Acceptability: The extent to which clinic stakeholders perceive an innovation as agreeable, appropriate, and satisfactory.

Action Plan: A detailed plan that includes all the actions needed to meet a goal. In the context of this toolkit, the plan lays out the necessary steps for successful implementation of changes to increase access and quality care for SGM patients, along with a timeline, a list of people who will do the work, and implementation strategies to address barriers and facilitators.

Biphobia: Dislike of or prejudice against bisexual people.

Capacity: The ability of an organization or community to accomplish its goal through planning, solving problems, and starting new programs; collecting and using data; and evaluating its work.

Cisgender/Cis: People whose sex designated at birth matches their current gender. The term describes people who are not “transgender.”

Champion: An employee or community member dedicated to supporting change to improve some aspect of an organization’s operations. Champions can be part of the Implementation Team or work to garner support from other staff and community members. Champions are ideally people with some level of influence in an organization or the community it serves to assure that the desired change is successfully and sustainably implemented.

Feasibility: Relative ease or difficulty involved in realistically getting an innovation in place in the clinic.

Gender Affirmation/Transition: Processes that transgender and gender-diverse people engage in to live in their experienced gender more fully. This may include “social transition,” which involves changing the way the individual presents outwardly, through clothing, hair style, etc., and/or the use of a name and pronouns that reflect their experienced gender. Gender affirmation or transition can include the use of hormone therapy and/or surgery to bring an individual’s body into better alignment with their gender. Many young transgender people prefer the term “affirmation” to “transition” as it presents the process as a way of embodying a gender already present, rather than changing from one gender to another.

Gender-Affirming Care: Medical or behavioral health care that supports all people’s experience of gender, whether it matches their sex designated at birth. Depending on identity, age, or other individual characteristics, this may be as simple as using the name and pronouns preferred by the patient or may involve the prescription and provision of medical interventions, such as puberty blockers, hormone therapy, and surgeries.

Gender Binary: The concept that only two genders (i.e., male and female) exist or are valid.

Gender-Diverse/Expansive: People whose experience of gender falls outside the binary or who identify as something other than male or female. For many, use of gender-diverse or expansive replaces “gender nonconforming” and is preferred for describing variation in gender identity without defining it as outside the norm.

Gender Expression: The external characteristics and behaviors defined in society as  masculine, feminine, and androgenous, such as dress, grooming, mannerisms, speech patterns, and social interactions. This includes both things people choose to express and things like physical mannerisms that may be unconscious. People may express gender differently in various contexts, and their gender expression may or may not fully align with their gender or sex designated at birth.

Gender Identity: A person’s deeply-felt identification as male/man/boy, female/woman/girl, or something else. Gender identity may or may not correspond to the sex designated at birth.

Gender-Inclusive or Gender Neutral-Language: Inclusive and neutral language does not make assumptions about an individual’s gender identity, gender expression, or sexual orientation. Examples can include asking about someone’s “significant other” or “person you’re dating” instead of saying “boyfriend” or “girlfriend,” saying “students” instead of “boys and girls,” or simply using individuals’ names.

Gender Pronouns: Words that refer to people without using their names. Common gender pronouns include she/her/hers, he/him/his, and they/them/theirs. (Note that it is acceptable to use they/them/theirs as a singular pronoun.)

Health Disparity: Significant difference in overall health between two groups of people, usually due to systemic social or structural inequalities between genders, races, classes, or any other identity that may result in a decrease in power.

Heterosexual/Straight: Someone who is attracted to people of the opposite gender.

Homophobia: Fear, dislike, or discrimination against people based on non-heterosexual sexual orientations.

Homosexual/Gay: Someone who is attracted to people of the same gender. “Gay” is sometimes used to refer to gay men exclusively, with gay women referred to as “lesbians.”

Hormone Therapy: The use of hormones in medical treatment. Some transgender people use hormones to help align their bodies with their experienced gender.

Interphobia: Negative attitudes and feelings towards people who are believed to possess biological sex traits that are not typically male or female, known as Intersex Traits (whether they are actually born with them or simply exhibit non-binary gender identity or expression). Also known as intersexphobia.

Intersectionality: A term first coined by Kimberlé Crenshaw to describe the theory that the overlap of multiple social identities, such as race, gender, sexuality, and class, can amplify systemic oppression and discrimination experienced by individuals.

