Trans voices in social work research: what are the recommendations for anti-oppressive practice that includes trans people?

Author: O Stevens1
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  • 1 University of Sussex, , UK
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This rapid review explores research that relates to trans people and social work, with the aim of investigating the experiences of trans people in social work. The article is concerned exclusively with research that platforms the voices of trans people, specifically, those whose input is in direct reference to their experiences in relation to social work. However, the exploration revealed no studies that reference the perspectives of trans social workers. Key recommendations include: the responsible inclusion of trans identities within educational and professional development materials; a visible commitment within social work to confronting transphobia; engaging with practice beyond a binary comprehension of gender; and renewed commitment to person-centred practice that promotes and understands the necessity for self-identification. Additionally, this review restates the need for further ethical research in this area that is more accurately representative and enables the voice and influence of trans people in social work knowledge production.

Abstract

This rapid review explores research that relates to trans people and social work, with the aim of investigating the experiences of trans people in social work. The article is concerned exclusively with research that platforms the voices of trans people, specifically, those whose input is in direct reference to their experiences in relation to social work. However, the exploration revealed no studies that reference the perspectives of trans social workers. Key recommendations include: the responsible inclusion of trans identities within educational and professional development materials; a visible commitment within social work to confronting transphobia; engaging with practice beyond a binary comprehension of gender; and renewed commitment to person-centred practice that promotes and understands the necessity for self-identification. Additionally, this review restates the need for further ethical research in this area that is more accurately representative and enables the voice and influence of trans people in social work knowledge production.

Introduction

The UK’s Women and Equalities Committee recently produced a review that evidenced the disparities in health and social care experienced by lesbian, gay, bisexual and trans (LGBT) people and concluded that monitoring these inequalities is ‘far too important to be an aspiration rather than a concrete goal’, particularly when it comes to provision for trans people (WEC, 2019: 34). In parallel to this, it has been three years since an initiative from the Department for Education found no mention of trans people within HCPC-approved course content for social work qualifying courses (DfE, 2018). In 2016, the Women and Equalities Committee published evidence provided by UK organisation Mermaids, a national charity for the support of gender-variant children, which stated that ‘[s]ocial workers have no formal knowledge or training around gender variance and appear to act on their own prejudices rather than researching gender issues’ (Mermaids, quoted in WEC, 2016: 78). This report implored the government to address the lack of knowledge in social work around ‘trans issues’ as a matter of urgency (Mermaids, quoted in WEC, 2016: 78). Professional standards dictated by Social Work England dictate that social work students and practitioners must promote the rights, well-being and strengths of the people they work with, and must not only advocate for social justice, but also ‘confront and resolve’ issues around inclusivity and equality (SWE, 2020a: para 1.6). Furthermore, social workers must ‘challenge practices, systems and processes’, with a view to upholding prescribed professional standards (SWE, 2020a: para 6.2).

With these conclusions and commitments in mind, this article presents findings from a rapid review of research that relates to trans people and social work, with the aim of exploring their experiences within the profession. Based on the review, the article offers recommendations for anti-oppressive social work practice that includes trans people in the UK. The review contains research that platforms the perspectives of trans people across social work, including only studies that contain the first-person voice of a trans person or persons, specifically, those whose input is in direct reference to their experiences of interacting with social work.

Efforts have been made to blur the boundaries between trans people as students, as social workers or as people using services and/or caring for others, and social work is the subject of dissection, rather than positing trans people as something to be observed and researched from the outside. It is significant, however, to consider my positionality as a trans person and author. Navigating this has required reflection and supervision, and I have aimed to utilise my position ethically and reflexively in order to inform the methodological and ethical approaches in my exploration and synthesis of the data (Chavez, 2008; Corbin Dwyer and Buckle, 2009; Wilkinson and Kitzinger, 2013).

Although the ‘insider–outsider’ binary is imperfect and dynamic (Wilkinson and Kitzinger, 2013), it needs to be addressed. The group of trans voices within this review are so necessarily broad and varied in respect to their transness – and more so by intersections of race, age, economic status, geography and so on – that to call oneself an ‘insider’ to every trans experience documented would be reductive and presumptuous. Instead, it is more accurate to say that my position is as a trans insider-outsider (IO) (Rosenberg and Tilley, 2020). Being a trans IO has permitted me to collate this review with the benefit of some experiential shorthand, allowing me to navigate the data with some accuracy and an informed/invested anti-oppressive approach (Rosenberg and Tilley, 2020).

The term ‘trans’ is employed here to describe persons/people whose gender is not aligned with that which they were assigned at birth, though this language may shift among the different authors. An example of this is the use of the term ‘trans*’ within one study (Asakura et al, 2020), designed to further emphasise the inclusivity of ‘trans’ as an umbrella term (Tompkins, 2014). It is recognised that the use of the term ‘trans’ as an ‘umbrella’ descriptor is, at best, an approximation, could be reductive and potentially includes people who would not attribute this language to themselves (Valentine, 2007). Additionally, while possibly the most temporally recognisable language in this context, this term is derivative of the word ‘transgender’. Both are relatively new terms that are ‘rooted in Euro-American ideology’ (de Vries, 2015: 16) and therefore fail to incorporate fully the cultural and historical breadth of gender and gender expression. In addition, this article uses the antonym ‘cis’ or ‘cisgender’ to describe people who are not trans.

Often, discourse concerning trans people is preceded by a description and/or explanation of trans identities and history. This article will not include such an approach beyond the brief clarification of terms in the previous paragraph. Instead, it is immediately concerned with research and findings on social work that are derived from a trans perspective. If required, examples of such accounts can be found within two articles included within this review (see Taylor, 2013; Siverskog, 2014). Within academia, it has been argued that this prerequisite to preface research by making ourselves understood is exhausting and undermining, and delays the progress of knowledge production by and about trans people (Hord, 2018).

For broader educational purposes, while research and education regarding the lives and experiences of trans people are lacking within social work, there is a wealth of information available not specific to social work. An anti-oppressive approach requires paradigmatic change across the board, in so much as promoting the acceptance that the responsibility for developing ‘trans awareness’ and affirmation lies with the cisgender student/professor/practitioner. For students, recommended starting points for this may be: resources provided by Amnesty International (2020); professional development and competency gained through paid consultation with trans-led initiatives, for example, Gendered Intelligence in the UK (GI, 2020); and, finally, buying and engaging with the work of trans writers, musicians, artist and so on, specifically, and particularly, Black people, people of colour, migrants and disabled people.

