Hi I'm Danielle German i'm super happy to be here with you today to share with you our
Communities Leveraging Evidence for Action and Resources otherwise known as CLEAR.
First I'd like to acknowledge our project team and those
responsible for these slides that i'm going to be able to share with you today. Those folks include Brendan Holloway, August Cason, Kevi
Smith-Joyner, Elizabeth Gall, Mannat Malik and Jennifer Glick.
And then additionally we have within our co-investigator team Merrick Moses,
Molly Gribbin, Jean-Michel Brevelle, and Colin Flynn.
And a fantastic combination of community advisory board members.
And together this team of people
and their dedication and commitment and expertise
Is extremely valuable and important for the projects that i'm going to be sharing with you.
So,
CLEAR was created in 2018
to better understand health social and service needs of trans people in the Baltimore Metro Area,
which includes eight different counties in and around Baltimore City. As you see in our mission we were
designed to identify the strengths and assets and understand health,
social and service needs of trans and non-binary
individuals. We are
considered to be a sister project of BESURE,
which some of you may be familiar with? So be sure is part of CDC's National HIV Behavioral Surveillance System.
It's implemented across the country in about 25 different places,
and we are
a community health project designed to directly inform program planning to address community needs and fight the spread of HIV.
Our primary purpose is to be able to assess prevalence and trends in
HIV
risk behaviors, testing behaviors, and service utilization,
and also are an annual survey
on social issues, health and well-being
across different populations in Baltimore.
BESURE focuses on people who inject drugs, men who have sex with men, and people at increased risk for heterosexual transmission.
But notably,
the NHBS system was not designed to be
particularly, well inclusive of trans people.
And thus there are important gaps in the available data.
CDC has recently implemented a survey that focuses on trans women,
but it's not inclusive of other trans and non-binary
identities, so CLEAR was created as a partnership
between Johns Hopkins and the Maryland Department of Health, with funding from the Maryland Department of Health
to help to address these gaps.
When CLEAR started it was a priority to make sure that we were hiring individuals who were
part of the trans and non-binary communities, with the hope that participants and community members
would see themselves reflected in our staff and all across the project, and so currently the majority of our staff
identify as trans or non-binary.
Part of our co-investigator team is trans, and all of our CAB members are trans as well.
So, CLEAR has three primary project components: Research, Service Linkage, and Capacity Building.  All of them are separate,
but were designed to intersect and inform each other
to provide a holistic and
cohesive experience
of using data to support community members.
The research component prioritizes actionable data collection that will directly impact the trans community,
and our plan and hope is to share findings with a very range of diverse audiences,
but explicitly with trans community members seeking to
use the data,
and whose lives are are reflected within the information that we're collecting.
We also include within the service linkage component a
variety of mechanisms to help individuals
access resources on a more immediate basis, and I'll tell you in the next couple of slides a bit more about that.
And then the capacity building component focuses on community engagement and building partnerships throughout the community,
recognizing that we'll be collecting information about what community members need
and aim to
problem-solve based on that.
Our overall goal is to be able to maximize the use of the information
to be able to
inform how better for the trans community to be able to access
resources and supports that they need
within affirming and accessible ways
A bit more about the service linkage component.
Service linkage includes the development of a database of trans affirming services and resources.
This has been developed
with an assessment of organizations determining the extent to which they are trans affirming,
and then using this database
to be able to facilitate referrals for individuals based on an assessment of their own
needs and assets, and what it is that they're looking for.
To support this on an ongoing basis, the service linkage team will also follow up with individuals after they've
visited a referred organization,
to ensure that their experience was in fact affirming.
We also want to highlight that the service linkage component was built on principles of harm reduction and trauma-informed care,
and that we're aiming to ensure that
individuals are met with affirming and positive experiences at referral locations.
So in general,
the service linkage is available to any trans and non-binary community members in the Baltimore
Metro Area, regardless of whether they've participated in the research components.
Essentially, individuals just need to make an appointment by calling or email -- we're also doing video chats in the context of COVID --
and within an initial conversation, we'll go through a quick
needs and strengths assessment to better understand what they're looking for and
what their goals are, and then make a referral based on that.
Within the research component, I'll share with you some of what we're doing, thinking about, and
what is likely to be coming next.
From the beginning of CLEAR,
the priority has been to ensure that the data are actionable, useful, and wanted by  trans community members.
To do this we've had a variety of steps. We've had meetings with trans people to identify
what the gaps are.
In 2018, we held an event to summarize results of early conversations and plans about the project
with trans community members. There were about 30 people, within that meeting,
who then provided their feedback.
We ended up hearing from that [meeting]  some specific gaps that currently exist in Baltimore
in regards to locally specific
data needs, that we were able to then use to inform our adaptation of
the existing
NHBS BESURE survey to better meet local needs.
So, these include the
topics that are on this slide,
and we've continued to
re-assess the extent to which these remain priorities this time has gone on --
and for the most part they still do.
So reading from left to right and top to bottom,
what we identified was
need for information on health access and health literacy,
experience with gender affirming surgeries, hormone use experiences, conversion therapy, stigma and discrimination,
social relationships and stability, housing challenges and opportunity,
experiences related to passing,
individual and community experiences with violence,
family life and fertility goals, general life goals and achievements, and the role of religion and faith.
