iiinova — where your digital self keeps evolving

Erika R. Shira, LMHC, MT-BC @erikashira.com · 18/09/2026

Right, and CAQH isn't actually the issue. The service that Masshealth uses has programmed it to flag anyone whose gender in CAQH either is X/other or who has "unmatching" gender field and legal sex field (a couple others have messaged me with the same issue so I'm piecing this together).

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Erika R. Shira, LMHC, MT-BC @erikashira.com · 11/09/2026

Still not fixed. Still no answers why it’s acceptable for MassHealth to have programmed their website to flag providers with a non-cis gender. @gladlaw.bsky.social @massago.bsky.social @massgovernor.bsky.social @aclum.bsky.social

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Erika R. Shira, LMHC, MT-BC @erikashira.com · 11/09/2026

Yes we have this! Just with communication somewhat underground unfortunately because of the unhinged folks out there. JKR’s people tried to report me for “grooming children” for running queer kid playgroups. Similar stuff happens to many of us.

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Erika R. Shira, LMHC, MT-BC @erikashira.com · 11/09/2026

Texas is part of PsyPact, but not Counseling Pact. Kids in Texas can see someone with a psychology license in any of the 40ish PsyPact states. Folks can message me for recs. And yeah, we are doing the “support grp, not therapy” thing at Alphabet Alliance so it’s open to ppl anywhere in the world.

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Erika R. Shira, LMHC, MT-BC @erikashira.com · 31/08/2026

YES. I teach this in my sexuality education course for teens. Consent is key, there's nothing at all morally wrong with BDSM (or with not doing it), BUT no one should be doing or consenting to anything that could send someone to the hospital -- strangulation, mystery drugs, serious injury, etc.

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Erika R. Shira, LMHC, MT-BC @erikashira.com · 28/08/2026

See also: "We don't acknowledge any legal sex other than M or F even in places we are legally required to, which we say is because we use sex-based metrics for screening, but also, anyone who wants to can self-select the sex they use in our system."

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Erika R. Shira, LMHC, MT-BC @erikashira.com · 28/08/2026

Sincerely, a music therapist who took time out of my day to try and help your cause, and would have been able to if you’d done your research or consulted one of us.

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Erika R. Shira, LMHC, MT-BC @erikashira.com · 28/08/2026

I appreciate that the @americanredcross.bsky.social plays music at their sites to muffle screening questions for privacy, but I recommend they review the literature as to what aspects of music increase/decrease heart rate. I was ineligible for a pulse 2 bpm high taken while fast dance music blasted.

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Eric Michael Garcia @ericmgarcia.bsky.social · 26/07/2026

In honor of #ADA36, who is a person with a disability in history most people don’t know but should?

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Erika R. Shira, LMHC, MT-BC @erikashira.com · 26/07/2026

PLEASE SHARE 🏳️‍⚧️ 🏳️‍🌈 LGBTQ Dungeons and Dragons! 🧚🏿‍♀️ 🔮 🧙🏾 Ages ~12-17 Zoom 5pm-6:30pm EDT Mondays Our 5-week campaign starting tomorrow is low on players, and I hate to disappoint our teen DM. No experience necessary. $10 a week, able to slide as low as you need. email erika at erikashira dot com

Image is a player's handbook with polyhedral dice lying on it and two buttons that say "be gay do crimes" with a rainbow D20 and "be gay play DND" also with a rainbow D20. The buttons and the photo are from Etsy shop TeaWeltzer who I am not in any way affiliated with but whose stuff I think is really cool and highly recommend.

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Erika R. Shira, LMHC, MT-BC @erikashira.com · 21/07/2026

There is such a disconnect. Massachusetts has had three legal genders and has allowed self-selection for years. The state agencies though have not been required to care. I can't be a MassHealth provider, my neighbor can't register for disability services, DCF gets to misgender kids and parents...

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Erika R. Shira, LMHC, MT-BC @erikashira.com · 20/07/2026

More LGBTQDND coming up! By request, I've added a section that works better for European/Middle East time zones as well. Please feel free to share in your spaces. blog.erikashira.com/2026/07/low-...

blog.erikashira.com

Low-cost Zoom D&D groups for tweens and teens starting soon

Image: roleplaying dice and stones reading "magic" and "strength," lying on a six-color pride flag Groups meet weekly on Zoom for 90 minut...

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eeka @eeka1313.bsky.social · 07/07/2026

LGBTQDND! Please share.

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Erika R. Shira, LMHC, MT-BC @erikashira.com · 07/07/2026

Summer D&D groups starting soon. Ages 8-12 and 13-17. Open to people anywhere in the world. Sliding scale available. Also hiring more teen/young adult dungeon masters to co-lead future groups with me. blog.erikashira.com/2026/07/low-...

blog.erikashira.com

Low-cost Zoom D&D groups for tweens and teens starting soon

Image: roleplaying dice and stones reading "magic" and "strength," lying on a six-color pride flag Groups meet weekly on Zoom for 90 minut...

