People from seven surrounding states and Canada regularly travel to Family Tree Clinic in Minneapolis for gender-affirming hormone care. In some industries, attracting patients from far away may seem like a sign of success, but staff at the 50-year-old reproductive and sexual health clinic are doing everything they can to change that. They want people to get the care they so desperately desire without having to travel hundreds of miles.
A five-year, $757,000 Community Innovation grant from the St. Paul-based Bush Foundation will soon make it possible for Family Tree staff to teach health care providers in isolated communities how to offer gender-affirming hormone care, hopefully reducing the need for their patients to travel long distances for treatment.
Alissa Light, Family Tree Clinic executive director, said that the Bush Foundation grant is, “an opportunity for our staff to develop a democratized training institute where we can both share protocols and do the technical-skills training content of an informed-consent hormone-care program.”
Light explained that Family Tree staff plan to help participants learn how to provide the type of care that patients receive at their clinic, through virtual trainings, mentorship and support.
“We can provide relational mentorship virtually, by including providers in our care conferences and in mentoring relationships with Family Tree providers so they can get that ongoing support needed to provide excellent gender care to their patients,” said Light.
As the clinic’s reputation as a national leader has grown, Family Tree staff have been fielding calls from health care providers across the region who are interested in expanding hormone-care options for their patients, said Nathalie Crowley, Family Tree director of people and culture. Many calls come from communities located far from major metropolitan centers.
“There are providers in Brainerd and South and North Dakota who want to provide these services for their patients but don’t have that support,” Crowley said. On a smaller scale, “Family Tree has been educating other providers and clinics about how to provide patient-centered LGBTQ trans-competent care.”
One such provider is WE Health, a reproductive health clinic in Duluth. “We audited their clinic, talked to their provider, offered some training. Now their provider is part of our biweekly care conference,” Crowley explained. With their new training institute, she and her Family Tree colleagues will be able to reach even more providers.
Ramla Bile, Bush Foundation grantmaking officer, said that in 2014 the foundation supported Family Tree in its early efforts to expand care to the trans community.
The earlier Bush grant was, Bile explained, “to support the development of a gender-affirming hormone care program.” The foundation’s financial support had the desired effect, she added: “Family Tree has emerged as a regional leader.” When the clinic went back to Bush with a request for another grant to support their virtual training plans, Bile said that the proposal felt well aligned with Bush’s Community Innovation program.
“In the first read it was like, ‘We see the vision,’” she said. “We clearly saw what they wanted to achieve and the steps they were going to take to get there. It was the perfect match.”
The hardship of distance
Not so long ago, when she lived in Duluth and needed gender-affirming hormone care, Crowley had to travel two and a half hours each way to see her health care providers.
“I traveled down to the Cities every other week for different types of care, whether it was mental health stuff or gender-affirming care or even just hair removal.” She continued this for two years, with five-hour ‘round-trip drives for appointments, some that lasted as little as 15 minutes.
“I figured out I had driven close to 20,000 miles going up and down, back and forth,” Crowley said. “I was really lucky that I had a job that was flexible and that I had a family where we were making enough money so I could take that time off — but most people aren’t in my position.”
Crowley and her colleagues at Family Tree think that gender care, like other health care, should be easily accessible to everyone who needs it: No one should have to travel 20,000 miles just to get care. The Bush Community Innovation Grant will help fund clinic staff, outreach and training to establish a virtual training institute, where medical providers from around the country can learn from the expertise of Family Tree staff.
“We know there are medical providers in clinics who want to provide this level of care to their patients but they don’t have the knowledge, the support system, the colleagues to ask questions of,” Crowley said. “We hope this will be a good option for them.”
Crowley left Duluth for the Twin Cities five years ago, when she took a job at Family Tree. She said that her experience seeking gender-affirming care from a distance informs her work today: “I know how important it is for people living in rural areas to have access to this type of care. What I’m excited about is making that care available to people who don’t have the access and privilege I did. I love living down here and I love Family Tree, but I’m also really, really glad that Duluth has those options now.”
As much as having patients who travel hours for care at their clinic reinforces Family Tree staff’s belief that they are doing a good job providing a needed service, Crowley said that she and her colleagues are convinced that the kind of care offered at their Minneapolis clinic could be provided in clinics in isolated communities as well. “We love that people come to our clinic from seven different states. But that’s not what we want. We people to see providers in their own communities. We want it to be something that’s widely available.”
Light explained that in 2021 Family Tree went back to the Bush Foundation to seek financial support for the project. “We said that we are at the point where we could see serious systems change. We told them that we see an opportunity to do tele-mentorship so that providers doing primary care in the home communities where these patients are traveling from could get support to provide the gender care that our patients are traveling so far to get from us.”
Bile said the request was directly in line with Bush’s mission — and the foundation was confident that Family Tree staff was up for the challenge of creating a new virtual training institute. “As a foundation,” Bile said, “we care a lot about equity in the many different ways it shows up. That is a core value. Being able to expand care to a community that is marginalized felt really compelling. It addresses a gap that exists in the medical infrastructure. We said we will invest in the care for a community whose health needs have been overlooked and not prioritized.”
Staying small, responsive
Family Tree’s new Minneapolis clinic at 1919 Nicollet Ave. is outfitted with the technology needed to support the expansion of their training programs. “We can seamlessly train people and do things like this all over the region,” Crowley said, “all over the country.”
The growing interest in Family Tree’s training programs could mean that the clinic would physically expand to reach more patients, but Crowley said that kind of growth is not in the cards for the clinic.
“We don’t want to build a bunch of Family Tree Clinics,” Crowley said. “We’re small and we want to stay small, which gives us a little bit more ability to be responsive. We have enough need in our own communities that we can keep ourselves going.”
Light said that the experience of supporting WE Health in Duluth and some smaller providers in North Dakota gave Family Tree staff the confidence that they could mentor other providers around the region. “That was a way for us to go through a learning process of supporting their expansion and inviting them to join our care conferences.”
Another part of the vision of the training institute is to spread information about Family Tree’s informed-consent model of care, where patients are given the information they need to know about their treatments and then empowered to make decisions about their own care, Light explained.
“Historically, with hormone care, abortion care and other kinds of care false roadblocks are put up,” Light said. “Historically gender care has required a mental health diagnosis and a letter from a therapist. An informed-consent model says that we as provider and patient can talk through risks and benefits of any medical treatments and the patient gets to provide consent.”
In the Family Tree-run trainings, health care providers will learn about an informed-consent approach to gender-affirming hormone care. “Part of the vision for this program is the technical skills of training folks in our hormone care protocols and the informed consent model,” Light said. “Another central part is moving the home of medical expertise out of system and providers and instead centering individuals as the leaders in their care.”
This open, respectful approach to gender care was a selling point for Bush, Bile said. The clinic’s commitment to medical equity and spreading knowledge to providers in the foundation’s granting region made funding the new program feel like a good move.
Through the grant-making process, “We learned a lot as a foundation about this idea and why it matters,” Bile said. “For example, training to provide this type of care is something that is not offered in a lot of medical schools, so how do providers learn? That’s where providers like Family Tree come in. There needs to be more in terms of creating a model for places were providers can learn these skills.”
Bush felt comfortable supporting Family Tree’s expansive, forward thinking model, she added. “We loved how they were thinking bigger and thinking differently and moving from the place of saying, ‘We gotta do better for folks.’”