Academic Papers

N.R. Holt, T.Z. Huit, G.P. Shulman, et al., Trans Collaborations Clinical Check-In (TC3): Initial Validation of a Clinical Measure for Transgender and Gender Diverse Adults Receiving Psychological Services, Behavior Therapy,

Key Points

  • This article presents initial validation of a behavioral health measure, the Trans Collaborations Clinical Check-in (TC3), for use with TGD clients
  • The TC3 was developed with substantial community and stakeholder input
  • Scores on the TC3 relate to important psychological domains including depression, anxiety, and marginalization stress
  • TC 3 is available here and is free for clinical or research purposes, do not modify without permission. Please let us know if you publish any data using the TC3 at

Holt, N. R., Hope, D. A., Mocarski, R., Meyer, H., King, R. E., & Woodruff, N. The provider perspective on behavioral health care for transgender and gender non-conforming individuals in the Central Great Plains: A qualitative study of approaches and needs. American Journal of Orthopsychiatry.

Key Points

  • Ten interviews with affirming mental health providers in the Central Great Plains
  • Providers emphasized the importance of individualizing care, helping clients navigate stigma, and finding support and resources
  • Providers' approaches to therapy mapped onto cultural competency, but few discussed using an evidence-based model

Holt, N. R., Hope, D. A., Mocarski, R., & Woodruff, N. (2018). First impressions online: The inclusion of transgender and gender nonconforming identities and services in mental healthcare providers' online materials in the USA. International Journal of Transgenderism. Advanced online publication.

Key Points

  • Only about half of therapists who advertise online as working with TGNC clients use affirming language to ask about gender on their intake forms
  • Therapists in states with few legal protections for TGNC people use stigmatizing language on intake forms more often than therapists in states with legal protections
  • TGNC clients may face stigma in their search for a therapist and before face-to-face interaction with therapists

Shulman, G. P., Holt, N. R., Hope, D. A., Mocarski, R., Eyer, J., & Woodruff, N. (2017). A Review of Contemporary Assessment Tools for Use With Transgender and Gender Nonconforming Adults. Psychology Of Sexual Orientation And Gender Diversity, doi:10.1037/sgd0000233

Key Points

  • Reviews 8 culturally-responsive questionnaires for use with TGNC populations
  • Recent assessment tools focus less on diagnosis of gender-related disorders and instead measure constructs important for quality of life and psychological well-being
  • More research is needed on the validity of these tools

Hope, D. A., Mocarski, R., Bautista, C. L., & Holt, N. R. (2016). Culturally competent evidence-based behavioral health services for the transgender community: Progress and challenges. American Journal Of Orthopsychiatry86(4), 361-365. doi:10.1037/ort0000197

Key Points

  • The mental health field has contributed to TGNC stigma
  • Mental health care providers need more than good intentions to provide affirmative services to TGNC communities
  • Proposes a research agenda to develop evidence-based behavioral health care for TGNC communities

*Paper was mentioned in the Huffington Post.