Methodology

This study was initially undertaken as part of my BA in Social Work dissertation. The approach to producing this article has been necessarily dynamic and has evolved over the process of writing. It has always been the broad aim of this review to explicate research recommendations for practice that includes and is affirming for trans people. However, following reflection, the specifics of the methods and criteria for this exploration have evolved while writing.

The review relied on a rapid review methodology (Grant and Booth, 2009). While executed under systematic conditions (expanded upon later), due to the varied and necessarily qualitative nature of the research produced, it does not adhere to all the requisites of a systematic review (Crisp, 2015; Bell, 2017).

Four databases were employed within the search: Applied Social Sciences Index & Abstracts (61); National Institute for Health and Care Excellence (2); Scopus (265); and Web of Science (322). The key term ‘social work’ was combined with at least one of the following ‘trans’ OR ‘transgender’ OR ‘TGNC’ (‘trans and gender non-conforming’), and the search was limited to where this appeared within the title or abstract of a study. Articles from 2006 and later were included, with a view to maintaining contemporary relevance. The search was restricted to articles produced in English, rather than focusing solely on studies within the UK.

A preliminary review of each abstract was employed to restrict findings to those that specifically referred to social work and not, for example, to ‘the helping professions’ (Acker, 2017). Additionally, there were many articles among this initial search that relate to the broader experiences of Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ+) people. Upon further exploration, these often focused on the experiences of cisgender participants. A decision was made to eliminate these findings in favour of exploring those that focused explicitly on trans people and social work.

This created a pool of 31 potential articles. However, it became apparent that further exclusion criteria needed to be applied to extract a collection of data that would answer to perspectives of trans people on social work practice (and not a practice/research perspective on trans people). A rational and quantifiable approach to establish this focus was devised: to exclusively incorporate research that encompassed some semblance of first-person narrative of a trans person or persons. There were 11 articles that met these criteria.

In order to critically appraise these 11 papers, Orme and Shemmings’ (2010) key questions for appraisal of social work research were applied, namely: ‘How relevant is the study to the review question?’; ‘How much information does it contribute?’; ‘How trustworthy are its findings?’; ‘How generalisable are its findings?’; and ‘Was it conducted ethically?’. Through this process, four further articles were excluded based on their irrelevance to the questions posed by this review. This research was excluded at this point as while it did specifically reference social work and was based on verbatim accounts from trans respondents, the data described each person’s experience of being trans and did not relate to their perspectives/experiences in relation to social work (Witten, 2014; Shelton, 2016; Capous-Desyllas and Barron, 2017; Matsuzaka and Koch, 2018). The remaining five articles are summarised in Table 1.

Table 1:

A summary overview of the articles selected for the rapid review of literature

Author(s) (date)LocationTitleSummary and relevance
Ahmed and Rogers (2017)UK‘Polly’s story: using structural narrative analysis to understand a trans migration journey’Structural narrative analysis, with a focus on one woman’s life story. This research explores the significance of empirical research and practice within social work, and how analysis of narrative structure can give a voice to marginalised communities. In parts, the data and analysis document and explore ‘Polly’s’ experiences in relation to social work as she interacts with services.
Asakura, Lundy, Black and Tierney (2020)Canada‘Art as a transformative practice: a participatory action research project with trans* youth’This participatory action research (PAR) includes participation of five trans* young people and contextualises and discusses art as transformative social work research practice. The interviews explore the young people’s experiences of this radical practice.
Rogers (2016)UK‘Breaking down barriers: exploring the potential for social care practice with trans survivors of domestic abuse’As a UK-based qualitative study, this research was undertaken to identify the social care needs of trans people who experience domestic violence and the barriers they face in accessing support in this area. This article includes accounts from 24 respondents (nine practitioners and 15 people who have engaged with services), and trans accounts in relation to social work are central to the analysis.
Siverskog (2014)Sweden‘“They just don’t have a clue”: transgender aging and implications for social work’This is Swedish study based on qualitative data that is concerned with transgender ageing and the implications for social work. It includes data from life-story interviews with six trans participants aged 62–78. A key discussion includes the respondents’ experiences of interacting with care and social services.
Taylor (2013)Canada‘Transmen’s health care experiences: ethical social work practice beyond the binary’This Canadian article, inspired by institutional ethnography approaches, is based on semi-structured interviews with three self-identified trans men about their experiences of accessing healthcare. The study goes on to derive implications for social work, asking practitioners to challenge the gender binary in practice and engage with transgender theory. Within a Canadian context, a social worker can be one of several professional gatekeepers to medical gender affirmation (Ontario Government, 2019). However, the article discusses the implications of its findings for social work practice broadly speaking and so speaks to this research question.

As noted, this review was initially undertaken as an undergraduate dissertation. The original piece additionally discussed findings around social work education. As this article refers only to experiences of practice, I have further excluded two articles that refer exclusively to experiences within social work education (Austin et al, 2016, 2019).

Thematic analysis of this data set was implemented, emulating the six stages outlined by Braun and Clarke (2006). I was specifically concerned with qualitative accounts by trans people of social work practice and education and employed inductive analysis to code these data (Braun and Clarke, 2006). The first ‘stage’ involved familiarisation with the data. Following this was a stage of generating initial codes, identifying data that answered to the enquiry of this review. The third stage was to begin identifying themes in these data through collating identified information until a series of coherent topics began to emerge. I then reviewed and refined these themes to ensure the cohesiveness of each argument, while defining each with a title. The last of Braun and Clarke’s (2006) six steps includes completing the final report of this information; I then used this material to form the discussion and draw conclusions in relation to the implications of the findings.

Limitations

This exploratory review presents a small, but formative, pool of data derived from North America, Canada, Sweden and the UK, and explores social work across disciplines, including gerontological practice, practice within domestic abuse services, transformative art practices with young people and social work within a multidisciplinary medical setting. Due to their exploratory nature, the sample sizes in the review studies are generally small.

It has been noted that research around trans communities primarily concerns the experience of economically privileged, non-disabled, white people (Vincent, 2018). This is true of the majority of papers reproduced within this review. Without an intersectional representation, there is a limit to the application of this work towards empowerment through practice (Vincent, 2018).

