Diverse Young People Research Articles

Options and realities for trans and gender diverse young people receiving care in Australia's mental health system: findings from Trans Pathways.

Trans and gender diverse young people experience mental health difficulties self-harm and suicidality at markedly higher rates than the general population, yet they often feel isolated from mental health services. There is little qualitative research on the experiences of trans and gender diverse young people accessing mental health support in Australia. The objective of this study was to comprehensively explore the experiences of trans and gender diverse young people in Australia who have sought mental health support from therapists, counsellors, psychiatrists and/or inpatient care providers. We report on findings from the Trans Pathways study, which was a mixed-methods study to evaluate the experiences of trans and gender diverse young people accessing mental health services: specifically, therapy and counselling services, psychiatric services and mental health inpatient services. A total of 859 trans and gender diverse young people aged 14-25 years across Australia completed an anonymous online questionnaire. Therapy and/or counselling services (64.4%) were most frequently sought by trans and gender diverse young people in this study, followed by psychiatric services (43.0%) and mental health inpatient services (12.3%). The findings demonstrated that many mental health professionals lacked expertise in gender diversity, and that trans and gender diverse young people found it difficult to locate mental health professionals who were able to meet their needs in a timely manner. These findings indicate that training is necessary for all mental health professionals to improve their knowledge of gender diversity, enhance the support provided to trans and gender diverse young people and help to address the high rates of poor mental health. The findings outlined here provide insight into the areas in which clinicians could optimise their care of trans and gender diverse young people.

The Role of the Avatar in Gaming for Trans and Gender Diverse Young People.

A significant proportion of trans and gender diverse (TGD) young people report membership of the gaming community and resultant benefits to wellbeing. To date their experiences and needs regarding a key feature of games, the avatar, are largely unexplored, despite increasing interest in the therapeutic role of avatars in the general population. The aim of this study was to better understand the role of the avatar in gaming, its impact on TGD young people’s mental health, and their unique needs regarding avatar design. N = 17 TGD young people aged 11–22 years (M = 16.3 years) participated in four focus groups. A general inductive approach was used to thematically analyze the transcribed data. TGD young people report considerable therapeutic benefits of using avatars with positive mental health implications. Importantly, TGD young people use avatars to explore, develop and rehearse their experienced gender identities, often as a precursor to coming out in the offline world. They also report negative experiences of feeling excluded due to the constraints of conventional notions of gender that are widely reflected in game design. Participants described simple design features to better reflect gender diversity, such as increased customization. Such changes would facilitate the positive gains reported by participants and better reflect the diversity of young people who use games. The findings have important implications for both recreational and serious or therapeutic game design.

“No One Stays Just on Blockers Forever”: Clinicians’ Divergent Views and Practices Regarding Puberty Suppression for Nonbinary Young People

PurposeApproximately half of transgender or gender diverse youth identify as gender nonbinary (not entirely or exclusively male or female). This study aimed to explore the views and practices of Australian clinicians working with transgender or gender diverse young people regarding puberty suppression for nonbinary youth, including requests for ongoing puberty suppression into adulthood. MethodsIndividual semistructured key informant interviews were conducted with 14 clinicians (medical and mental health) in Australia to explore their practices, views, and decision-making regarding puberty suppression for nonbinary youth. Transcripts were analyzed using inductive content analysis. ResultsRequests for puberty suppression from nonbinary young people are occurring, with 12 of 14 clinicians reporting they have received such requests. Although all clinicians were prepared to support short-term puberty suppression for nonbinary youth, clinicians diverged in their preparedness to support long-term puberty suppression. Clinicians expressed concerns in relation to risks, resource allocation, and medicalization. Some clinicians required nonbinary young people to choose a masculinizing or feminizing puberty. Some clinicians also put forward arguments in favor of long-term puberty suppression, including potential psychosocial harm of discontinuing puberty suppression, respect for autonomy, equity, and harm minimization. Clinicians also highlighted practical challenges of obtaining long-term puberty suppression in the adult setting. ConclusionsThe decision of whether to provide puberty suppression, particularly long-term, to a nonbinary young person is both ethically and clinically complex. There is currently a diversity of practice in this area, and evidence-based ethical guidelines and outcome data could promote more informed decision-making and support clinicians working in this complex area.

