Adrienne B. Hancock

For the purpose of this paper, gender-diverse people include all persons who do not wish to position themselves as the gender they were presumed at birth. They may identify themselves as transgende...

Purpose: The Voice and Communication Situation Questionnaire developed with and for transgender and gender-diverse People Presumed Female At Birth (VCSQ ^PFAB ) is the first questionnaire developed with and for transgender and gender-diverse (TGD) people presumed female at birth (PFAB) that considers all possible gender identifications and intersections with other aspects of human diversity. It is informed by contemporary conceptual models of person-centered care, minority stress, and voice and gender as a dynamic, biocultural assemblage of agents, as well as reflections and feedback from intended users. Previous work confirmed content validity and developed guidance for implementation that would foster its use as a tool for person-centered care. This study aimed to psychometrically evaluate and finalize the VCSQ ^PFAB for use as a patient-reported outcome measure. Method: Seventy-three TGD people PFAB and 88 cisgender speakers completed the VCSQ ^PFAB . Thirty-one of the TGD people PFAB completed the VCSQ ^PFAB twice to evaluate test–retest reliability. We evaluated whether scores on the VCSQ ^PFAB were robustly different for the two groups (criterion validity) and calculated the test–retest reliability and the amount of measurement error. Results: The VCSQ ^PFAB had strong criterion validity (area under the receiver operating characteristic curve = .997). Reliability was excellent (intraclass correlation coefficient = 93%), and the degree of measurement error in the VCSQ ^PFAB was small (17% of the total range of the scale). Conclusion: The VCSQ ^PFAB is a reliable and valid tool that can be used to provide person-centered and culturally responsive professional voice and communication support for TGD people PFAB. Supplemental Material: https://doi.org/10.23641/asha.30615281

Purpose: Transgender and gender-diverse (TGD) people and their communication wishes are diverse and heterogeneous, so it is important to understand the situation and goals of each person individually when they arrive for professional interventions. This article describes the development and content validation of the Voice and Communication Situation Questionnaire developed with and for TGD people presumed female at birth (VCSQ ^PFAB ). Method: Phase 1 included a transdisciplinary literature review and an initial draft of a questionnaire designed to collect self-reports of sociocultural positioning, voice and communication function, and well-being of TGD people presumed female at birth (PFAB). Phase 2 involved collection of information and feedback on the draft questionnaire via focus groups of 31 members of the PFAB community in Germany, Sweden, and the United States. Results: Revisions were based on the feedback from all focus groups and consensus within the research team. Feedback highlighted the need to develop a clear approach to introducing the questionnaire to respondents and to provide support during its completion so that self-ratings and descriptions capture the client perspective regarding categories built into the questionnaire. Conclusions: The final draft of the VCSQ ^PFAB provides an adequate framework for a person-centered and culturally responsive approach to working with TGD people PFAB. The tool is now ready to be piloted in clinical settings and statistically analyzed for further psychometric properties.

When engaging in research with marginalized communities, it is important for researchers to reflect on their practice and consider what steps they can take to avoid perpetuating inequality or causing harm. This article provides guidance for researchers working with trans and gender-diverse individuals from the perspective of two speech-language pathologists. Key considerations presented by the authors include the importance of engaging in reflexive research practices—thinking deeply about and acknowledging impacts of one's personal beliefs, values, and practices on one's research—and developing an awareness of factors that contribute to the trans and gender-diverse community's ongoing minority stress. Specific suggestions to redress power imbalance between the researcher and the researched community are provided. Finally, practical methods for implementing the guidance are presented: the community-based participatory research model and an example in speech-language pathology research with trans and gender-diverse individuals.

