Ca(u)se of gender-affirming healthcare for children: Reconciling ‘best interests’ and the ‘public interest’ in Re Devin

Background: Canadian specialty clinics offering gender-affirming care to trans and gender diverse children and youth have observed a significant increase in referrals in recent years, but there is a lack of information about the experiences of young people receiving care. Furthermore, treatment protocols governing access to gender-affirming medical interventions remain a topic of debate.Aims: This qualitative research aims to develop a deeper understanding of experiences of trans youth seeking and receiving gender-affirming care at Canadian specialty clinics, including their goals in accessing care, feelings about care and medical interventions they have undergone, and whether they have any regrets about these interventions.Methods: The study uses an adapted Grounded Theory methodology from social determinants of health perspective. Thirty-five trans and gender diverse young people aged 9 to 17 years were recruited to participate in semi-structured interviews through the specialty clinics where they had received or were waiting for gender-affirming medical interventions such as puberty blockers, hormone therapy, and surgery.Results: Young people felt positively overall about the care they had received and the medical interventions they had undergone, with many recounting an improvement in their well-being since starting care. Most commonly shared frustrations concerned delays in accessing interventions due to clinic waiting lists or treatment protocols. Some youth described unwanted medication side-effects and others said they had questioned their transition trajectory at certain moments in the past, but none regretted their choice to undergo the interventions.Discussion: The results suggest that trans youth and gender diverse children are benefiting from medical gender-affirming care they receive at specialty clinics, providing valuable insight into their decision-making processes in seeking care and specific interventions. Providers might consider adjusting aspects of treatment protocols (such as age restrictions, puberty stage, or mental health assessments) or applying them on a more flexible, case-by-case basis to reduce barriers to access.

I am a child of the 1970s. I grew up in Adelaide in the Dunstan decade. My earliest political recollection is of my parents discussing the dismissal of Whitlam in 1975. I believed university educat...

Caring for Gender-Diverse Children and Youth

Whose Consent is it Anyway? A Transgender Child's Right to Transition

Given growing public awareness about transgender and gender diverse identities, it is expected that greater numbers of children and families will seek mental health and social services, including transition-related services, from social workers and other mental health professionals. Transgender and gender diverse children have a range of transition-related needs which require the support of informed practitioners with transgender and gender diverse-specific knowledge and skills. Moreover, the needs and experiences of families and caregivers of transgender and gender diverse children will vary greatly. To date, research suggests a paucity of transgender and gender diverse-specific expertise among social workers and other mental health providers; this seems particularly evident with respect to the needs of transgender and gender diverse children. An affirmative practice framework to guide therapeutic work with transgender and gender diverse children and families is presented. In addition, key clinical practice considerations associated with engagement, assessment, psychoeducation, support and referral are provided. Finally, clinical examples illustrating use of the affirmative practice approach with transgender and gender diverse children are provided.

State-level gender-affirming healthcare policy and depressive symptoms among LGBTQ+ youth

Background: Transgender (trans) youth who identify outside the gender binary are a growing subpopulation. In this article, we document differences in access to gender-affirming health care between binary and non-binary identified trans youth and explore ways of meeting the health needs of non-binary youth within primary care settings. Methods: The Canadian Trans Youth Health Survey is a national online survey of trans youth, 14–25 years, conducted in 2013–2014. Among the 839 participants who responded to gender identity items in the survey, 41% identified as non-binary. We compared demographic, health outcome, and health care access responses between non-binary and binary (trans girls/women and trans boys/men) youth. Results: Non-binary and binary youth were similar in most demographics, including age, geographic distribution, and ethnocultural backgrounds, however a larger proportion (82%) of non-binary youth were assigned female at birth. Older non-binary youth (aged 19–25) were significantly more likely to forego needed healthcare than older binary youth; no significant differences were found between younger (14–18) non-binary and binary youth in foregoing healthcare. Overall, non-binary youth (13%) were significantly less likely than binary youth (52%) to access hormone therapy, but they were more likely than binary youth to report experiencing barriers to accessing hormone therapy when needed. Conclusions: Non-binary trans youth in Canada report challenges in accessing needed gender-affirming healthcare. Primary care providers are well-situated to integrate a broad range of gender-affirming care services into practice in order to address the unique needs of non-binary youth. Future research is warranted to explore experiences of non-binary youth related to barriers to care and to explore how services can be designed and delivered to better meet the needs of non-binary youth seeking gender-affirming primary care.