A psychological support group for parents in the care of families with gender diverse children and adolescents.

Parenting gender diverse children and adolescents can be a challenging experience, entailing doubts about how to protect and support them during their development. Parental reactions impact on the child's sense of security and well-being. Therefore, when caring for families with gender diverse children, it is important to offer support to parents. In this article we present an experience with a 12-month support group for parents of young people who attended the service for gender identity development at a paediatric hospital. We describe the group structure and methodology, together with the process for evaluating the intervention. At 6-month intervals, parents were asked to indicate the most important topics that had emerged during the monthly sessions. At 12 months, they completed a semi-structured feedback questionnaire about their experience in the group, including possible difficulties encountered. Thematic analysis showed an evolution in time, with participants taking a more complex perspective on gender diversity and the needs of their children, while feeling more able to deal with the uncertainties related to gender identity development. After attending the group, parents reported feeling less lonely, more confident, and better able to communicate with their children. They related these positive changes to the opportunity of sharing experiences and mutual learning. This feed-back provides preliminary evidence that the psychological support group was perceived to be a useful resource by parents of gender diverse young people.

The Perth Gender Picture (PGP): Young people’s feedback about acceptability and usefulness of a new pictorial and narrative approach to gender identity assessment and exploration

Background A number of psychological assessment tools have been developed to describe various dimensions of gender. Some of these tools are restricted to a binary gender concept and are inflexible in reflecting how a young person’s gender may change and develop over time. Most are text questionnaires which require a good level of literacy. Aims This study aimed to evaluate a newly developed pictorial tool that facilitates a conversation about gender between a child or adolescent (aged 11–18) and their clinician, enabling a diverse understanding and expression of gender identity. Methods The Perth Gender Picture (PGP) was co-created between clinicians and young clients between 2016 and 2018. In 2018, the measure was evaluated through a pilot study at the Gender Diversity Service at Perth Children’s Hospital in Western Australia. After use of the PGP during a clinical consultation, clients were invited to fill in a feedback questionnaire about their experience of its use. Clinicians participated in unstructured interviews to give their feedback. Results Most participants rated the PGP as easy to understand, acceptable and useful, and many stated that they found gender easier to describe with the picture rather than words. The results show positive uptake from clients, demonstrating feasible implementation with gender diverse young people. Discussion This evaluation positions the PGP as a useful tool to facilitate conversations about gender identity between gender diverse children and adolescents and their clinicians, in a nonjudgmental and playful manner. It is well-suited to young people who may have limited literacy or difficulty with complex language. The PGP has potential for use in other age groups and non-clinical contexts.

A Longitudinal Study of Features Associated with Autism Spectrum in Clinic Referred, Gender Diverse Adolescents Accessing Puberty Suppression Treatment.

Literature has documented inflated rates of features associated with autism spectrum (AS) in clinic referred, gender diverse young people. This study examined scores on the Social Responsiveness Scale, Second Edition (SRS-2) over time in a group of clinic referred, gender diverse adolescents accessing gonadotropin-releasing hormone analogues (GnRHa) to supress puberty. Primary caregivers of 95 adolescents presenting to the Gender Identity Development Service (GIDS) completed the SRS-2 prior to receiving endocrine input (mean age: 13.6 ± SEM: 0.11) and after approximately one year of accessing GnRHa (mean age: 14.6 ± SEM: 0.13). No significant differences in SRS-2 scores over time and between birth assigned sex were found. No interactions between time and birth assigned sex were established for SRS-2 subscales or total scores.

'I think we're getting a bit clinical here': A qualitative study of professionals' experiences of providing mental healthcare to young people within an Australian rural service.