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Erika R. Shira, LMHC, MT-BC @erikashira.com · 01/07/2026

Relatedly, have been trying for years to address how state agencies don’t allow people with a legal sex of X on their birth certificate to register themself with the state agency.

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Erika R. Shira, LMHC, MT-BC @erikashira.com · 01/07/2026

Oh thank you for that. I will try that. I’ve emailed my various contacts at EOHHS and the AGO and they didn’t seem to grasp that someone at Carelon programmed this to intentionally flag providers with a non-cis gender in CAQH. It was just “well they’re manually letting you apply what’s the problem?”

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Erika R. Shira, LMHC, MT-BC @erikashira.com · 01/07/2026

Or if you’re Masshealth, biological gender! 🤦🏼 bsky.app/profile/erik...

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Erika R. Shira, LMHC, MT-BC @erikashira.com · 01/07/2026

@esqueer.net Masshealth is making providers specify our “biological gender” in order to be credentialed. So very much not a thing.

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Alejandra Caraballo @esqueer.net · 01/07/2026

The term "biological sex" was adopted widely only in the last decade as a reaction to mainstream acceptance of trans people. It was rarely if ever used before that. By any metric, from legislative usage to search query usage, it's plainly evident this is a novel term only made popular by the right.

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aslynn is just a ghoul 👻 @aslynnromano.com · 23/10/2025

ahhhhh my trade name acceptance went through! Neurospace: Affirming Psychiatry & Counseling is now officially a DBA for my company, Aslynn J. Romano PLLC do you have a therapist? do they know I exist? would you like to tell them, especially if you live in a state I am licensed in? thanks so much!

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Erika R. Shira, LMHC, MT-BC @erikashira.com · 30/05/2026

This is a somewhat valid concern (I’ve written about this; will link below), but we have plenty of high-support-needs autistics with sufficient language to serve as the experts in this area. We don’t need neurotypical “autism mommies” speaking for autistic folks.

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Johnathan Perkins @johnathanperk.bsky.social · 22/05/2026

White people truly believe the distinction of whether they’ve just said something racist is open to debate and opinion. I truly cannot fathom being white and ARGUING with a Black person who’s just called out my racism.

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Erika R. Shira, LMHC, MT-BC @erikashira.com · 21/05/2026

PLEASE SHARE: There is currently no waitlist for several of my weekly low-cost LGBTQ youth Zoom groups. These spaces are particularly needed for our youth right now. Note that no records are kept and youth register with just a first name. blog.erikashira.com/2025/06/no-w...

blog.erikashira.com

Some sections of LGBTQ youth groups currently have no waitlist

Alt: heavily edited photo of rainbow umbrellas and banners at a pride parade weekly Zoom groups for LGBTQ youth 8-18 open to folks located ...

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Erika R. Shira, LMHC, MT-BC @erikashira.com · 16/05/2026

I honestly don't understand the need to constantly emphasize "well MY kid can't work, go to college, parent, whatever" other than to be ableist. OK then those are things your kid doesn't need support with. Other folks do. Are you just attached to calling your kid defective? Because that's gross. 4/4

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Erika R. Shira, LMHC, MT-BC @erikashira.com · 16/05/2026

If we are just discussing a lack of appropriate supports, which we should be, we should be talking in terms of support needs. The "profound autism parents" never talk about support needs unless it's to overshare and violate their child's privacy to talk about bathroom needs or similar nonsense. 3/

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Erika R. Shira, LMHC, MT-BC @erikashira.com · 16/05/2026

These folks are not calling themselves profoundly autistic, though their support needs are similarly significant. Parents who want to emphasize that "my autistic kid is nothing like your autistic kid" are the ones calling their kids profoundly autistic. 2/

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Erika R. Shira, LMHC, MT-BC @erikashira.com · 16/05/2026

And it's just an ableist construct. It doesn't actually provide useful shorthand for support needs. I know many autistic folks (and some folks with other diagnoses) who require 24/7 significant support, can't go places alone, and don't have intellectual disability/can do academics/employment. 1/

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Erika R. Shira, LMHC, MT-BC @erikashira.com · 15/05/2026

It's honestly spam at this point when we do have a business relationship with you, but you are sending constant e-mails and there is no way to opt out. (My e-mail last week asking to only receive e-mails needed to access the conference and to opt out of the constant advertising was ignored). 2/2

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Erika R. Shira, LMHC, MT-BC @erikashira.com · 15/05/2026

Young people running conferences: I love the enthusiasm and the tech skills, but I beg of you, stop using our e-mail boxes like your personal social media feed! We do not not need several e-mails per day full of hashtags and gimmicks begging us to "upgrade our ticket" and all this. 1/

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Erika R. Shira, LMHC, MT-BC @erikashira.com · 29/04/2026

How do we get the governor's office or a group of legislators to, say, force an audit of the grievances? 3/3