Background: Transgender (trans) youth who identify outside the gender binary are a growing subpopulation. In this article, we document differences in access to gender-affirming health care between binary and non-binary identified trans youth and explore ways of meeting the health needs of non-binary youth within primary care settings. Methods: The Canadian Trans Youth Health Survey is a national online survey of trans youth, 14–25 years, conducted in 2013–2014. Among the 839 participants who responded to gender identity items in the survey, 41% identified as non-binary. We compared demographic, health outcome, and health care access responses between non-binary and binary (trans girls/women and trans boys/men) youth. Results: Non-binary and binary youth were similar in most demographics, including age, geographic distribution, and ethnocultural backgrounds, however a larger proportion (82%) of non-binary youth were assigned female at birth. Older non-binary youth (aged 19–25) were significantly more likely to forego needed healthcare than older binary youth; no significant differences were found between younger (14–18) non-binary and binary youth in foregoing healthcare. Overall, non-binary youth (13%) were significantly less likely than binary youth (52%) to access hormone therapy, but they were more likely than binary youth to report experiencing barriers to accessing hormone therapy when needed. Conclusions: Non-binary trans youth in Canada report challenges in accessing needed gender-affirming healthcare. Primary care providers are well-situated to integrate a broad range of gender-affirming care services into practice in order to address the unique needs of non-binary youth. Future research is warranted to explore experiences of non-binary youth related to barriers to care and to explore how services can be designed and delivered to better meet the needs of non-binary youth seeking gender-affirming primary care.

Youth and Caregiver Perspectives on Barriers to Gender-Affirming Health Care for Transgender Youth

Australia was, until recently, the only country in the world in which court authorisation was required for the medical treatment of children diagnosed with gender dysphoria. The decision of the Full Court of the Family Court of Australia in Re Kelvin (2017) 351 ALR 329 swung the pendulum of decision-making authority for transgender children’s medical treatment from the Family Court back to the child and the child’s parents and treating medical practitioners. The Re Kelvin decision was touted a victory for transgender children’s rights. This article re-reads the Full Court’s judgment from a children’s rights perspective. It argues that the Full Court was not concerned with the rights of transgender children at all. Rather, transgender children benefit incidentally from the Full Court’s decision, which was about the extent to which the Family Court should encroach upon parents’ responsibility to make medical treatment decisions for their children, consistently with the latest developments in medical science.

The Australian family courts introduced Child Inclusive Conferencing after the country adopted the United Nations Convention on the Rights of the Child. The legislation governing these conferences is minimalistic but the Family Court Consultants in the Family Court of Australia and the Federal Circuit Court have well-developed and documented guidelines. The Family Court of Western Australia is, however, a separate entity and in the absence of regulatory guidelines its Family Consultants developed their own process and criteria. This model is unique, in Australia at least, because it has been organically developed by the practitioners providing the Child Inclusive Conferences with very little, if any, statutory and regulatory guidance. This model therefore serves as an example of how practitioners think child inclusive services should be offered. The model is, however, not documented and the aim of this study was to understand and document Family Consultants’ decision making regarding if and when they will conduct a Child Inclusive Conference in the Family Court of Western Australia. Ten Family Consultants were interviewed using semi-structured interviews. A thematic analysis was conducted on the transcripts of the interviews identifying 12 themes. Overall the data suggested that Family Consultants take into account a range of criteria and although they were very cognisant of the importance for the child to be engaged in decision making they noted specific challenges regarding how they could use Child Inclusive Conferencing to do this. These findings provide a basis for the development of regulations that ensure that Child Inclusive Conferences are used optimally to improve the inclusion of children in the family court procedures in Western Australia and potentially elsewhere. Further research is, however, necessary before such regulations can be finalised.

