoming agitated. Mr. Flowers was concern about when he was able to leave and was under the impression he could leave tonight. TACT spoke with Paige from MCBH who informed TACT that MCBH was still seeking placement for Mr. Flowers. Mr. Flowers was informed of the current status of his disposition. Mr. Flowers gave this clinician verbal permission to speak with his wife Vickie Flowers about the status of his disposition and explain the process to her. This clinician explain the process and informed her of status.

Patient is a 46 year old male who presented to the ED via LEO from Daymark for anxiety and depression over relationship issue, and financial issues.Patient reports a lot going on in his life right now and he went to Daymark seeking outpatient therapy. However, he was agitated that he was brought to the hospital for further evaluation. The patient reports that he was speaking with a worker at Daymark about his experience last year and was told to wait in the waiting room. The patient stated, " I fell like I was tricked into staying until the police came and brought me to the hospital. During the assessment the patient expressed that he has been feeling some anxiety, depressive symptoms, and aggression due to his situation. Further, the patient

D-Met with the patient to address her request for a change of counselor. According to the patient, she expressed that her assigned counselor shows no empathy towards her personal issues when she attempts to discuss it with her assigned counselor. The patient then says, " With Cherron, every session is negative, nothing positive. No encouragement by him......I've through a lot. I broke up with the love my life 8 months as he left me for another woman....I was there for him when he was incarcerated for two years (the patient was emotional-in tears). I tried to talk to Cherron but he was not being understanding. I, know, I keep testing positive, but I am going through a lot, you know. I am the care taker of my parents. No social life." This writer reviewed the patient's case history as there has been numerous no shows and the patient is currently on a Step 3 for the no shows/ongoing illicit use. According to the patient, she continues to miss her session due to her feelings towards her counselor. When questioned as to why she did not mentioned this prior as to why it took 8 months. The patient says, " I did and was told that it will be entered in some green book.....I need a female counselor that can relate to me or even have empathy. I need guidance and Cherron is not helpful at all.....He tends to keep me in session for an hour whereas it was suppose to be a 1/2 hour session." Nevertheless, the patient is seeking to enrol in mental health services through Brownstone for treatment or IOL.