Title: Employing Dissemination and Implementation Science to Promote Mental Health Equity for Transgender Youth
Abstract: Background: In recent years, the United States has witnessed increased transphobic rhetoric and legislation aimed at restricting the rights of transgender youth, ranging from banning transgender youth from school sports, to denying access to gender-affirming care. This climate has a detrimental impact on the mental health of transgender youth - a community that already experiences profound mental health risks due to their exposure to transphobia across multiple levels and in myriad settings. To combat transphobia and its negative effects on transgender youth’s mental health, scientific studies and methods addressing multiple levels and forms of transphobia are needed.Discussion: We review research on negative impacts of multilevel transphobia on transgender youth mental health, the benefits of gender-affirming psychotherapy practices, and argue that these practices should be re-defined as evidence-based practices (EBP). We then describe how dissemination and implementation (D&I) science—the scientific study of multilevel strategies and methods that facilitate the uptake of EBP —can be used to promote the mental health of transgender youth. We call for increased D&I research to support the mental health needs of transgender youth. We recommend two broad domains of D&I research: (1) identify, test, and scale EBPs for transgender youth and (2) address contextual barriers to implementing these EBPs - specifically, state-level laws/policies, and lack of access to gender-affirming psychotherapy. Methodological recommendations and example studies are included in each domain.Conclusions: To enhance mental health equity for transgender youth, we must leverage D&I science to identify, test and scale EBPs for transgender youth, which we define as practices that have been shown to be effective and acceptable for transgender people based on qualitative data, observational research, and/or pilot studies. These research efforts must also address law/policy barriers through advocacy and policy dissemination research, and overcome lack of access to appropriate care via online/mobile interventions.