It has been a privilege to bring together this special edition of the Family Court Review , which features a range of research and socio-legal commentary, each article dealing with the question of how respective family law communities are meeting the needs of and according due rights to children affected by postseparation dispute. This edition came from a meeting of two main story lines. The 4th World Congress on Family Law and Children’s Rights in Cape Town in 2005 was attended by many AFCC members and encouraged a new level of responsibility for moving the field beyond its own rhetoric about children’s rights and reinforced the need to better understand what was happening in practice. Concurrently, my own research and clinical inquiries into child inclusion in family law matters began to cohere into a body of work that suggested a potential connection between children’s inclusion and the elusive best interests principle. Seeing the intersection of interests, the Family Court Review editorial team invited me to bring together this special edition. The invited articles were selected to represent a diversity of current thought and action in the arena of children’s rights, and specifically the right to safe and appropriate inclusion. Empirical research about divorce impacts for children, together with the United Nations Convention on the Rights of the Child (CRC), have created an ethical mandate for widespread review of the core responsibilities of family law interventions. In particular, Articles 3, 9, and 12 of the CRC have been a driving force behind a move toward sensitive representation of children in legal matters that affect them. Article 12 states:

Background Transgender and gender diverse (TGD) children and youth face significant disparities when accessing healthcare. Telehealth has become a promising strategy for improving healthcare access. The experiences of TGD children and youth using telehealth to access healthcare are poorly understood. Aim To synthesize the current evidence on TGD children and youths’ experiences using telehealth. Methods A meta-ethnography was conducted on seven papers examining TGD children and youths’ experiences with telehealth. Results The main findings expressed by TGD children and youth regarding their experiences of telehealth encompassed the themes of feeling safe, feeling seen, ease of access, and technological affordances. Discussion We propose a model to consider when designing telehealth for TGD children and youth entitled Trans-IT, incorporating the four key themes: feeling safe, feeling seen, ease of access, and technological affordances. Overall, this study identifies the range of user experiences that influence the accessibility and relevance of care available through telehealth for TGD children and youth and provides a foundation for future policy, practice, and research.

The American Academy of Pediatrics (AAP) recently published a policy statement: Ensuring comprehensive care and support for transgender and gender-diverse children and adolescents. Although almost all clinics and professional associations in the world use what’s called the watchful waiting approach to helping gender diverse (GD) children, the AAP statement instead rejected that consensus, endorsing gender affirmation as the only acceptable approach. Remarkably, not only did the AAP statement fail to include any of the actual outcomes literature on such cases, but it also misrepresented the contents of its citations, which repeatedly said the very opposite of what AAP attributed to them.

Knowledge of prepubertal transgender and gender diverse (TGD) children is limited. This study fills a gap in the research literature by exploring the lived experiences of prepubertal TGD children related to gender identity, centering their voices. Interviews with 10 TGD Swedish children 4–12 years old were analyzed through Thematic Analysis. The analysis resulted in two main themes: (1) “The journey of gender exploration,” with subthemes Discovering me and The joys, and challenges of being me; (2) “Meeting the outside world,” with subthemes Can I belong? and Staying me: my tips, tricks and help from others. The children’s evolving gender identity was traced, emphasizing emotional aspects and pivotal milestones like affirmed names. Even though the children had supportive environments, challenges of misgendering and the need for continual self-assertion were exposed. Despite struggles for recognition, the study highlights TGD children’s resilient coping and well-being. Still, cisgender norms were observed to challenge their prevalent pride and positive self-images, emphasizing the need for enhanced knowledge of gender diversity for a broader societal change. This study expands the literature on TGD children’s gender identity development, informs professionals and a broad audience and provides an enhanced understanding of TGD prepubertal children through their own words.