Ethics: ‘empowering’ methods

This article specifically aims to explore trans people’s experiences of social work through choosing to include only research containing the verbatim words of trans people speaking on this subject. Ensuring that the content platforms trans voices requires that this review be primarily based on qualitative sources. Within qualitative research, ‘small facts speak to larger issues’ and conclusions are created at a macro level through micro-level observations and the ‘particulars’ of people’s perspectives and experiences (Geerz, quoted in Shaw and Holland, 2014: 4).

Focusing solely on trans voices is a step towards promoting literature that employs empowering methods, as suggested within a proposed research agenda for the field of ‘trans studies’ (Hill, 2005). Hill (2005, p.107) states that empowering methods include those that ‘maximize trans people’s power’. This is particularly reflected through the inclusion of a participatory action research study with trans* youth (Asakura et al, 2020) and a collaborative and participatory qualitative research article exploring trans men’s lived experiences (Taylor, 2013). Ideally, this review would have been based solely on research devised and conducted by trans researchers; however, there are very few studies of this nature in the area of social work (Rosenberg and Tilley, 2020). When addressing ethics, there are also questions around which trans voices are being platformed – which arguably undermines the notion of empowering methods (addressed under ‘limitations’). While the inclusion of first-person testimony from trans people does not ensure the ‘empowering’ or collaborative nature of a study, it at least allows conclusions to be drawn based primarily on the documented voices of trans people.

Findings: what areas must be addressed within social work practice in order to promote anti-oppressive social work?

No information, misinformation and discrimination

The literature unanimously observes a lack of knowledge around trans identities within social work practice. This was recognised on a personal (Taylor, 2013; Siverskog, 2014; Rogers, 2016; Ahmed and Rogers, 2017), organisational (Taylor, 2013; Rogers, 2016) and systemic level (Taylor, 2013; Siverskog, 2014; Asakura et al, 2020). For example, a participant in the Ahmed and Rogers (2017: 234) study notes: ‘but they didn’t understand the gender side of it whatsoever’.

While the research describes a general omission of trans knowledge within social work practice, two studies provide broader context of cultural consciousness within this area, acknowledging misinformation and misrepresentation within contemporary media, which informs the interactions of trans people across all contexts (Siverskog, 2014; Asakura et al, 2020). In their qualitative study of the experiences of trans older adults, Siverskog (2014) states that while trans people are increasingly present within Swedish media, this has often been related to entertainment. Siverskog (2014) states that this has not translated into greater understanding of trans people and that there is still a general confusion around gender identity, even within LGBTQ+ contexts. In their article documenting a participatory action research study with trans young people, Asakura and colleagues (2020: 4) put forward that trans people are largely invisible in the media, and where they are seen, they are presented as stereotypes constructed by the ‘hegemonic power’. The authors explain that (when present) representations of trans people are inadequate and problematic, and they call for further ‘scholarly engagement’ in this area to challenge negative attitudes and contribute to shifting the discourse, policies and service availabilities for trans people (Asakura et al, 2020: 4). These observations imply that society at large is generally misinformed about trans people, or not informed at all.

Several studies depict accounts of individual practitioners’ lack of competence in transgender identities, stating that this is disempowering to service users (Ahmed and Rogers, 2017), affects the quality of their relationships with professionals (Taylor, 2013) and undermines their confidence in accessing services (Taylor, 2013; Rogers, 2016). Some describe how, at times, a deficiency in their understanding left practitioners unsure in the moment and/or unwilling to provide the necessary support to people using services (Rogers, 2016; Ahmed and Rogers, 2017).

Rogers’ (2016) study into the barriers trans people face in accessing domestic abuse services in the UK describes services’ lack of knowledge around trans identities and how this might prevent or impede people accessing support. Despite a commitment from individual practitioners and agencies to improve this, training was rarely provided or maintained. Service user respondents still perceived practitioners as not knowing, or as assuming, what their needs were. This was cited by the survivors interviewed as partially responsible for none of them having accessed services while experiencing domestic abuse (Rogers, 2016). Indeed, the inexperience and inaccessibility of the services discussed is evidenced in that none of the practitioners or agencies within this study has ever knowingly supported a trans person (Rogers, 2016). It is relevant to note that competency was also observed as a key barrier for trans people in need of medical care (Taylor, 2013).

Where knowledge is lacking within contexts of social work practice, research shows that trans people often feel that they must assume the position of educator within their relationships with practitioners and ‘dismantle misconceptions’ about trans people (Taylor, 2013; Siverskog, 2014: 396). Within Taylor’s (2013: 112) research into the experiences of trans men accessing healthcare, while describing the extra work undertaken by participants to access services, one respondent recounts tackling ignorance and misconceptions by approaching services ‘armed with … information’ in order to advocate for themselves. The study also reports the experience of being used as a tool for research by professionals, who saw trans patients as an opportunity for knowledge production while providing care. This experience is extended somewhat within Siverskog’s (2014) article through a participant’s story of a friend who had died after experiencing transphobia while in hospital, where she and her body had been ‘sensationalised’ by professionals.

Conversely, Asakura and colleagues (2020) describe an instance in which the burden of self-advocacy and education had been effectively reclaimed by trans people. The research process within this article had included collaborating to create art that would expand ‘the borders of knowledge and representation’ for a primarily cisgender audience (Asakura et al, 2020: 12). A young participant challenged assumptions about trans people through employing performance art. They describe the ‘liberating act’ of educating an ‘old[er] … white … and rich’ audience while reversing the ‘hostile gaze’ of feeling on display (Asakura et al, 2020: 11).

Siverskog (2014) writes of the conflation between transness and sexuality, and one respondent interviewed expressed a worry that ‘if [professionals] know something it is probably about homosexuals; trans people are, for most, rather unknown’ (Siverskog, 2014: 397). Related to this, Rogers (2016) also highlighted a common assumption that within the context of domestic violence, trans people are best supported by services specifically for LGBT people, when most respondents did not express a preference for this.

On a related note, Rogers’ (2016) study refers to discrimination in delineating the barriers faced by survivors who may otherwise access support in a domestic abuse context. A contributor describes a worry that services would blame them for ‘being trans’, referring to the perception of trans identities as a lifestyle choice (Rogers, 2016: 72). The research shows that respondents thought that this misconception negates their existence and would lead to transphobic practice. While Rogers (2016) concludes that there are individuals and services that are committed to increasing accessibility for trans survivors, the article states that domestic abuse settings are often (and more often assumed to be) exclusively for cis women – praxis that is ‘scaffolded’ by ignorance and transphobia.