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Erika R. Shira, LMHC, MT-BC @erikashira.com · 29/04/2026

I know people have filed grievances with the state agencies around them not being able to register with their correct gender. The state agencies either ignore these completely ("not a grievance issue") or say the STAFFER did nothing wrong by not checking off a field that doesn't exist. 2/

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Erika R. Shira, LMHC, MT-BC @erikashira.com · 29/04/2026

Oh, thank you! That would be really helpful. I've met with higher-ups there, who've been saying "it's in the works" for years. I know diversity and similar folks over there, who are 100% sympathetic but can't do anything. I think the only path is finding a legislator who can force their hand 1/

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Erika R. Shira, LMHC, MT-BC @erikashira.com · 28/04/2026

EOHHS has also been ignoring my requests for years to require state agencies to let people with legal third gender be registered in their systems. For years "it's in the works." Why isn't implementation required within a few days of the laws passing?!

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Erika R. Shira, LMHC, MT-BC @erikashira.com · 28/04/2026

Thanks. I've tagged AGO Campbell a few times regarding this issue and have never gotten any acknowledgement.

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Erika R. Shira, LMHC, MT-BC @erikashira.com · 28/04/2026

100%. Professionals, STOP ENCOURAGING THIS. The MA state agency that handles adoptions is particularly awful with "the parent is bringing up 'adult matters' that the child hasn't initiated" when foster/kinship/adoptive parents mention information that is the child's right to have.

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Thinking Person's Guide to Autism @thinkingautism.com · 15/04/2026

“We recommend listening to neurodivergent people to find out about their preferences and using the words that they prefer, instead of solely being led by traditions which have developed without the input of the communities we are referring to.” theconversation.com/what-neurodi... #neurodiversity

theconversation.com

What neurodivergent people really think about the words used to describe them

Research reveals a clear preference for how neurodivergent adults want to be described, though not everyone agrees.

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Erika R. Shira, LMHC, MT-BC @erikashira.com · 15/04/2026

So I have e-mails that confirm that the behavioral health network Masshealth uses has intentionally programmed their website to flag clinicians with a none/other/nonbinary or trans status on their CAQH profile and give an error message. Folks are OK with this?

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Erika R. Shira, LMHC, MT-BC @erikashira.com · 08/04/2026

So Carelon has written back after months and said that, yes, their website is programmed to flag clinicians with a none/other/nonbinary or trans status on their CAQH profile and not let them apply, but they assure me they are committed to inclusion and there was nothing queerphobic here.

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Erika R. Shira, LMHC, MT-BC @erikashira.com · 20/03/2026

When you have a "sensory-friendly event" but you say everyone must attend with a caregiver, it's pretty clear that these events aren't actually for all community members who could benefit. They're for "autism mommies," who generally don't actually want to be in community with disabled adults. 4/4

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Erika R. Shira, LMHC, MT-BC @erikashira.com · 20/03/2026

If your organization won't be providing care/supervision for people, it makes sense to specify that people needing care need to come with a caregiver, but it's ableist to require all attendees to bring a caregiver. Why can't teens/adults who travel independently just go to your event alone? 3/

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Erika R. Shira, LMHC, MT-BC @erikashira.com · 20/03/2026

If a teen or adult gets themself to an activity, presumably they travel independently. The organizer isn't responsible for them if they decide they're done midway through and head back to their car or the transit station alone, and shouldn't be telling them they aren't allowed to do this. 2/

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Erika R. Shira, LMHC, MT-BC @erikashira.com · 20/03/2026

I swear, if I see another flyer for a social event for disabled folks that either requires people to attend with a caregiver or to stick with the group the entire time regardless of needs... Can people not wrap their heads around how people with the same disability can have varying skills? 1/

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Chantal James @chantalalive.blacksky.app · 18/03/2026

Suicide prevention is not telling suicidal people to call a number for cops to take them to the psych ward. It’s being community for people. People suffer alone. You abandon your sad & mentally ill & lonely friends because they bum you out. We’re the ones with the duty of caring for each other.

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Erika R. Shira, LMHC, MT-BC @erikashira.com · 19/03/2026

Yes! When I first got trained in writing gender letters 20+ years ago, the aim was to gatekeep that the person had absolutely no psychiatric disability. It's shifted some, but not enough. It's ridiculous, because it's not the standard we use for deciding someone can't make other life decisions. 1/

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Erika R. Shira, LMHC, MT-BC @erikashira.com · 19/03/2026

And like, why did we decide gender needs an official permission slip when we don't require any assessment for making decisions like getting bad nose jobs or mortgages you can't afford? I mean, I know why, but no, not gonna participate. 4/4

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Erika R. Shira, LMHC, MT-BC @erikashira.com · 19/03/2026

I've assessed people for gender letters who had all sorts of different ways of thinking and interacting, but have yet to see anyone who I believed didn't have the capacity to understand their decisions. I put that I don't see any disability that would impair their judgment. 3/

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