Essentially, our team is committed to doing research that helps to address these different areas.
We included quite a bit of early stage formative work
that helped us to create the survey and other data collection tools, as well as just some of how we operate as a team
The first thing that we did was to
summarize existing information about trans people in the local area, and then to have
a series of individual
meetings and small group discussions with trans people and stakeholders who work in and with the trans community.
We held about 13 small group discussions, 15 in-depth interviews,
and through these discussions, we essentially laid the foundation for our project
and what we were aiming to do.
We identified needs and strengths of community members
based on their personal experiences and stories;
were able to identify gaps in existing research,
and we were explicitly intentional about reaching and including diverse groups
within the trans community. Some of these included
Black trans men,
trans people who were engaged in sex work, non-binary community members,
and trans people in professional and organizational roles, as well as
sort of diverse combinations of all of these different identity and experiential groups.
Within the primary data report, we
were able to highlight three main themes that I'll briefly talk about next.
The first thing was the strengths and assets of the community. Within the small group discussions,
we learned that mentorship and individual relationships were identified as key sources of community support.
For example many trans women spoke about their experiences as being mothers to other trans people,
and they would often provide housing, food and stability for their chosen children.
Another strength that came up quite often was resilience that was enacted through social support.
So, due to a lack of family support, trans people
reported often helping to cover housing costs or funeral costs,
and to be involved in
organizing rallies including against police brutality;
offering resources and
recommendations for providers that were particularly strong.
We also heard a lot about social determinants of health.
Within the small group discussions, housing, employment, and violence were priority topics. These are also
affirmed by the Community Advisory Board who has identified these as key issues to focus on,
in order to better understand community experiences.
And then the final theme was
service needs and barriers to accessing care.
Within discussions with trans people,
they identified three different tiers of
service needs. On an individual level, housing, employment, healthcare, transportation, and legal services.
At the provider level, cultural competency training
in order to support trans people being able to access affirming care.
And at an organizational level, the need for increased funding for organizations that are affirming to hire more staff,
and more of an institutional commitment to competency trainings and capacity building.
We also just heard a lot about within the organizations that are form affirming, challenges to access such as wait-lists
and generally more of a lack of knowledge about specific trans community needs,
and experiences of intersectionality
or combined marginalized identities, and how that affects people's lives and experiences.
We also started to explore how we could
best learn from others about the most effective practices for trans and
non-binary research.
We have been interviewing trans and allied researchers
and stakeholders across the country who have experience with trans health
research, especially community engaged work,
and you see some of the areas that
we've focused on in those interviews reflected on this slide.
Some of the key things that have emerged from that, are that at the individual level
it's important to use research to address immediate needs of community members,
and that flexibility is important to ensure participation and inclusivity.
At the community level, it's critical that researchers
appreciate the histories and legacy of exploitation of trans community members
within HIV research, and
learn about strategies that can be used effectively within this context to collect
useful data that reflects community priorities.
At an organizational level, there's a strong need
for trans and non-binary people to be part of all of the different aspects of a project team,
so not only staff but other layers within the project, such as co-investigators and the
Community Advisory Board.
A a structural level, the need to address hiring barriers
and create pipelines for trans people to
enter into this work and have a career path that is supported.
In terms of our research component,
we have a variety of different, aspects that are in progress.
Firstly, a primary component is the core survey, which is the adaptation of the
NHBS/BESURE activity.
We've done that adaptation, and
in fact, we were just about ready to launch that component right before COVID-19
put us all into a very different reality.
So, we're doing some adaptations to that,  that hopefully
will allow us to be able to launch
relatively soon.
So, please keep an eye out for announcements
about that, and ways
to be able to be part of that activity.
We also have been working on
a component that will allow us to
understand trans and non-binary peoples'
experiences related to COVID-19 and the
preventative measures that have been in place.
The goal is to understand community's
experiences through qualitative research, to inform
community needs and future policies
as the pandemic continues and other
emergency response measures that might come up.
We will be asking about a range of different topics,
which you can see here reflected on the slide and we're
hoping um to be able to launch this --
we're still pending, IRB review, but are definitely seeing
this as a priority, so hope to have this in place
over the next period of time.
Then we're also working on a qualitative
component focused on housing experiences.
This is currently under review by the IRB
and it focuses on two different groups.
First is the experiences of trans community members
who have experienced housing instability,
and then also service providers and
community members who provide either informal or
formal housing services to trans people.
The goal is to be able to understand needs barriers and
challenges that trans people are facing when accessing housing.
We're also hopeful that we'll be able to learn how we can
better advocate for and support housing providers
who provide services again informally or not
within the trans community.
So, with that, I will say thank you very much.
We would have really loved to have been there with you
in person, but we appreciate you being here
with us, even if it's virtual.
If you'd like to connect more with us, you can find us
through all of these different social media channels.
We also have a newsletter that that you can sign up for,
and please feel free to reach out to us. We'd love to hear
from you.  If you'd like to be involved in the
project, one way or another, we'd really love to hear
from you as well, and hope you'll be as
excited as we are for the upcoming research
components and the data that we'll be able to generate
to support overall and improved landscape for trans
health within the Baltimore Metro Area.
Thanks so much for giving us this
opportunity to share this project.