Implementation Leadership: Members of a clinic’s staff, including Implementation Team members, who are centrally involved in the process of implementing change. These leaders can either possess the power to affect change in an organization or have access to leaders with influence.

Implementation Strategy: A specific set of activities or methods for successful adoption and sustainment of new interventions.

Implementation Team: The individuals who help an organization or system establish a supportive environment and facilitates the implementation of evidence-based practices and effective innovations.

LGBTQ: Ever-growing acronym encompassing a non-homogenous community of people who are lesbian, gay, bisexual, transgender, and queer or questioning. Sometimes additional letters might include “I” for intersex and “A” for asexual. Here, the term is used interchangeably with SGM.

Organizational Assessment: A systematic process for obtaining information about the performance of an organization in many areas and the factors that affect its performance. This type of assessment focuses on the organization as the primary unit of analysis.

Minority Stress: Chronically high levels of stress faced by members of stigmatized minority groups. It may be caused by several factors, including poor social support and low socioeconomic status. Well understood causes of minority stress include interpersonal prejudice and discrimination.

Patient-Centered Health Care: Provision of care that is respectful of and responsive to individual patient histories, preferences, needs, and values and ensures that patient perspectives guide clinical decisions.

Plan-Do-Study-Act: A model for implementing change through an iterative process that involves planning, implementation, assessment, and adjustments in each cycle.

Pre-Exposure Prophylaxis (PrEP): An anti-retroviral medication prescribed to individuals at high risk for HIV before exposure to decrease the likelihood that they will contract the virus.

Post-Exposure Prophylaxis (PEP): An anti-retroviral medication prescribed to individuals who may have been exposed to HIV to prevent the development of HIV infection. Treatment must begin within 72 hours of exposure.

Puberty Blockers: Gonadotropin-releasing hormone (GnRH) agonists that stop the development of puberty by inhibiting the action of testosterone and estrogens. These medications can be used for several medical reasons, including the delay of puberty in transgender and gender-diverse youth.

Queer: Previously a pejorative term used to refer to SGM people, this term was reclaimed by SGM communities in the 1990s. Sometimes used as an umbrella term for all SGM people, but there are many meanings. It is best to clarify what someone means if they state their identity as “queer.”

Safe Space: A place or environment in which a category of people can feel confident that they will not be exposed to discrimination, criticism, harassment, or any other emotional or physical harm.

Sexual and Gender Minority (SGM): As defined by the National Institutes of Health, this umbrella term refers to LGBTQ populations and persons whose sexual orientation, gender identity and expressions, or reproductive development varies from societal, cultural, or physiological norms. The term includes individuals with differences of sex development, also known as intersex conditions.

Sexual Orientation: A person’s physical or emotional attraction and desire for intimate relationships toward people of the same gender, people of a different gender, or people of multiple genders.

Sexual Orientation/Gender Identity (SO/GI) Data: Information about people’s identity related to sexual orientation and gender identity.

SMART Objective: SMART is a mnemonic device/acronym that provides criteria to guide the setting of objectives. SMART objectives are Specific, Measurable, Achievable (or Attainable), Relevant, and Time-bound. This device is designed to help with planning by assuring that the objectives of the work are defined in a way that best supports successful implementation and evaluation.

Stakeholders: Individuals who have a direct or indirect interest or stake in a program. These include people who conduct, participate in, manage, or fund a program or are affected by decisions related to the program.

Structural Vulnerability: An individual’s or a group’s condition of being at risk for adverse health outcomes because of social forces that are economic, racialized, political, and cultural. Patients are structurally vulnerable when these social forces, combined with their institutional and policy-level status (e.g., immigration status, labor force participation), compromise their ability to access health care and pursue healthy lifestyles.

Transgender/Trans: People whose sex designated at birth does not fully align with their current gender identity.  The term generally applies to people whose current gender identity differs from their designated sex on the gender binary (e.g., someone who was designated male and now identifies as female or vice versa). It also applies to people whose current gender identity falls outside the binary (e.g., people who identify as genderqueer, gender-diverse, gender-expansive, or gender fluid).

Transphobia: Fear, dislike, or discrimination against people who are transgender.