Exploring perceptions of alcohol and other drug (AOD) service workers regarding the inclusion of transgender and gender diverse (TGD) clients in accessing public residential treatment in Victoria, Australia.

Abstract

Introduction: There are unique challenges associated with providing inclusive, equitable care to transgender and gender diverse (TGD) people within residential alcohol and other drug (AOD) settings. With an increase in inclusion-based legislation, publicly funded services are required to provide inclusive care for TGD people. This study explored perceptions of AOD service workers regarding the inclusion of TGD clients in public residential AOD services in Victoria, Australia. We assessed workers' perspectives on their services' ability to provide TGD-inclusive care, and identified individual services workers levels of TGD inclusive practice.

Method: A mixed-methods cross-sectional design was employed combining a quantitative survey with qualitative perspectives from key informant interviews. The survey (completed by 85 workers) included demographic questions and the Trans-Inclusive Provider Scale (TIPS) and Transgender Inclusive Behavior Scale (TIBS) to measure inclusive practices and behaviors. Key informant interviews provided deeper context and understanding of the barriers and facilitators to TGD inclusive care.

Results: We found significant gaps in TGD-inclusive practices among AOD service workers, despite a general willingness to support TGD clients. Participants who identified as LGBTIQA+ reported significantly higher TIBS scores than non-LGBTIQA+ identifying participants (χ² = 19.132, p = .004), and those with a TGD friend or family member had higher TIBS scores (χ² = 20.030, p = .000). A negative correlation was observed between participant age and TIBS scores (r = -0.344, p = .002), indicating that younger workers exhibited more inclusive behaviors. Qualitative findings highlighted the need for visible indicators of inclusion, enhanced training, and flexible service models to improve TGD inclusivity.

Discussion: While there appears to be a strong desire to provide TGD inclusive care, significant gaps in knowledge and practice remain within the residential AOD sector. Addressing these gaps through targeted training, improved visual signaling, and flexible service provision can work to address inequities in care.