Concurrent Sessions

CD7 Gender Affirming Surgical Assessments & Referrals in an Interprofessional Primary Care Context

Theme 7. Clinical innovations for specific populations

Presentation Details

  • Date: Thursday, October 26, 2017
  • Concurrent Session C & D
  • Time: 8:30am-10:15am
  • Room:
  • Focus: Practical (e.g. Presentation on how to implement programs and/or practices in the team environment)

1. Gender Affirming Surgical Assessments/ Referrals in an Interprofessional Primary Care Context: Sherbourne Health Centre’s Journey

Style: Presentation (information provided to audience, with opportunity for audience to ask question)

Target Audience: Clinical providers

Learning Objectives

  1. Increase awareness about legislative changes allowing primary care providers to carry out assessments and referrals for OHIP funded gender confirming surgeries
  2. Conceptualize the implications of the legislative change for surgery referrals in primary and integrated care settings
  3. Review and reference the World Professional Association for Transgender Health (WPATH) standards of care related to gender confirming surgeries
  4. Explore assessment and readiness components of the surgical referral process from primary and mental health care perspectives
  5. Identify resources needed/available to support FHTs to begin or refine assessments and referrals for trans clients
  6. Examine what facilitators and barriers currently exist to carrying out referrals in FHTs through panel-audience discussion


On March 1, 2016, the Minister of Health announced that people who are seeking OHIP approval for transition related surgeries (TRS) no longer needed to go through The Centre for Addiction and Mental Health (CAMH).  Instead, people now have the additional option to get approval from “qualified” primary care providers (Family Physicians, Nurse Practitioners, Registered Nurses, Psychologists and Social Workers with Masters level education).  This is a great change for trans people, removing an unnecessary and highly challenging barrier to access.  To ensure that providers are prepared and comfortable with the assessment and referral process, the Ministry requires providers to take training in accordance with the WPATH Standards of Care.    After the Minister’s announcement, Sherbourne Health Centre began working to increase capacity in the family health team to effectively serve trans primary care clients, including providing assessments and referrals for surgery. In this interactive presentation, family doctors, nurses and mental health counsellors will:

  • Explain the legislative changes and their importance;
  • Provide an overview of the standards of care;
  • Share their process to doing surgical assessments and referrals in an interprofessional family health team context; and
  • Share resources to support FHTs to assess their readiness, and increase their capacity to provide assessments and referrals


  • Dr. Laura Pripstein, Medical Director and Staff Physician, Sherbourne Health Centre
  • Rahim Thawer, MSW, RSW, Mental Health Counsellor, Sherbourne Health Centre
  • Laura Sparrow, RN, Registered Nurse, Sherbourne Health Centre
  • Jeffrey Reinhart, RN, Registered Nurse, Sherbourne Health Centre

2. Transgender and Gender Diverse Care: St. Michael’s Hospital Family Health Team’s Drive to Create an Interprofessional Model for the Referral Process for Gender Affirming Surgery

Style: Workshop (session is structure for interaction and/or hands-on learning opportunities)

Target Audience: Leadership (ED, clinical lead, board chair, board member, etc.), Clinical providers

Learning Objectives

  1. Participants will learn how surgical intervention can be integrated into the healthcare provided to  transgender and gender non-conforming patients
  2. Participants will be familiarized with new MOHLTC referral guidelines for gender affirming surgery
  3. Participants will learn about an inter-professional family health team’s step by step protocol development for assessing/preparing patients for gender affirming surgery
  4. Participants will be familiarized with resources in Ontario for supporting health in transgender and gender nonconforming patients


This workshop outlines an interprofessional approach for Family Health Teams (FHT) to support surgical transition in transgender, non-binary, and gender nonconforming patients (referred to here as “trans people”). The St. Michael’s Academic Family Health Team (SMAFHT) is located downtown Toronto, and offers multidisciplinary services used by trans people. Many trans people seek surgical intervention to bring their primary sex characteristics in line with their gender identity, a group of surgeries called “gender affirming surgeries(GAS)”. In March 2016, MOHLTC updated the referral process for GAS, greatly expanding the health professionals that can refer patients for GAS, including Physicians, Nurse Practitioners, Nurses, Social Workers, and Psychologists. This is an exciting step forward that is significantly improving access to these essential surgeries. One major barrier that remains however is that many primary healthcare and Allied Health providers are not familiar with the process of referring for GAS. To address this barrier, a multidisciplinary working group within the SMAFHT have developed a protocol outlining a multistep, team-based approach to assessing and preparing patients for GAS. The protocol is based on MOHLTC guidelines and is designed to increase practitioners’ confidence and build competency. This workshop will review the new MOHLTC guidelines and the step-by-step processing for assessing readiness and preparing patients for surgery. The workshop will also discuss how this process will vary across different professions. Participants will leave with a greater understanding of their role in helping trans patients access GAS as well as resources for how to incorporate this into their FHT setting.


  • Kathleen Tallon, MA, Psychology PhD Student, Ryerson University, St. Michael’s Hospital Academic Family Health Team
  • Ammaar Kidwai, MA, Psychology PhD Student, Ryerson University, St. Michael’s Hospital Academic Family Health Team
  • Kelly Horner, Ph.D., CPsych, Director, Psychology Training Clinic, Ryerson University, St. Michael’s Hospital Academic Family Health Team
  • Celia Schwartz, MSW, RSW, Registered Social Worker, St. Michael’s Hospital Academic Family Health Team

Authors & Contributors

  • Sue Hranilovic, Nurse Practitioner, St. Michael’s Hospital Academic Family Health Team
  • Amy Babcock, MSW, RSW, Registered Social Worker, St. Michael’s Hospital Academic Family Health Team
  • Linda Jackson, MSW, RSW, Executive Director St. Michael’s Hospital Academic Family Health Team, Program Director Inner City Health, St Michael’s Hospital
  • Thea Weisdorf, MD, FCFP, ABAM, Staff Physician, St. Michael’s Hospital-Inner City Health Program, Assistant Professor, Department of Family and Community Medicine, University of Toronto