1.5 CE Credit
Michelle Cuevas, Ph.D. | Kaiser Permanente-Otay Mesa Clinic
Krista Freece, Ph.D., ABN | Kaiser Permanente- San Diego, CA
Jeffrey Ryan Murray, Psy.D. | Kaiser Permanente – Vallejo, CA
Individuals who identify as transgender (TG) and gender non-binary/nonconforming (NB/NC) face various medical, psychiatric, and social barriers. Specific to medical transition, there appears to be a rise in those seeking support related to gender-affirming medical and surgical interventions. However, the transition process requires a medical regimen that includes the use of hormone blockers and/or hormone replacement therapy (HRT), which can begin several years prior to surgery with ongoing sequelae well after transition has completed. While the World Professional Association for Transgender Health (WPATH) Standards of Care are the established guidelines for HRT within the TG and NB/NC population, they are not rigid, and HRT can be individualized based on anatomic, social, and/or psychological variables. Given the potential variability of when HRT is started, what type of HRT is implemented, and the duration of HRT over the lifespan, these variants in regimen can have significantly different impacts on psychiatric and neuropsychological health, including neurodevelopment, cognitive functioning, and neurodegeneration. In the context of understanding how transition may impact neuropsychological functioning, we will discuss the evolving best practice guidelines for selecting comparison data for cognitive and psychological measures as part of a neuropsychological assessment. We will conclude by discussing two clinical cases which differed in stage of life and transition (including TG vs. NB/NC). We will discuss how the results of neuropsychological testing impacted the transition process and how neuropsychologists can stay ahead of the curve in treating this population.
After the session, participants will be able to:
1. Describe WPATH guidelines as they relate to the assessment and evaluation for Gender Dysphoria and readiness for medical transition.
2. List at least three gender-specific neurological differences in individuals who identify as TG and NB/NC, as well as changes pre- and post-hormone treatment (e.g., HRT).
3. Select appropriate comparison group data for cognitive and emotional measures based on the referral question, stage of medical transition, and unique characteristics of each examinee.
4. Utilize information from this seminar to improve approaches to neuropsychological evaluation with individuals who identify as transgender or non-binary/nonconforming across various stages of transition.
Target Audience: Neuropsychologists and graduate-level neuropsychology students
Instructional Level: Intermediate
Michelle Cuevas, Ph.D. is a clinical child and adolescent psychologist for Kaiser Permanente in San Diego. She is also a clinical supervisor for their APA-accredited predoctoral internship program. Her research and current clinical interests include neuropsychological/psychodiagnostic assessment; neurodevelopmental disorders, parent training and psychoeducation, learning disabilities, diversity/multicultural issues, and evidence-based treatments. Her clinical and research experiences include program development for a regional center, bedside assessment in rehabilitation settings, consultation and assessments for the Department of Education, assessment, treatment, and program development for the Department of Developmental Services, and assessment and research in pediatric cancer survivorship through the City of Hope.
Krista Freece, Ph.D., ABN earned her doctorate from Fielding Graduate University with an emphasis in neuropsychology. She earned board certification in neuropsychology in 2015 and currently serves as a work sample reviewer for the American Board of Professional Neuropsychology. She works for Kaiser Permanente in San Diego, and her clinical focus is on neuropsychological assessment of individuals with a broad range of presenting problems including dementia, stroke and traumatic brain injury. Dr. Freece’s clinical training in psychotherapy includes experience in Prolonged Exposure and Cognitive Processing Therapy for treatment of Posttraumatic Stress Disorder.
Jeffrey Murray, Psy.D. is currently a first year neuropsychology postdoctoral fellow in the neuropsychology department at the Kaiser Foundation Rehabilitation Center in Vallejo, California. Prior to his fellowship, Jeffrey completed his APA-accredited internship with Kaiser Permanente - San Diego. Prior to internship, Jeffrey completed practicum training in the neuropsychology department at the Loma Linda University Medical Center and the UCLA Semel Institute performing inpatient and outpatient neuropsychological evaluations and brief therapy.
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