Academic Papers

All papers are available without charge through UNL Digital Commons by clicking the paper title in red

Trans Collaborations Clinical Check-In (TC3)

Test-Retest Reliability and Sensitivity of a Brief Clinical Monitoring Measure for Transgender and Gender Diverse Adults: The Trans Collaborations Clinical Check-In (TC3) (click here to access)

Authors: T. Zachary Huit, Natalie R. Holt, Alexander Farquhar-Leicester, Rebecca L. Brock, Richard Mocarski


Key Points

  • The study aimed to further validate the TC3 by examining the test-retest reliability and sensitivity at multiple time points over a period of time
  • The findings suggest that the TC3 demonstrates excellent test-retest reliability and reliably covaries with expected TGD-specific constructs over time
  • The TC3's ability to track gender identity domains is a valuable complement to often implemented general mental health progress monitoring measures to provide effective and affirming care for GD clients

Huit, T. Z., Holt, N. R., Farquhar-Leicester, A., Brock, R., Mocarski, R. A., Woodruff, N., & Hope, D. A. (2022). Test-retest reliability and sensitivity of a brief clinical monitoring measure for transgender and gender diverse adults: The Trans Collaborations Clinical Check-In (TC3). Psychology of Sexual Orientation and Gender Diversity. Advance online publication. 10.1037/sgd0000598

TGD Training and Mental Health Providers

Educational preparedness to care for transgender and gender diverse adults: Perspectives of mental health professionals (click here to access)

Authors: Sharon N. Obasi, Robyn King Myers, Natalie Holt, Richard Mocarski, Debra A. Hope, Nathan Woodruff


Key Points

  •  In this study, 142 mental health professionals who advertised that they work with TGD clients completed an online survey reporting training they received to provide care to TGD people as well as a self-assessment of their comfort, competence, and ability to provide TGD-sensitive care
  • Assessment showed that the majority of these mental health professionals received TGD-specific training and reported high levels of comfort, competence, and ability to offer TGD-sensitive care
  • The number of hours of TGD-specific training these mental health professionals received had a statistically significant effect on the prediction of their self-reported level of competence to work with TGD clients progress monitoring measures to provide effective and affirming care for TGD clients

Obasi, S. N., King, R.E., Holt, N. R. Mocarski, R., Hope, D. A., & Woodruff, N. (2022). Educational preparedness to care for transgender and gender diverse adults: Perspectives of mental health professionals. Journal of Gay and Lesbian Social Services, 1-14. 10.1080/10538720.2022.2056782

 Area and Marginalization Stress in TGD Adults

Mental health and marginalization stress in transgender and gender diverse adults: Differences between urban and non-urban experiences (click here to access)

Authors: Allura L. Ralston, Natalie R. Holt, Arthur R. Andrews III, T. Zachary Huit, Jae A. Puckett, Nathan Woodruff, Richard Mocarski, Debra A. Hope


Key Points

  • Many TGD people will encounter marginalization stressors--such as experiences of discrimination and internalized transphobia--which are associated with greater psychological distress, however, this distress may be heightened for TGD people living in nonurban areas
  • Although all areas (urban, urban cluster, and rural) experienced high levels of distress, TGD people living in urban cluster areas appear to be experiencing the broadest and most severe psychological distress
  • TGD people in rural areas may experience surprising benefits from the close-knit community, even if they are more isolated from TGD community support available to those living in urban areas

Ralston, A. L., Holt, N. R., Andrews, A. R., Huit, T. Z., Puckett, J. A., Woodruff, N., Mocarski, R., & Hope, D. A. (2022). Mental health and marginalization stress in transgender and gender diverse adults: Differences between urban and non-urban experiences. Psychology of Sexual Orientation and Gender Diversity. https://doi.org/10.1037/sgd0000595v



TGD Media Representation

The Rise of Transgender and Gender Diverse Representation in the Media: Impacts on the Population (click here to access)

Authors: Richard Mocarski, Robyn King, Sim Butler, Natalie R. Holt, T. Zachary Huit, Debra A. Hope, Heather M. Meyer, Nathan Woodruff


Key Points

  • While increased GD media representation has expanded public understanding of GD people and exposed them to role models to identify with, these media portrayals are often not representative of most GD people's lived experiences
  • Media with GD representation often highlights transition narratives involving economically privileged, white, heterosexual, binary trans people. This narrow view of acceptable representations for GD people can increase the scrutiny on GD individuals who do not fit into these categories, especially those who do not follow binary forms of gender
  • These narrow narratives create a reality where some GD people do not feel seen by the larger culture despite the progress being made in terms of pure volume of representation

*Paper was mentioned in the Forbes.