This is linked to another idea within the article, that ‘many … [trans people] experience a lot of transphobia and harassment in … [their] day-to-day lives and come to expect it from services’ (Rogers, 2016). This study shows that past exposure to ignorance, discrimination and exclusion can, in itself, be a barrier to attempting to access support. Comparably, Siverskog (2014) explains how previous experiences of discrimination informed preconceptions of care provision and that this may deter older people from accessing services and contribute to worries around how they will be received when seeking support.

Self-definition and person-centred practice

Several articles draw on trans people’s experiences to explicitly highlight people’s right to self-definition and relate this to person-centred practice, correctly positing trans people as the experts of their own experience (Taylor, 2013; Siverskog, 2014; Rogers, 2016; Asakura et al, 2020). As a respondent in Asakura and colleagues’ (2020: 10) study expressed, ‘we have the power to define ourselves’.

For some, discrimination in this sense presented as a misplaced focus on their trans identity, and they resented being labelled by professionals. Polly, the subject of Ahmed and Rogers’ (2017: 235) study exploring the life story of one woman and the implications for research and practice, emphasised her expectations of social work and her identity by asking why she should ‘admit to being anything else but female’ once she had informed social workers and other professionals the gender she wanted to be addressed as. Similarly, respondents to Rogers’ (2016: 71) study felt that best practice meant not focusing on their transness, but for practitioners to just treat them as they would all women – not as ‘“trans” or other’. This was in opposition to procedures within domestic abuse support, which often focused unduly on their transness when assessing eligibility or social care needs (Rogers, 2016). Participants in Siverskog’s (2014) study feared situations in which they may face a lack of agency and have no recourse if the professionals around them did not acknowledge their correct gender or discriminated against them because of their gender identity: ‘He said “I’m not sure how I should deal with that”. I said “just treat me as another female. That’s what I am”’ (respondent quoted in Rogers, 2016: 74).

One participant explains that practitioners should never assume and should ask people directly how they would like to be addressed (Rogers, 2016); congruently, Siverskog’s (2014) article asserts clients’ absolute right to define their identity without assumptions or discrimination as crucial in supporting transgender people. The article states that the way this self-definition is approached is important in forming service users’ perceptions about whether they feel safe to be open about their identity (Siverskog, 2014: 402). Furthermore, within their discussion of ethical practice, Taylor’s work explicitly defines the concepts of ‘self-determination, self-definition, and self-actualization’ as principles of social work (Hick, quoted in Taylor, 2013: 116).

Social work and the gender binary

The majority of the research was concerned with the limitations posed by practice that operates under ‘binary understandings’ of gender – or practice that assumes people can only be male or female (Rogers, 2016: 72). Preceding their study of art as transformative practice, Asakura and colleagues cite previous research to argue that trans youth struggle on a daily basis due to people and organisations around them not recognising gender outside of the binary system (Asakura et al, 2020).

In Rogers’ (2016: 72) study, when exploring the access barriers posed by domestic abuse services that operate inflexibly within binary gender categories, one participant indicated that they would not access services because agencies providing support would want to categorise them as male, making them feel ‘very vulnerable’. The article emphasises that trans people do not engage with domestic abuse services, and vice versa, and attributes this, at least in part, to services’ determined attachment to binary thinking. Rogers explains that while there is government-level pressure for services to be ‘gender neutral’ and to recognise men as domestic abuse survivors, this does not translate into policy or practice at an organisational level that acknowledges the diversity of experiences and needs in the context of domestic abuse (Rogers, 2016: 75).

Moreover, Taylor (2013: 113) writes extensively on the oppressive nature of a professional resistance to the ‘non-binary complexities of … gender identity’ within medical service provision. Respondents to this study found that when they did not conform to contemporary colonial understandings of gender, they faced opposition from practitioners and were sometimes actively refused services. Practitioners’ judgements in this respect led respondents to modify or conceal their gender presentation within services in order to be more likely to receive care (Taylor, 2013). Analysis by Siverskog (2014: 401) reveals similar themes, documenting several experiences of people not receiving the affirming medical care that they were entitled to as they were not ‘considered to fit’ within the binary gender model. Service users perceived the service provision not as designed with them in mind, but as created as a means of ‘policing of gender and bodies’ (Siverskog, 2014: 398). This led to clients lacking trust in social welfare services and, as they aged, worrying about their future care needs.

This rapid review had intended to represent trans people indiscriminately as people using services, as social workers and as researchers. However, the results of the literature search found trans people almost exclusively represented as subjects of study and recipients of services. This is an inaccurate presentation of the community as ‘solely dependent … passive victim[s]’ (Asakura et al, 2020: 13) and arguably an extension of the pathologisation of the community (Markman, 2011). In addition to this, it is pertinent to observe that despite a long history of social advocacy (Feinberg, 1996), there was no research concerning trans people as social workers to be found. This highlights the positioning of trans people only as people using services and not, in line with my experience locally, as additionally over-represented among practitioners of social work and adjacent professions. There are several perspectives represented here but a great many voices that were not to be found.

Discussion

Implications for social work practice and education

In 2017, a study was undertaken in the UK into the preparedness of students of social work to practise with sexual and gender minority communities (Inch, 2017). This research found that, when questioned, all students were unsure about how prepared they were to work with trans people (Inch, 2017). While the study was small, it is at least indicative that there is a real gap in professional confidence as social workers approach qualification into qualified practice. It is no surprise, then, that the findings of this review unanimously reiterate a lack of knowledge as a barrier to anti-oppressive practice. In relation to recommendations made around education training in LGBTQ+ ‘issues’, Social Work England (SWE, 2021) recently recognised the need to address these ‘perceived’ gaps and to ‘continue these conversations’. However, despite ample evidence to support the need for change, there has been little urgency in addressing the absence of relevant course content or the ‘preparedness’ of practitioners.

In order that social work practice adhere to professional standards in relation to social justice and inclusion (SWE, 2020a: para 1.6), it is imperative (more so than aspirational) to ensure that all practitioners are provided the opportunity to develop a holistically competent approach and confidence in their readiness to practise. This might be achieved through inclusive education within qualifying social work courses specifically around trans identities and affirmative practice, as well as by the provision of training and education for qualified practitioners, both within the workplace and as a requirement for continuing professional development (CPD) (SWE, 2021). Furthermore, it would be beneficial to take steps to responsibly include trans people (alongside other marginalised communities) within discussions of practice and case studies across the social work syllabus. Within this, people should be encouraged to reflect upon their own identities and relationships with gender as an element of personal and professional development. This could contribute to an affirmative teaching environment, as well as reflecting society as it is. Naturally, it would be paramount to ensure that course content is created in association with (paid) trans people and is far removed from damaging stereotypes and misinformation that could contribute to, rather than erode, oppressive practice.

