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Indian Country ECHO: Enhancing Capacity to Provide High-Quality Gender-Affirming Care to Indian Country

by Morgan Thomas, Trans & Gender-Affirming Care ECHO Program coordinator

Quality healthcare is an essential part of thriving, strong communities. However, across the United States, gender-diverse (non-cisgender) Indigenous people often do not have access to the care they need. During Transgender Awareness Week, we are helping to raise the visibility of transgender people and address issues members of the community face.

In 2015, a national survey Exit Disclaimer: You Are Leaving  of over 27,000 transgender adults found that one-half of all Indigenous respondents reported at least one negative experience with a healthcare provider in the past year. Negative experiences ranged from subtle discrimination and insufficient treatment to abusive language and harassment. This poor treatment affected individuals’ desire to access care. Over one-third of Indigenous respondents indicated that they opted not to visit a medical provider in the past year because they feared disrespect or mistreatment.

In response, in 2019 a group of dedicated clinicians came together in partnership with the Northwest Portland Area Indian Health Board to grow the capacity of health care providers to provide culturally responsive, gender-affirming care. Over several months the Trans & Gender-Affirming Care ECHO Program Exit Disclaimer: You Are Leaving  took shape.

To create opportunities for clinicians to share knowledge, consult with clinical experts, and grow their capacity to deliver high-quality care to gender-diverse patients, the team organized a series of virtual clinics, which ran from March-August 2020. These clinics served as problem-solving sessions, where Indian Country ECHO faculty and participants shared professional insights, discussed case presentations and up-to-date treatment recommendations, and provided each other with community and support.

The organizers found that clinician participants expressed an increase in overall knowledge, skills, and ability to provide quality care to Indigenous gender-diverse patients. Clinicians also expressed increased comfort in advocating for patients’ needs at both the tribal and national levels. Specifically, they said that the program helped demystify gender-affirming care, minimized their fears about treating this population, and provided practical information and feasible solutions that they could apply in their practice.

Program participants reported that they were able to take concrete steps toward creating clinical environments conducive to gender-affirming care, such as staff wearing pronoun pins, ensuring posters and pamphlets in clinic spaces are inclusive, and adapting electronic health records to ensure patients are called their correct names and pronouns.

The Trans and Gender-Affirming Care ECHO Program is now a communal space where providers can share their stories and support each other personally and professionally. These exchanges create more competent clinicians and a strong network of well-trained IHS, tribal, and urban Indian organization staff competent and confident in their skills. Ultimately, this helps clinics provide resilient gender-affirming services in Indian Country, where patients feel safe and respected and, as a therefore, are more likely to access care. Plus, Project ECHO offers a culturally resonant way of doing so through a format that encourages everyone to share their gifts. ECHO values relationships and connection, and offers discussion and guidance on topics most pressing for clinicians practicing in Indian Country.

To learn more about how IHS is working to ensure that all American Indian and Alaska Native individuals and their families receive equal access to health services in the communities where they live, please visit

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Morgan Thomas, Trans & Gender-Affirming Care ECHO Program coordinator
Morgan Thomas coordinates the Trans & Gender-Affirming Care ECHO and collaborates with the Northwest Portland Area Health Board on other projects related to 2SLGBTQ+ health equity. They have an MFA from the University of Oregon and have been working in advocacy for LGBTQ+ people since 2017.