Mocarski, R., King R., Butler S., Holt N. R., Huit T. Z., Hope D. A., Meyer, H. M., Woodruff, N. (2022). The rise of transgender and gender diverse representation in the media: Impacts on the population. Communication, Culture and Critique, 12(3), 416-433. doi:10.1093/ccc/tcz031

 

Mitigating the Mental Health Impact of Marginalization and Discrimination (click here to access)

Authors: Debra Hope


Key Points

  •  Invited paper in honor of the life and contributions of Aaron T. Beck
  • Dr. Beck's cognitive therapy can be applied to work with TGD clients who face mental health impacts due to the stigmatization of their identities
  • Collaborative empiricism, cognitive restructuring, and emphasis on behavioral change can be particularly helpful for use with GD clients

Hope, D.A. (2022). Mitigating the mental health impact of marginalization and discrimination. Cognitive and Behavioral Practice, 29(3), 533-536. doi:10.1016/j.cbpra.2022.03.001



Practice Adaptations

Bridging the gap between practice guidelines and the therapy room: Community-derived adaptations for psychological services with transgender and gender diverse adults in the Central United States (click here to access)
Additional link

Authors: Debra Hope, Natalie Holt, Nathan Woodruff, Richard Mocarski, Heather Meyer, Jae Puckett, Joshua Eyer, Shelley Craig, Jamie Feldman, Jay Irwin, John Pachankis, K.J. Rawson, Jae Sevelius, Sim Butler


Key Points

  • Offers 12 Adaptations for therapists to apply to their clinical work with transgender and gender diverse clients
  • Based on input from dozens of transgender and gender diverse adults living in the Central Great Plains, affirming therapists working in underserved locations, and national experts on transgender health
  • Each adaptation is accompanied by practical guidance to demonstrate examples of affirming therapy

Hope, D.A., Holt, N. R., Woodruff, N., Mocarski, R., Meyer, H. Puckett, J. A., Eyer, J., Craig, S., Feldman, J., Irwin, J., Pachankis, J., Rawson, K.J., Sevelius, J., Butler, S. (in press). Bridging the gap between practice guidelines and the therapy room: Community-derived adaptations for psychological services with transgender and gender diverse adults in the Central United States. Professional Psychology: Research and Practice. doi: 10.1037/pro0000448



Trans Collaborations Clinical Check-In (TC3)
Trans Collaborations Clinical Check-In (TC3): Initial Validation of a Clinical Measure for Transgender and Gender Diverse Adults Receiving Psychological Services, Behavior Therapy (click here to access)

Authors: Natalie Holt, Zach Huit, Grant Shulman, Jane Meza, Jolene Smyth, Nathan Woodruff, Richard Mocarski, Jae Puckett, Debra Hope


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 transcollaborations@unl.edu.

Holt, N. R., Huit, T. Z., Shulman, G. P., Meza, J. L., Smyth, J. D., Woodruff, N., Mocarski, R., Puckett, J. A., & Hope, D. A. (2019). Trans Collaborations Clinical Check-in (TC 3 ): Initial Validation of a Clinical Measure for Transgender and Gender Diverse Adults Receiving Psychological Services. Behavior Therapy, 50(6), 1136–1149. doi: 10.1016/j.beth.2019.04.001



Transgender Congruence Scale (TCS)
Psychometric Evaluation of the Transgender Congruence Scale (click here to access)

Authors: T. Zachary Huit, Allura L. Ralston, J. Kyle Haws, Natalie R. Holt, Debra A. Hope, Jae. A. Puckett, Richard A. Mocarski, & Nathan Woodruff


Key Points

  • The researchers, Kozee and colleagues, developed a measure of gender identity congruence (to what extent a TGD person's gender identity matches how they view themselves and their bodies).
  • The current study looked at how the TCS performed in an additional sample of TGD folx, with a greater balance of gender diverse people (about 36% transmasculine, 35% transfeminine, and 22% gender diverse).
  • The study found that the scale worked in the new sample of TGD folx, but that a couple of the items in the measure did not accurately capture gender congruence in this sample.

Huit, T. Z., Ralston, A. L., Haws, J. K., Holt, N. R., Hope, D. A., Puckett, J., Mocarski, R. A., Woodruff, N.. (Accepted). Psychometric evaluation of the Transgender Congruence Scale. Sexuality Research and Social Policy.



Review of Current Literature Recommendations for TGD Therapy
A Systematic Review of Recommendations for Behavioral Health Services with Transgender and Gender Diverse Adults: The Three-Legged Stool of Evidence-Based Practice is Unbalanced (click here to access)

Authors: Natalie Holt, Allura Ralston, Debra Hope, Richard Mocarski, & Nathan Woodruff


Key Points

  • Utilizing evidence-based practice in psychology is important to ensure that clients receive behavioral health services that are supported by the best available research evidence but are also tailored to the individual and provided by an experienced clinician.
  • This article reviews recommendations for therapy with transgender and gender diverse adults to identify if the current literature incorporates aspects of research evidence, patient characteristics, clinical judgment, and assessment.
  • This article found that all components of evidence-based practice are not equally represented in therapy recommendations.

Holt, N. R., Ralston, A. L., Hope, D. A., Mocarski, R., & Woodruff, N. (2021). A systematic review of recommendations for behavioral health services with transgender and gender diverse adults: The three-legged stool of evidence-based practice is unbalanced. Clinical Psychology: Science and Practice.