When considering misinformation, the content of the findings touches upon the global misrepresentations of trans people in culture and media, and how this contributes to transphobia and discrimination experienced by people who may access services (Siverskog, 2014; Asakura et al, 2020). Within a UK context, this is no doubt exacerbated exponentially by a vocal collection of journalists, politicians and academics who broadcast and publish misinformed and misinformative anti-trans ideas. As the relative ‘visibility’ of trans communities has notably increased (Stephens and Sellberg, 2019), a transphobic rhetoric has been adopted by a white, middle-class minority in the UK and has played out extensively across the press, social media, academia and legislation (Pearce et al, 2020). Although too intricate and broad a timeline to summarise in full, suffice to say that in recent years, the UK has seen an ongoing ideological and material attack on trans people’s rights and lives.

This rhetoric has been echoed within social work circles in the UK. This was exemplified recently when an article published by a mainstream social care news platform described transphobia as a ‘brave’ and admirable stance to take in the social work classroom (Fenton, 2021). While arguably a ‘vexing diversion’ of attention and energy from the ‘more pressing priorities’ of the community (Pearce et al, 2020: 885), this form of interference significantly obstructs the provision of equitable services and support for women and other trans people in the UK (Pearce et al, 2020), and has arguably contributed extensively to a large upswing in targeted transphobic violence (Bradley, 2020; Pearce et al, 2020).

Findings within this review demonstrate that trans people experience multi-level discrimination through social work and that, for some, the expectation of transphobia alone is enough of a barrier to attempting to access services at all. While this bears exploration specific to the UK, the national prevalence of transphobia would indicate that these findings are at least accurate in this context, if not an underestimation of the prejudice experienced by the UK’s trans population through interaction with social work. It goes without saying, then, that social workers should endeavour to help cultivate and protect the safety of trans people, not the violence they experience.

The next recommendation of this article, then, is more so a reiteration of social work values and ethics. Social workers practise with people on an individual level, while interacting with powerful centralised organisations (and often gatekeeping) at a systemic level. They also have a remit to advocate for and empower the people they work with. There is certainly an argument to say that social workers are ‘ethically obligated and uniquely situated’ to learn about and work to eradicate oppression faced by trans people (Burdge, quoted in Markman, 2011: 315; see also Lerner and Robles, 2016).

Guidance on Social Work England’s professional standards asks that practitioners commit to preventing discrimination and ‘pursue positive change, particularly with and on behalf of people … who are … facing oppression’ (SWE, 2020b: paras 1.5, 1.6). Both the International Federation of Social Workers (IFSW) and the British Association of Social Workers (BASW) specifically dictate that social workers should challenge discrimination on the basis of gender identity among several listed characteristics (BASW, 2018; IFSW, 2018).

A commitment to social work values should undoubtedly translate into anti-oppressive practice at an individual level. Moreover, once duly informed in ideas around gender identity and the experiences of trans people of intersecting identities, social work students/practitioners/academics ought to demonstrate a reinforced commitment to their responsibility to educate and challenge individuals, organisations and structures engaged in oppressive practice and discrimination. In addition to tackling discrimination in action, taking a loud, visible and informed stance on supporting trans people can create an affirming environment that people are more likely to feel safe to access (TOP, 2019). This could reduce the barriers to services and promote the employment and retention of trans professionals. Moreover, social workers as educated advocates in practice will serve to reduce the onus on trans people to self-advocate (Taylor, 2013) and will decrease the need to educate others (Taylor, 2013; Siverskog, 2014).

The majority of the findings denote a professional opposition to engaging with the ‘non-binary complexities of … gender identity’ (Taylor, 2013) and make the point that it is impossible to include trans people within social work if it is designed to exclude those of non-binary identities. Arguments have been made for social workers to reject hegemonic ideas of dichotomous gender in favour of a social-constructivist approach (Burdge, 2007; Markman, 2011; Taylor, 2013). This recognises that the male–female gender binary is a new, colonial construct and creates space in its understanding for those of all genders without discrimination. Derived from experience and the findings of this review, it is a further recommendation and observation that it is within the remit of social justice that as social workers, we must undertake ‘more accurate and affirming conceptualizations of gender’ and challenge those individuals and organisations who would exclude people or discriminate on this basis (Burdge, 2007: 243).

Finally, a key implication of this review is a reminder of the importance of holistic and person-centred practice when working alongside anyone as a social worker (BASW, 2018: para 2.1), as well as an approach that positions people as experts by experience (CQC, 2020). The findings of this review clearly connect this concept to the ‘power [of trans people] to define [them]selves’ (respondent quoted in Asakura et al, 2020: 10). It is a necessity for practitioners to listen to the people they are working alongside and to become accustomed to asking, not assuming, when it comes to people’s identities.

Implications for research

It is particularly significant that a literature search of this remit produced only five articles and that only a small minority among these appear to have been authored by trans people themselves. Further to this, the existing research relates primarily to the experiences of white and able-bodied people. Given the significance placed on person-centred practice and co-production in social work (BASW, 2018; IFSW, 2018; SWE, 2020a), it is surprising that there has been truly little engagement with, or platform for, the experiences of all trans people in developing practice understanding through research. Furthermore, bias in the literature fails to present or duly celebrate the trans community holistically – as multifaceted in their strength, joy and rage as in their systemic vulnerability.

As previously noted, there is an absence of the voices of trans social workers within research. As a trans student, this has been felt quite profoundly over the course of my professional development. I feel that I would have benefited substantially from a community voice within the literature. This deficit also came as a surprise due to my experiences of my community as necessarily engaged in mutual aid, community support and social justice action, both professionally and personally. There is an element of disempowerment and inauthenticity in the placement of trans people within the literature as solely those who engage with services and not those who, as is so often the case, are the ones to provide them.

