Abstract: ELKE as a framework for stabilizing trans-affirmative quality of life

The ELKE approach (Ethics-based, Body-oriented, Critical, Evidence-informed) is an innovative, human-centred way of providing healthcare for trans children and adolescents. It supports key outcomes such as happiness, altruism and solidarity on three interrelated levels:

• Happiness (congruence happiness) is facilitated by ELKE, which recognises the subjective bodily experience and desire for a harmonious body as valid foundations for medical and social transitions. Here, happiness is not a random product of medical care, but the result of bodily-anchored self-determination.
• Altruistic quality of life arises from an ethics-based orientation towards responsibility (e.g. according to Levinas). Those who are recognised in their sexuality can turn to others without constantly having to justify themselves. ELKE promotes this extension of care beyond the self.
• Solidarity-based quality of life is supported by the critical component. ELKE recognises structural transphobia as a form of violence and strengthens resistance through education, empowerment, and collective knowledge. This embeds individual congruence within a social network that provides protection and encouragement.

The realisation that congruent happiness remains unstable without social resonance and systemic recognition is central. ELKE counteracts this by stabilising individual moments of happiness through structural protection.

Connections to the JBI model

The JBI (Joanna Briggs Institute) model presents evidence-based practice as an interplay of existing evidence, clinical expertise, and the values and experiences of those affected. The ELKE approach can be classified here directly:

• Evidence-informed reflects the JBI evidence-based principle, but critically expands upon it by taking into account the bias of scientific studies and emphasising empirical knowledge.
• Body orientation incorporates somatic experiential knowledge, corresponding to the perspective of those affected in the JBI model.
• An ethics-based approach and critique of the social relations of violence make the moral and social responsibility implicit in the JBI model explicit in relation to value-based care.

Overall, ELKE can be understood as a contextualised, trans-affirmative specification of evidence-based practice with a focus on sustainable, socially embedded well-being.