Trans Collaborations Advocacy Efforts
Advocacy opportunities from academic-community partnerships: Three examples from Trans Collaborations (click here to access)

Authors: Debra Hope, Nathan Woodruff, & Richard Mocarski


Key Points

  • This article is part of a special section on psychologists’ role in advocacy to support the health of marginalized populations. We have posted a link to the entire issue. Our paper starts on p. 247.
  • Although advocacy is not the primary mission of Trans Collaborations, we have had opportunities to advocate and support TGD communities in important ways
  • Community-academic partnerships can have important benefits for the community at large by leveraging the relationships and resources of the partnership

Hope, D. A., Woodruff, N., Mocarski, R (2020). Advocacy opportunities from academic-community partnerships: Three examples from Trans Collaborations. The Behavior Therapist, 43, 247-249.



Analysis of WPATH Providers Websites
Specialists in name or practice? The inclusion of transgender and gender diverse identities in online materials of gender specialists (click here to access)

Authors: Natalie R. Holt, Robyn E. King, Richard Mocarski, Nathan Woodruff & Debra A. Hope


Key Points

  • Analysis of intake forms and websites of behavioral health and medical providers who are members of the World Professional Association for Transgender Health (WPATH)
  • Most (82.5%) providers stated they have a specialty to work with TGD clients, but only about half used gender-affirming language on their intake forms
  • Even when seeking care from a gender specialist, TGD people may experience stigmatizing materials

Holt, N. R., King, R. E., Mocarski, R., Woodruff, N. & Hope, D. A. (2020) Specialists in name or practice? The inclusion of transgender and gender diverse identities in online materials of gender specialists, Journal of Gay & Lesbian Social Services, DOI: 10.1080/10538720.2020.1763225



Interviews with Mental Health Providers
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 (click here to access)

Authors: Natalie Holt, Debra Hope, Richard Mocarski, Heather Meyer, Robyn King, Nathan Woodruff


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., Meyer, H., King, R., & Woodruff, N. (2020). The Provider Perspective on Behavioral Health Care for Transgender and Gender Nonconforming Individuals in the Central Great Plains: A Qualitative Study of Approaches and Needs. American Journal of Orthopsychiatry, 90(1), 136–146. https://doi.org/10.1037/ort0000406



Interviews with TGD Folx about Health Care Experiences
Unmet Expectations in Health Care Settings: Experiences of Transgender and Gender Diverse Adults in the Central Great Plains (click here to access)

Authors: Heather Meyers, Richard Mocarski, Natalie Holt, Debra Hope, Robyn King, Nathan Woodruff


Key Points

  • This paper discusses unmet expectations in the TGD patient and health care interactions based on in depth interviews with TGD individuals.
  • Four main themes of unmet expectations were inappropriate probing questions, gatekeeping, stigmatizing stance, and misgender/deadnaming.
  • Recommendations for better experiences with health care providers are discussed.

Meyer, H. M., Morcarski, R., Holt, N. R., Hope, D. A., King, R. E., & Woodruff, N., (2020) Unmet Expectations in Health Care Settings: Experiences of Transgender and Gender Diverse Adults in the Central Great Plains. Qualitative Health Research, 30(3), 409-422. doi.org/10.1177/1049732319860265



Chosen Name
Renaming me: Assessing the influence of gender identity on name selection (click here to access)

Authors: Sharon Obasi, Richard Mocarski, Natalie Holt, Debra Hope, Nathan Woodruff


Key Points

  • Chosen to be the American Name Society's 2019 Best Article of the Year.
  • This paper explores how transgender and gender diverse people choose a name to reflect their gender identity.

Obasi, S. N., Mocarski, R., Holt, N. R., Hope, D. A., & Woodruff, N. (2019 ). Renaming me: Assessing the influence of gender identity on name selection. Names: A Journal of Onomastics, 67(4), 199-211. doi.org/10.1080/00277738.2018.1536188



Analysis of Mental Health Providers Websites
First Impressions Online: The Inclusion of Transgender and Gender Nonconforming Identities and Services in Mental Healthcare Providers' Online Materials in the USA (click here to access)

Authors: Natalie Holt, Debra Hope, Richard Mocarski, Nathan Woodruff


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

Holt, N. R., Hope, D. A., Mocarski, R., & Woodruff, N. (2019). 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, 20(1), 49-62, doi.org/10.1080/15532739.2018.1428842



Review of TGD Related Questionnaires
A Review of Contemporary Assessment Tools for Use With Transgender and Gender Nonconforming Adults. Psychology of Sexual Orientation and Gender Diversity (click here to access)

Authors: Grant Shulman, Natalie Holt, Debra Hope, Richard Mocarski, Joshua Eyer, Nathan Woodruff


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

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, 4(3), 304-313, doi.org/10.1037/sgd0000233



Discussion of TGD Behavioral Service Needs
Culturally Competent Evidence-Based Behavioral Health Services for the Transgender Community: Progress and Challenges (click here to access)

Authors: Debra Hope, Richard Mocarski, Chandra Bautista, Natalie Holt


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.

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.org/10.1037/ort0000197