There is much that can be inferred from this exploratory review in regard to developing anti-oppressive social work practice. However, it is hoped that it also serves to highlight the omissions within research relating trans people and social work. There have been several arguments put forward for further general research in this area (Taylor, 2013; Siverskog, 2014; Nothdurfter and Nagy, 2016; WEC, 2016, 2019; Inch, 2017; DfE, 2018). This review also recommends further ethical research in this area, both produced by and with trans people, with the provision that this research centre those experiencing intersecting oppression, including trans women, Black trans people, trans people of colour, disabled trans people and those of holding other marginalised identities. Finally, it is the hope that further research will include the experiences and perspectives of trans practitioners of social work. Indeed, there is ‘much to learn from the [trans] community about courage, resilience, authenticity, and social justice’ (Burdge, 2007: 249).

Conclusion

In summary, this rapid review has found several recommendations for anti-oppressive social work that includes trans people, as derived from the literature. These are as follows: the introduction of responsible education around (and including) trans identities within qualifying social work courses and professional environments; the initiation of visible commitment within social work to tackling transphobia on an individual, organisational and systemic level; taking steps in understanding and engaging practice beyond a binary comprehension of gender; and a person-centred and holistic approach to social work, which promotes and supports people in self-identifying. In parallel to this, this exploratory article serves to highlight several areas in which there is a lack of research that could significantly contribute to social work and professional development on a national and global platform.

Although similar recommendations have been made in research previously, and comparable proposals exist across the literature that formed this review, there has been little urgency in their implementation. This review was undertaken over 2020–21 in the context of the COVID-19 pandemic, which has served to further highlight the increasing precarity of trans lives in the UK (Pearce et al, 2020). One can hope that these ‘conversations’ soon become action in support of anti-oppressive social work that includes trans people in the UK (SWE, 2021).

Acknowledgements

This article would not have been possible without the exceptional support of my academic advisor and mentor Dr Reima Ana Maglajlic (University of Sussex). Dr Maglajlic provided essential practical editorial input, as well as research supervision and fierce support and encouragement, for which I am really grateful. I would also like to say thank you to Dr Michelle Lefevre (University of Sussex) for her input and support as supervisor on my undergraduate dissertation, which formed the basis of this article. Thanks go also to my colleague, Lorne Power, for their feedback and advice when approaching publication. Final acknowledgement must be to trans practitioners and students of social work; many more of whom I have been lucky to meet since completing this article in 2021. It is our nature to build communities that serve our community, regardless of the climate in which we find ourselves. I am grateful to be a member of this burgeoning iteration.

Conflict of interest

The author declares that there is no conflict of interest.

References

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    • Search Google Scholar
    • Export Citation
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    • Search Google Scholar
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    • Search Google Scholar
    • Export Citation
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    • Search Google Scholar
    • Export Citation
  • Austin, A., Craig, S.L., Dentato, M.P., Roseman, S., McInroy, L. (2019) Elucidating transgender students’ experiences of microaggressions in social work programs: next steps for creating inclusive educational contexts, Social Work Education, 38(7): 90824. doi: 10.1080/02615479.2019.1575956

    • Search Google Scholar
    • Export Citation
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    • Search Google Scholar
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    • Search Google Scholar
    • Export Citation
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    • Search Google Scholar
    • Export Citation
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    • Search Google Scholar
    • Export Citation
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    • Search Google Scholar
    • Export Citation
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    • Search Google Scholar
    • Export Citation
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    • Search Google Scholar
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    • Search Google Scholar
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    • Search Google Scholar
    • Export Citation
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    • Search Google Scholar
    • Export Citation
  • IFSW (International Federation of Social Workers) (2018) Global social work statement of ethical principles, www.ifsw.org/global-social-work-statement-of-ethical-principles/

    • Search Google Scholar
    • Export Citation
  • Inch, E. (2017) Are you ready? Qualifying social work students’ perception of their preparedness to work competently with service users from sexual and gender minority communities, Social Work Education, 36(5): 55774. doi: 10.1080/02615479.2016.1237628

    • Search Google Scholar
    • Export Citation
  • Lerner, J., Robles, G. (2016) The need for social work advocacy to create social justice for transgender people: a call to action, The Journal of Sociology & Social Welfare, 43(1), https://scholarworks.wmich.edu/jssw/vol43/iss1/2

    • Search Google Scholar
    • Export Citation
  • Markman, E.R. (2011) Gender identity disorder, the gender binary, and trans­gender oppression: implications for ethical social work, Smith College Studies in Social Work, 81(4): 31427. doi: 10.1080/00377317.2011.616839

    • Search Google Scholar
    • Export Citation
  • Matsuzaka, S., Koch, D.E. (2019) Trans feminine sexual violence experiences: the intersection of transphobia and misogyny, Affilia, 34(1): 2847, doi: 10.1177/0886 109918790929.

    • Search Google Scholar
    • Export Citation
  • Nothdurfter, U., Nagy, A. (2016) Few and far from radical? LGBT-related contributions in European social work journal publishing, The British Journal of Social Work, 46(8): 222744. doi: 10.1093/bjsw/bcw140

    • Search Google Scholar
    • Export Citation
  • Ontario Government (2019) Gender confirming surgery, www.ontario.ca/page/gender-confirming-surgery

  • Orme, J. and Shemmings, D. (2010) Developing Research Based Social Work Practice, Basingstoke: Palgrave.

  • Pearce, R., Erikainen, S. and Vincent, B. (2020) Afterword: TERF wars in the time of COVID-19, The Sociological Review, 68(4): 8828. doi: 10.1177/0038026120934712

    • Search Google Scholar
    • Export Citation
  • Rogers, M. (2016) Breaking down barriers: exploring the potential for social care practice with trans survivors of domestic abuse, Health & Social Care in the Community, 24(1): 6876.

    • Search Google Scholar
    • Export Citation
  • Rosenberg, S., Tilley, P.J.M. (2021) ‘A point of reference’: the insider/outsider research staircase and transgender people’s experiences of participating in trans-led research, Qualitative Research, 21(6): 923938. doi: 10.1177/1468794120965371.

    • Search Google Scholar
    • Export Citation
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    • Search Google Scholar
    • Export Citation
  • Siverskog, A. (2014) ‘They just don’t have a clue’: transgender aging and implications for social work, Journal of Gerontological Social Work, 57(24): 386406. doi: 10.1080/01634372.2014.895472

    • Search Google Scholar
    • Export Citation
  • Stephens, E., Sellberg, K. (2019) The somatechnics of breath: trans* life at this moment in history: an interview with Susan Stryker, Australian Feminist Studies, www.tandfonline.com/doi/full/10.1080/08164649.2019.1605490

    • Search Google Scholar
    • Export Citation
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  • SWE (2020b) Professional standards guidance, www.socialworkengland.org.uk/standards/standards-guidance/professional-standards-guidance/

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    • Search Google Scholar
    • Export Citation
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    • Search Google Scholar
    • Export Citation
  • Tompkins, A. (2014) Asterisk, TSQ Transgender Studies Quarterly, 1(1–2): 2627, doi: 10.1215/23289252-2399497.

