"Supported Loving" Critique of a webinar claiming to offer guidance on supporting autistic and/or learning disabled people who "identify as transgender".

A COMMENT BY EBSWA MEMBER MIRIAM B

"...a subjective, personal view on how social care professionals should interact with trans people based on the speaker's personal wishes and preferences."

There was little context provided. Throughout the training it was assumed that a wide range of people would require support to be trans and that social workers and carers would be involved in this. However, it also discussed the workplace and other environments in which trans people would not be likely to have the kind of care and advocacy assumed at other times. 

There was no discussion about when or why being autistic might overlap with learning disability, or what other kinds of diagnosis or presentation they were referring to by learning disability. 

The definition of transgender that was advocated for in this webinar was extremely broad and included anybody who identifies away from their birth sex. The causes were not explored. It was taken as indisputable that a divergent relationship to the sexed body and the primacy of a divergent sense of self is fundamental to authenticity. Gender distress was not a requirement. Gender identities were described as innumerable as stars in a galaxy, rendering the notion of a single category somewhat redundant. The speaker emphasised throughout the webinar that the aim in supporting trans people is to facilitate them being their authentic selves. It was proposed that autistic trans people are more authentic in their gender identities and presentations due to resisting historic pressures to present as the opposite sex to access a medical pathway, but beyond this, it was not explored as to why trans people are 6x more likely to be autistic. 

There were significant internal contractions.  It was described that many trans identifying people encounter a "catalyst" for transition. The significance of this underpinned the view endorsed by the speaker that all people, with learning disabled people as the focal point, should be exposed to a wide range of materials and stories about transgender identities and people so as to ensure they are exposed to potential catalysts. This suggests that, from the speaker's point of view, an external stimulus is essential for becoming trans.  At the same time, the webinar stated that being trans is not related to social influence, and that it is infantilising to autistic and people with learning disabilities to suggest identifying as trans could be responsive to influence rather than internally motivated. 

Throughout the webinar, it was presented that affirming the trans person's identity was the only manner of interaction that would be considered supportive and non-prejudicial. 

It acknowledged the significance of family relationships with the view that the family too must affirm, and when working with families who do not affirm a person's identify, the social care worker was reminded that 'you work for the trans person, not for their family'. As it appeared to be discussing adults with autism and learning needs, the ramifications of family dynamics concerning children are unclear. However, it is notable that there was no consideration given for any frameworks in which families may have greater influence over an adults decisions such as Adult Guardianship Orders or Deprivation of Liberty Orders. It was recognised that the advice to recognise a person's capacity and self-determination would be the aims of supporting them, but there was no discussion about how to consider when and whether this might not be the case. 

There was considerable minimisation of the risks associated with co-morbid mental health concerns in the trans-population. Anxiety, self-harm and suicidality were all mentioned with a supposed causal relationship with not being sufficiently supported in one's trans identity. It was stated that GPs should provide hormones during long waiting times to minimise mental health risks. Medicalisation was generally not endorsed, with the speaker considering that taking a medical pathway as part of transition would not be right for many people. That being said, the speaker was clear that once medical transition had been undertaken, the regret rate is 1%, comparing it with a 14% regret rate in other surgeries. In light of the Cass review and the clear landscape of minimal follow up, it is understood that the regret rate of medical transition is not known and this is misleading and reckless  information. Furthermore, genital surgery for males to undergo vaginaplasty was described as "simple", and in relation to recommendations on how to safely experiment with gender presentation, it was advised that some binders are "reputable". The benchmark used for dangerous binding practises was duct tape. On the other hand, the risks of hate crime for being trans and autistic were pinpointed as a particular support need that social care workers would need to support with. 

Another clear aim of the webinar was to endorse accessible information and reading materials to people with autism and/or learning disability. They were not able to provide examples and advised making your own. This was due to the CAHMS easy read materials being confusing for trans people with learning disabilities because they state that "men have penises and women have vaginas". It was not clear what kind of explanation of being transgender would be clear and not confusing, if it can be assumed that the highly metaphorical definition provided by the speaker might not always be suitable. 

In response to a question at the end, the speaker acknowledged that holding gender critical views is legal but should not lead to discrimination in practice. The speaker went on to conflate not discriminating with being actively inclusive which goes beyond the law in what employers or employees are required to do. There was a strong suggestion that if a social care employee holds gender critical views in an environment where supporting trans people may arise as part of the job, they should be asked to seek employment in a different team. This was discussed alongside more concrete examples such as a Christian social care worker not wanting to support a trans person with learning disability to access an LGBT community setting directly, but there was little distinction made between this kind of explicit personal objection to a practical work task, and discussing the welfare or assessing the needs of a trans identifying person with autism or learning disability. 

Training was suggested as a way of creating inclusive environments in anticipation of colleagues or service users coming out as trans, and that trainers should always have lived experiences of being trans. What kind of support trans people with autism and learning disabilities needed was based, enthusiastically, on unpublished research, which was presented as though an exciting preview, rather than un-moderated. The key need repeatedly came back to affirmation. However, the speaker did say that when considering how to practise with trans people with autism or learning disability, social workers should look to the law to ground their practice. While this could be as simple as promoting self-determination, the difficulty of how this might be achieved depending on the needs of a heterogenous population of autistic people and/or those with learning disabilities was not discussed. It was considered that any alternative to affirmation would force masking or not coming out as trans. 

There is an online community of trans and non-binary social care workers. There was an implicit connotation that discovering one's trans identity gains entry into a broadly defined community of shared, but unique, experiences which can support people to become an authentic version of themselves. There was some recognition that people who do not have trans identities may not be comfortable with gender expectations or might present equivalently diversely in gender presentation as trans people. The distinguishing characteristic is the manner of identifying. 

Overall, it was a subjective, personal view on how social care professionals should interact with trans people based on the speaker's personal wishes and preferences. There was minimal engagement with legal frameworks or in depth understanding of the shifting landscape around trans healthcare. There was little discussion of the challenges around consent, support and capacity for adults with complex needs, and the ability to easily recognise, promote and enable self-determination in these populations was assumed, despite the apparent context being those who need a care and/or social worker.