This paper contributes to scholarship on the medicalisation of mental health support for young people through a case study of a multidisciplinary mental health service in rural Australia. All staff (n=13) working at the service participated in semi-structured, individual interviews. Transcripts of interview data were read and selectively coded and interpreted in relation to the overarching question of how participants view and experience mental health care provision to a diverse range of young people. Following analytical reflection, codes pertaining to engagement, accessibility and care provision were re-examined using the concept of medicalisation to understand the biomedical underpinning of mental healthcare and how this plays out in the experiences and perceived challenges participants talked about in responding to the mental health concerns of diverse young people. The resulting analysis is presented under five theme headings: (a) privileging clinical expertise and priorities within service provision, which was an important source of conflict for some participants; (b) 'multidisciplinary' teams-a 'difficult kind of culture at times'; (c) articulations of where cultural barriers lie; (d) the tracks along which young people are directed to 'engage' with 'mental health'; and (e) a clinical 'feel' to space. We suggest that service and system investment needs to be given to alternative ways of thinking about and approaching mental health and care provision that are cognisant of, and engage with, the inherent connections between individual circumstance and social, place, cultural, economic and political contexts. This is particularly relevant to the provision of care in rural contexts because of limited service options and the complexities of access and providing care to a diverse range of young people living in isolated environments. Interdisciplinary frameworks need to be enacted and services must acknowledge their own cultural positions for alternative ways of working to become possibilities.

Gender diversity and safety climate perceptions in schools and other youth-serving organisations

Although there is a lack of data on experiences in other youth-serving organisations, past research on schools has found that transgender youth often perceive the school climate, as well as the physical aspects of the school environment, as less safe than their cisgender peers. Similarly, transgender students’ level of confidence in adults and staff in many US studies paints a poor picture of the support transgender students receive, which in turn can affect truancy, academic and social outcomes, mental health and discrimination experiences. The purpose of the current research was to extend previous US studies by examining an Australian sample of gender diverse and cisgender young people, and to investigate if differences between these groups existed in perceptions of safety (including confidence in adults to act, barriers to seeking help, and the culture of safety) across a variety of youth-serving organisations. Using the Australian Safe Kids and Young People survey 27 gender diverse, and 54 cisgender (27 male- and 27 female-identifying) triads were matched on age, Aboriginal identity, and then postcode. Participants were 11–18 years old (M = 14.54, SD = 2.14), and were part of a convenience sample of over 1400 participants in a larger study investigating perceptions of safety in youth-serving organisations. Results indicated that gender diverse youth report poorer school safety climate than cisgender male and female youth (who did not differ from each other) and more barriers to help seeking when they felt unsafe. Gender diverse youth however had more confidence in adults to support them when feeling unsafe than their peers. Like previous international studies, the results suggest that youth-serving organisations struggle to provide environments that foster more positive perceptions of safety in gender diverse young people.

Facilitating agency and engagement: Visual methodologies and pedagogical interventions for working with culturally and linguistically diverse young people

The 21st century has brought rapid global change to the cultural and linguistic landscape of many nations; this rapidly changing landscape has prompted educators to argue that the lived and evolving reality of contemporary classrooms demands a re-examination of current curriculum, pedagogies and assessment practices. Australian classrooms now include young people who speak many different languages and dialects of English; these young people draw on multiple ways of learning and understanding and are increasingly mobile and connected across time and space. Over the last two decades, rather than building on this linguistic diversity Australia’s national assessment program has relegated difference to a problem fixed by further commitment to standardized English curriculum and assessment practices. In this environment, attention is given to what is perceived as limited or lacking in young people’s knowledge of the English language and literacies practices most valued in school. This article presents research that aimed to acknowledge and build on the foundational linguistic resources of young people in super-diverse mainstream primary classrooms through the application of visual methodologies (language mapping) and corresponding pedagogical work. This research, undertaken in Western Sydney, one of the most diverse regions in Australia, offers possibilities for perpetuating and fostering a pluralist present and future in 21st century classrooms.