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    • Search Google Scholar
    • Export Citation
  • Valentine, D. (2007) Imagining Transgender: An Ethnography of a Category, Durham: Duke University Press.

  • Vincent, B.W. (2018) Studying trans: recommendations for ethical recruitment and collaboration with transgender participants in academic research, Psychology & Sexuality, 9(2): 10216.

    • Search Google Scholar
    • Export Citation
  • WEC (Women and Equalities Committee) (2016) Transgender equality, first report of session 2015–2016, House of Commons, https://publications.parliament.uk/pa/cm201516/cmselect/cmwomeq/390/390.pdf

    • Search Google Scholar
    • Export Citation
  • WEC (2019) Health and social care and LGBT communities, House of Commons, https://publications.parliament.uk/pa/cm201919/cmselect/cmwomeq/94/94.pdf

    • Search Google Scholar
    • Export Citation
  • Wilkinson, S., Kitzinger, C. (2013) Representing our own experience: issues in ‘insider’ research, Psychology of Women Quarterly, 37(2): 2515. doi: 10.1177/0361684313483111

    • Search Google Scholar
    • Export Citation
  • Witten, T.M. (2014) End of life, chronic illness, and trans-identities, Journal of Social Work in End-of-Life & Palliative Care, 10(1): 3458.

    • Search Google Scholar
    • Export Citation
  • Acker, G.M. (2017) Transphobia among students majoring in the helping professions, Journal of Homosexuality, 64(14): 201129. doi: 10.1080/00918369.2017.1293404

    • Search Google Scholar
    • Export Citation
  • Ahmed, A. and Rogers, M. (2017) Polly’s story: using structural narrative analysis to understand a trans migration journey, Qualitative Social Work: Research and Practice, 16(2): 22439. doi: 10.1177/1473325016664573

    • Search Google Scholar
    • Export Citation
  • Amnesty International (2020) LGBTI equality, www.amnesty.org.uk/LGBTI-equality

  • Asakura, K., Lundy, J., Black, D., Tierney, C. (2020) Art as a transformative practice: A participatory action research project with trans* youth, Qualitative Social Work, 19(5–6): 10611077. doi: 10.1177/1473325019881226.

    • Search Google Scholar
    • Export Citation
  • Austin, A., Craig, S.L., McInroy, L.B. (2016) Toward transgender affirmative social work education, Journal of Social Work Education, 52(3): 297310. doi: 10.1080/10437797.2016.1174637

    • Search Google Scholar
    • Export Citation
  • Austin, A., Craig, S.L., Dentato, M.P., Roseman, S., McInroy, L. (2019) Elucidating transgender students’ experiences of microaggressions in social work programs: next steps for creating inclusive educational contexts, Social Work Education, 38(7): 90824. doi: 10.1080/02615479.2019.1575956

    • Search Google Scholar
    • Export Citation
  • BASW (British Association of Social Workers) (2018) Code of ethics, www.basw.co.uk/about-basw/code-ethics

  • Bell, L. (2017) Research Methods for Social Workers, London: Palgrave.

  • Bradley, C. (2020) Transphobic Hate Crime Report 2020, London: Galop, https://galop.org.uk/resource/transphobic-hate-crime-report-2020/

  • Braun, V., Clarke, V. (2006) Using thematic analysis in psychology, Qualitative Research in Psychology, 3(2): 77101. doi: 10.1191/1478088706qp063oa

    • Search Google Scholar
    • Export Citation
  • Burdge, B.J. (2007) Bending gender, ending gender: theoretical foundations for social work practice with the transgender community, Social Work, 52(3): 24350. doi: 10.1093/sw/52.3.243

    • Search Google Scholar
    • Export Citation
  • Capous-Desyllas, M., Barron, C. (2017) Identifying and navigating social and institutional challenges of transgender children and families, Child and Adolescent Social Work Journal, 34(6): 52742. doi: 10.1007/s10560-017-0491-7

    • Search Google Scholar
    • Export Citation
  • Chavez, C. (2008) Conceptualizing from the inside: advantages, complications, and demands on insider positionality, The Qualitative Report, 13(3): 47494.

    • Search Google Scholar
    • Export Citation
  • Corbin Dwyer, S., Buckle, J. (2009) The space between: on being an insider-outsider in qualitative research, International Journal of Qualitative Methods, 8(1): 5463. doi: 10.1177/160940690900800105

    • Search Google Scholar
    • Export Citation
  • CQC (Care Quality Commission) (2020) Experts by experience, www.cqc.org.uk/about-us/jobs/experts-experience

  • Crisp, B.R. (2015) Systematic reviews: a social work perspective, Australian Social Work, 68(3): 28495. doi: 10.1080/0312407X.2015.1024266

    • Search Google Scholar
    • Export Citation
  • De Vries, K.M. (2015) Transgender people of color at the center: conceptualizing a new intersectional model, Ethnicities, 15(1): 327. doi: 10.1177/1468796814547058

    • Search Google Scholar
    • Export Citation
  • DfE (Department for Education) (2018) Transgender awareness in child and family social work, www.gov.uk/government/publications/transgender-awareness- in-child-and-family-social-work

    • Search Google Scholar
    • Export Citation
  • Feinberg, L. (1996) Transgender Warriors: Making History from Joan of Arc to Dennis Rodman, Boston, MA: Beacon Press.

  • Fenton, J. (2021) The case for promoting free speech, debate and enquiry in the social work classroom, Community Care, 23 April, www.communitycare.co.uk/2021/04/23/case-promoting-free-speech-debate-enquiry-social-work-classroom/

    • Search Google Scholar
    • Export Citation
  • GEO (Government Equalities Office) (2016) Government response to the Women and Equalities Committee report on transgender equality, UK Parliament, https://www.gov.uk/government/publications/transgender-equality-report-government-response

    • Search Google Scholar
    • Export Citation
  • GI (Gendered Intelligence) (2020) Understanding gender diversity in creative ways, http://genderedintelligence.co.uk/

  • Grant, M.J., Booth, A. (2009) A typology of reviews: an analysis of 14 review types and associated methodologies, Health Information & Libraries Journal, 26(2): 91108. doi: 10.1111/j.1471-1842.2009.00848.x

    • Search Google Scholar
    • Export Citation
  • Hill, D.B. (2005) Trans/gender/sexuality: a research agenda, Journal of Gay & Lesbian Social Services, 18(2): 1019.

