Employing dissemination and implementation science to promote mental health equity for transgender youth

Background: In recent years, the United States has witnessed increased transphobic rhetoric and legislation aimed at restricting the rights of transgender youth, ranging from banning transgender youth from school sports, to denying access to gender-affirming care. This climate has a detrimental impact on the mental health of transgender youth- a community that already experiences profound mental health risks due to their exposure to transphobia across multiple levels and in myriad settings. To combat transphobia and its negative effects on transgender youth's mental health, scientific studies and methods addressing multiple levels and forms of transphobia are needed. Discussion: We review research on negative impacts of multilevel transphobia on transgender youth mental health and the benefits of gender-affirming psychotherapy practices. We then describe how dissemination and implementation (D&I) science—the scientific study of multilevel strategies and methods that facilitate the uptake of effectives services—can be used to promote the mental health of transgender youth. We call for increased D&I research to support the mental health needs of transgender youth. We recommend two broad domains of D&I research: (1) identify, test, and scale effective services for transgender youth and (2) address contextual barriers to implementing these services- specifically, state-level laws/policies, and lack of access to gender-affirming psychotherapy. Methodological recommendations and example studies are included in each domain. Conclusions: To enhance mental health equity for transgender youth, we must leverage D&I science to identify, test and scale services that have been shown to be promising (e.g., acceptable and feasible) or effective for transgender youth based on empirical research, including qualitative, observational, and/or pilot studies, as well as randomized controlled trials. These research efforts should also address law/policy barriers through advocacy and policy dissemination research, and overcome lack of access to appropriate care via online/mobile interventions.