Purpose: Gender dysphoria is commonly conceptualized as a mental disorder in gender-diverse people who do not identify with the gender assigned to them at birth. Direct support for well-being tends to be delegated to the field of mental health (MH), whereas speech-language pathology (SLP) practice is charged with modifying gender-diverse people's voice and communication in the belief that well-being will improve as a byproduct. However, with the introduction of the minority stress model, gender dysphoria is now understood as the result of sociocultural processes of stigmatization, pathologization, coping, and resilience, and it is to be addressed by all professions providing transgender health services. The purposes of this tutorial are to examine practices in SLP in light of the current conceptualization of gender dysphoria and guide speech-language pathologists in their role in supporting the well-being of gender-diverse people. Method: We reviewed the SLP and MH literature in the topic area to compare the two disciplines' conceptualizations and approaches to professional support for gender-diverse people. Results: We propose a transdisciplinary, person-centered, and culturally responsive approach to SLP practice that directly attends to minority stress, microaggressions, coping skills, and resilience factors. Conclusions: It is not sufficient for speech-language pathologists to delegate support for well-being in gender-diverse people to MH practitioners. Rather, speech-language pathologists need to be proactive in taking responsibility for supporting their clients' well-being based on each individual clinician's knowledge, skills, and capacity to do so. We recommend addressing barriers and facilitators of gender-diverse people's well-being both within SLP as a professional culture and by adapting the clinician's own professional practice.

Purpose: The purposes of this study are to gather and analyze perspectives of people from racial and gender minority groups in order to identify barriers to voice and communication services for these populations. Method: In focus groups facilitated by community members, 11 people in racial and gender minority groups discussed their gender-related goals and accessibility of voice and communication services. Salient themes were derived using a grounded theory approach and analyzed using an access to care framework. Results: During discussion of voice and communication as it relates to gender presentation, most utterances were speculations on the processes and potential outcomes of interventions for voice and communication; the majority of these were characterized as uninformed or misinformed. Conclusions: Future studies will need to overcome barriers related to health literacy and beliefs in order to thoroughly assess potential interest or intentions regarding voice and communication services. Additional study is expected to provide valuable information that can be interpreted using the Levesque et al. (2013) framework of access to care and eventually eliminate barriers to voice and communication services for all.

Purpose The purpose of this study was to prospectively examine changes in gender-related voice domain of pitch measured by fundamental frequency, function-related domains of vocal quality, range, and habitual pitch level and the self-perceptions of transmasculine people during their first year of testosterone treatment. Method Seven trans men received 2 voice assessments at baseline and 1 assessment at 3, 6, 9, and 12 months after starting treatment. Results Vocal quality measures varied between and within participants but were generally within normal limits throughout the year. Mean fundamental frequency (MF0) during reading decreased, although to variable extents and rates. Phonation frequency range shifted down the scale, although it increased in some participants and decreased in others. Considering MF0 and phonation frequency range together in a measure of habitual pitch level revealed that the majority of participants spoke using an MF0 that was low within their range compared with cisgender norms. Although the trans men generally self-reported voice masculinization, it was not correlated with MF0, frequency range, or habitual pitch level at any time point or with MF0 note change from baseline to 1 year of testosterone treatment, but correlations should be interpreted with caution due to the heterogeneous responses of the 7 participants. Conclusion In trans men, consideration of voice deepening in the context of objective and subjective measures of voice can reveal unique profiles and inform patient care.

Inclusion of sex-atypical voices in speech perception protocols can reveal variations in listener perception and is particularly applicable in developing guidelines for transgender speech treatment. Ninety-three listeners, divided into four groups based on sex and sexual orientation, provided auditory-perceptual measures of sex and gender display for 21 cisgender men, 21 cisgender women, and 22 transgender women. There was no significant evidence that those listener characteristics were influential, except transgender women were perceived as significantly more feminine by nonstraight compared with straight listeners.

Purpose: The cultures and service needs of Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ) minority groups are relevant to speech-language pathologists (SLPs). In particular, transgender individuals seeking communication services from SLPs in order to improve quality of life require culturally and clinically competent clinicians. Knowledge and attitudes regarding a population are foundational stages toward cultural competency (Turner, Wilson, & Shirah, 2006). The purpose of this research is to assess LGBTQ knowledge and attitudes among aspiring and practicing speech language pathologists. Method: An online survey was completed by 279 SLPs from four countries. Results: Mean accuracy scores on LGBTQ culture questions were near 50%. Self-ratings indicated more comfort than knowledge, with generally positive feelings toward LGBTQ subgroups. Transgender communication is within SLPs' scope of practice, yet 47% indicated such services were not addressed in their Masters' curriculum and 51% did not know how to describe transgender communication therapy. When respondents were asked to indicate priority of 10 LGBTQ topics for a continuing education seminar, Communication masculinization/feminization best practice and case examples had the highest mean priority scores. Conclusions: There is a need to promote LGBTQ cultural competence within speech-language pathology. This study provides direction for improving LGBTQ cultural competence among SLPs.