  • Hord, L. (2018) The radical truths of transgender studies, TEDx, https://www.ted.com/talks/levi_hord_the_radical_truths_of_transgender_studies

    • Search Google Scholar
    • Export Citation
  • IFSW (International Federation of Social Workers) (2018) Global social work statement of ethical principles, www.ifsw.org/global-social-work-statement-of-ethical-principles/

    • Search Google Scholar
    • Export Citation
  • Inch, E. (2017) Are you ready? Qualifying social work students’ perception of their preparedness to work competently with service users from sexual and gender minority communities, Social Work Education, 36(5): 55774. doi: 10.1080/02615479.2016.1237628

    • Search Google Scholar
    • Export Citation
  • Lerner, J., Robles, G. (2016) The need for social work advocacy to create social justice for transgender people: a call to action, The Journal of Sociology & Social Welfare, 43(1), https://scholarworks.wmich.edu/jssw/vol43/iss1/2

    • Search Google Scholar
    • Export Citation
  • Markman, E.R. (2011) Gender identity disorder, the gender binary, and trans­gender oppression: implications for ethical social work, Smith College Studies in Social Work, 81(4): 31427. doi: 10.1080/00377317.2011.616839

    • Search Google Scholar
    • Export Citation
  • Matsuzaka, S., Koch, D.E. (2019) Trans feminine sexual violence experiences: the intersection of transphobia and misogyny, Affilia, 34(1): 2847, doi: 10.1177/0886 109918790929.

    • Search Google Scholar
    • Export Citation
  • Nothdurfter, U., Nagy, A. (2016) Few and far from radical? LGBT-related contributions in European social work journal publishing, The British Journal of Social Work, 46(8): 222744. doi: 10.1093/bjsw/bcw140

    • Search Google Scholar
    • Export Citation
  • Ontario Government (2019) Gender confirming surgery, www.ontario.ca/page/gender-confirming-surgery

  • Orme, J. and Shemmings, D. (2010) Developing Research Based Social Work Practice, Basingstoke: Palgrave.

  • Pearce, R., Erikainen, S. and Vincent, B. (2020) Afterword: TERF wars in the time of COVID-19, The Sociological Review, 68(4): 8828. doi: 10.1177/0038026120934712

    • Search Google Scholar
    • Export Citation
  • Rogers, M. (2016) Breaking down barriers: exploring the potential for social care practice with trans survivors of domestic abuse, Health & Social Care in the Community, 24(1): 6876.

    • Search Google Scholar
    • Export Citation
  • Rosenberg, S., Tilley, P.J.M. (2021) ‘A point of reference’: the insider/outsider research staircase and transgender people’s experiences of participating in trans-led research, Qualitative Research, 21(6): 923938. doi: 10.1177/1468794120965371.

    • Search Google Scholar
    • Export Citation
  • Shaw, I. and Holland, S. (2014) Doing Qualitative Research in Social Work, London: SAGE Publications.

  • Shelton, J. (2016) Reframing risk for transgender and gender-expansive young people experiencing homelessness, Journal of Gay & Lesbian Social Services, 28(4): 27791.

    • Search Google Scholar
    • Export Citation
  • Siverskog, A. (2014) ‘They just don’t have a clue’: transgender aging and implications for social work, Journal of Gerontological Social Work, 57(24): 386406. doi: 10.1080/01634372.2014.895472

    • Search Google Scholar
    • Export Citation
  • Stephens, E., Sellberg, K. (2019) The somatechnics of breath: trans* life at this moment in history: an interview with Susan Stryker, Australian Feminist Studies, www.tandfonline.com/doi/full/10.1080/08164649.2019.1605490

    • Search Google Scholar
    • Export Citation
  • SWE (Social Work England) (2020a) Professional standards, www.socialworkengland.org.uk/standards/professional-standards/

  • SWE (2020b) Professional standards guidance, www.socialworkengland.org.uk/standards/standards-guidance/professional-standards-guidance/

  • SWE (2021) Improving social work’s engagement with LGBTQ+ people, www.socialworkengland.org.uk/news/improving-social-works-engagement-with-lgbtqplus-people/

    • Search Google Scholar
    • Export Citation
  • Taylor, E.T. (2013) Transmen’s health care experiences: ethical social work practice beyond the binary, Journal of Gay & Lesbian Social Services, 25(1): 10220.

    • Search Google Scholar
    • Export Citation
  • Tompkins, A. (2014) Asterisk, TSQ Transgender Studies Quarterly, 1(1–2): 2627, doi: 10.1215/23289252-2399497.

  • TOP (The Outside Project) (2019) Supporting LGBTIQ+ homeless people in London, Homeless Link, https://homeless.org.uk/connect/blogs/2019/may/14/outside-project-supporting-lgbtiq-homeless-people-in-london

    • Search Google Scholar
    • Export Citation
  • Valentine, D. (2007) Imagining Transgender: An Ethnography of a Category, Durham: Duke University Press.

  • Vincent, B.W. (2018) Studying trans: recommendations for ethical recruitment and collaboration with transgender participants in academic research, Psychology & Sexuality, 9(2): 10216.

    • Search Google Scholar
    • Export Citation
  • WEC (Women and Equalities Committee) (2016) Transgender equality, first report of session 2015–2016, House of Commons, https://publications.parliament.uk/pa/cm201516/cmselect/cmwomeq/390/390.pdf

    • Search Google Scholar
    • Export Citation
  • WEC (2019) Health and social care and LGBT communities, House of Commons, https://publications.parliament.uk/pa/cm201919/cmselect/cmwomeq/94/94.pdf

    • Search Google Scholar
    • Export Citation
  • Wilkinson, S., Kitzinger, C. (2013) Representing our own experience: issues in ‘insider’ research, Psychology of Women Quarterly, 37(2): 2515. doi: 10.1177/0361684313483111

    • Search Google Scholar
    • Export Citation
  • Witten, T.M. (2014) End of life, chronic illness, and trans-identities, Journal of Social Work in End-of-Life & Palliative Care, 10(1): 3458.

    • Search Google Scholar
    • Export Citation
  • 1 University of Sussex, , UK

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