767 A holistic approach to young people with gender incongruence in a gender identity development service liaison clinic

Abstract

<h3>Aims</h3> To assess psychosocial health and needs of children and young people (YP) with gender incongruence seen in the gender identity and development service (GIDS) liaison endocrine clinic at University College London Hospital (UCLH). <h3>Methods</h3> During follow-up, we performed a psychosocial assessment using the HEEADSS tool.¹ We explored home environment, education/employment, activity, drug and alcohol use, diet and body image, self harm/suidality, sexuality and sleep. YP were allocated to broad categories of ‘concern’, ‘some concern’ and ‘no concern’ for each domain (figure 1). Basic demographics were also considered including, gender, age, ethnicity, current treatment (table 1). <h3>Results</h3> We performed HEEADSS assessment on a total of 33 YP (18 transfemales and 15 transmales). All were white Caucasian aged between 13 and 20 years. 14 were on the GnRHa (gonadotropin releasing hormone analogue) only and 19 had been started on gender affirming hormones (GAH). Home; the vast majority of patients had a stable home environment; 1 YP lives in placement in a children’s home. Education/employment; 21% of YP had concerns in this area; 3 YP who had significantly reduced school attendance and 4 who were either unemployed or not in education at all. Activity; 7 were not employed or in full time education, 4 did not engage in any activity at all. Drugs and alcohol; 6 admitted to smoking cannabis or cigarettes regularly. No alcohol excess or other recreational drug misuse was reported. Diet and body image; 2 displayed concerning signs of body dysmorphia requiring mental health support. two had a particularly poor diet and were referred for dietetic support. Sexual health; no concerns surrounding sexual health were reported. Self-harm and mood; 7 (21%) described very low mood needing mental health support. 3 (9%) of had a history of suicidal ideation and suicidal attempts. All 3 were either unemployed or not in full time education. Sleep; 7 struggled with their sleep, 3 of them had less than 4 hours of sleep/night. Two had significant concerns in multiple domains – education/employment, activities, mental health, sleep and body image. There was no obvious correlation between treatment plans (GnRHa versus GAH) and psychosocial health. <h3>Conclusion</h3> The majority of YP seen are doing well from a psychosocial health point of view. This could in part be explained by the ongoing support from the GIDS psychosocial team as well as the NHS criteria that YP need to meet to be considered for hormonal therapy. Those who are in full time education and employment appear to have better psychosocial outcome. Many YP have a mature level of understanding about their emotional health and wellbeing, as well as sexual health. There is a small proportion who do struggle in various domains and are likely to benefit from more holistic support. A fifth of the cohort are not in fulltime education or employment and would benefit from support in returning to education/finding employment. <h3>Reference</h3> Doukrou M, Segal TY. Fifteen-minute consultation: communicating with young people – how to use HEEADSSS, a psychosocial interview for adolescents. <i>Arch Dis Child Educ Pract Ed</i>. 2017 Jun 14. pii: edpract-2016-311553. doi: 10.1136/archdischild-2016-311553