Gender dysphoria in children and adolescents: A description of a newly established multidisciplinary public health service in Western Australia

Across the world, increasing numbers of children and adolescents are presenting with gender dysphoria, which can be defined as distress related to a marked incongruence between the birth assigned sex, and the person’s... [ view full abstract ]

Across the world, increasing numbers of children and adolescents are presenting with gender dysphoria, which can be defined as distress related to a marked incongruence between the birth assigned sex, and the person’s experienced/expressed gender identity. Although some limited research has been conducted in this area, there is limited literature on how public health services operate for children/ adolescents with gender dysphoria.

The Gender Diversity Service (GDS) located at Princess Margaret Hospital for Children in Perth, Western Australia is a newly funded dedicated tertiary service working with transgender children/adolescents, and their families. The GDS is an evidence-based best-practice tertiary Tier-4 clinical service, encouraging a shift in emphasis from problem focused, to a perspective of building child/family uniqueness, strengths and resilience. The service also supports families and services in the community and provides consultation, liaison and advocacy for families, schools and the wider community. The GDS is a multidisciplinary service, including expert clinicians in Psychology, Psychiatry, Mental-Health Nurse Specialists, Endocrinologists, Speech Pathologist, Fertility specialists and dedicated research assistant. This service is unique in that it is funded by Child and Adolescent Mental-Health, compared to many other services worldwide that are primarily funded by Adolescent Health or Paediatric Endocrinology Services.

Given minimal research has been conducted in the Clinical Paediatric Setting; this service aims to contribute to the body of knowledge regarding best practice and positive outcomes for transgender children/adolescents and... [ view full abstract ]

Given minimal research has been conducted in the Clinical Paediatric Setting; this service aims to contribute to the body of knowledge regarding best practice and positive outcomes for transgender children/adolescents and their families. Additionally, in the literature this group of young people have also been identified as being at an elevated risk for poorer mental-health and increased suicide risk, it is therefore clinically important to manage this risk.
This presentation has three aims, firstly to describe the GDS service and its role in the public health service in Western Australia. Secondly, to elicit and encourage feedback from a wide variety of services worldwide on current best-practice methods of service in a tertiary clinical setting to facilitate ongoing service improvement. Lastly, we aim to build international working relationships to encourage information sharing and transfer of knowledge to improve the clinical skills, education, rights and training in transgender health.

Children/Adolescents can be referred from a variety of sources including but not limited to General Practitioners, Paediatrician, other Child and Adolescent Mental-Health Service professionals, and Non-Government... [ view full abstract ]

Children/Adolescents can be referred from a variety of sources including but not limited to General Practitioners, Paediatrician, other Child and Adolescent Mental-Health Service professionals, and Non-Government community-based clinicians. The service has close links with community youth based support services for lesbian, gay, bisexual, trans, intersex, queer, questioning and otherwise diverse in their sexuality and/or gender(LGBTIQ).
Assessment includes an initial assessment by a mental-health nurse followed by a full mental health assessment and ongoing review by a multidisciplinary team. Each young person is assigned a primary case manager and also receives a second mental health opinion within the GDS. Young people are assessed using WPATH guidelines to determine if they are suitable for gender affirming treatment. Stage-1 puberty suppressing treatment may be prescribed from Tanner Stage 2–3. Stage-2 estrogen or testosterone treatment may be prescribed from age 16 and requires approval from the Family Court of Western Australia, which is a publicly funded, no-cost, non-adversarial process requiring two psychologist or psychiatrist opinions, and one endocrinologist opinion. Young people can access speech pathology and communication therapy, which is provided in a group setting or individually. Further services include endocrinology assessment and treatment, fertility and sexual health counselling and parent support groups.

The GDS strives to provide assessment, information, and access to gender affirming treatments, according to WPATH international guidelines and support for children/adolescents and their families accessing the service. ... [ view full abstract ]

The GDS strives to provide assessment, information, and access to gender affirming treatments, according to WPATH international guidelines and support for children/adolescents and their families accessing the service.
Families attending the service complete a set of empirically validated assessments including behavioural problems, behaviour and peer relationships, child physical, psychological and psychosocial functioning, child psychological, gender dysphoria and body image/body dissatisfaction. The information gathered from these assessments is used for both clinical and research purposes.
The service is funded to improve the psychological wellbeing of transgender and gender diverse young people. We aim to reduce the barriers to access for young people and their families to receive both assessment and gender affirming endocrinology treatment.
This clinical service focuses on building on the strengths and resilience of our young people and embracing diversity. The service has a role in supporting families and services in the community and provides consultation, liaison and advocacy for families, schools and the wider community to improve the wellbeing of transgender young people in our community.

Currently, the GDS has over 138 families with an active referral. Of these, 31 percent identify as male to female and 69 percent female to male. The service has discharged 60 families as they have transitioned to adulthood. ... [ view full abstract ]

Currently, the GDS has over 138 families with an active referral. Of these, 31 percent identify as male to female and 69 percent female to male.
The service has discharged 60 families as they have transitioned to adulthood.
Parents and children of the service complete an qualitative Experience of Service Questionnaire, and positive reports include that “their worries and views were taken seriously”, “people at the service were easy to talk to”, “if a friend needed help, I would recommend that they come here” and “the people at the service were working together to help”.

The GDS is the only public health service in Western Australia for families with children with gender dysphoria. This service aims to operate in the most current. evidence-based approach to facilitate the safety of the... [ view full abstract ]

The GDS is the only public health service in Western Australia for families with children with gender dysphoria. This service aims to operate in the most current. evidence-based approach to facilitate the safety of the children, young people and their families and barriers to accessing treatment and support are minimised.

We would like to acknowledge the hard work and dedication of the entire GDS multidisciplinary team, which includes the authors above and Bruce, T.; Bufacchi, T., Ganti, U., Guaia, E., Hunter, T., Imms, C., Mitchinson, A., Murray, S., Robinson, S., Siafarikas, Thomas, C., A. and Van Hall, H-W.