Working With At-Risk Culturally and Linguistically Diverse Young People in Australia: Risk Factors, Programming, and Service Delivery

Young people from particular culturally and linguistically diverse (CALD) backgrounds are overrepresented in Australia’s criminal justice system. Many possess the typical risk profiles of justice-involved young people. However, there are unique sociocultural factors that may affect a CALD young person’s ongoing contact, and interactions with the justice system. There exists little published research on these factors, and how service providers can best address the needs of justice-involved CALD young people. This article endeavored to fill this gap in our knowledge and advance policy development in this critical space. First, a number of key environmental and pre/post migratory stressors were identified that may be implicated in pathways to offending. Second, despite regular calls for culturally responsive programming, few programs have been developed, and no evaluations of such programs were detected in the extant literature. Third, several programming recommendations were articulated based on available expertise. One approach included building the capacities of culture-based community service providers to strengthen their ability to work with justice-involved CALD youth.

The Effects of Computer Science Stereotypes and Interest on Middle School Boys’ Career Intentions

Like other STEM fields, computer science (CS) lacks representation of minorities, such as Black and Hispanic individuals, both in the number of bachelor’s degrees obtained and the number of individuals in the CS workforce. Out-of-school CS programs are often designed with the intent to inspire young people to pursue careers in CS. Much of this programming focuses on developing student interest in CS and CS careers. Nevertheless, it is not well understood how the stereotypes that children hold about computer scientists contribute to CS interest and career choice. In this study, we set out to examine the complex relationships between CS interest, held stereotypes, and CS career choice. We surveyed participants in an after-school CS program offered to middle school boys who identified with racial and ethnic minority groups (N= 110). We tested three linear regression models and confirmed that CS interest and socially divergent stereotypes—those that diverged from societal norms—of computer scientists play unique and contrary roles in young boys’ career decision-making process even when controlling for home and school factors. These models suggest educational CS programs should include curriculum to dispel participants’ socially divergent stereotypes about computer scientists rather than targeting CS interest alone, particularly if a goal is to inspire diverse young people to pursue careers in CS.

Implications of Canadian youth views for measuring youth mental health from a socio-economic perspective.

Developing meaningful indicators to track youth mental health (MH) is important to support the development and evaluation of responsive mental health promotion (MHP) initiatives that address the socio-economic determinants of youth MH. Development of relevant indicators is challenged, however, by the lack of knowledge regarding the relations among socio-economic factors and youth MH. Thirty diverse young people from a Canadian metropolitan area were engaged within a process of social praxis to explore their experiences of the inter-relationship between their socio-economic environments and their MH and their processes of seeking to realize their MH. Participants emphasized 'needs' as foundational to MH, whereas 'wants', driven by materialistic and wealth-oriented values and social norms, constrained their MH. Their reflections on the inter-relations among their MH and socio-economic processes highlight eight inter-related MH needs within the Canadian socio-economic context. In this paper, we present these needs and show how these needs, young people's affective states, and their access to resources within co-evolving socio-economic processes (to enable their needs) illustrate the fundamental inter-relation between young people's MH and socio-economic processes. We identify implications for measuring youth MH within MHP practice, including the importance of iterative indicator frameworks that include measures of young people's access to resources to enable their MH needs and their degree of distress.

Shared Practice, Learning, and Goals between Police and Young People: A Qualitative Analysis of the National Volunteer Police Cadets

Abstract Engaging all members of the public is of paramount importance to British policing. This assists with demystifying the role of police in society, and also providing a shared vision and partnership between communities and the criminal justice system. The National VPC programme provides the opportunity to achieve this, recruiting diverse young people into a structured programme led by a range of police officers and staff. A series of focus groups were conducted across the country with both cadets and adult leaders to explore the benefits of the cadet programme for both groups—those relevant to policing but also more widely for community cohesion and individual development. Although the benefits to policing were clearly articulated, a range of strengths to the programme were also identified.

Mental Health Issues and Complex Experiences of Abuse Among Trans and Gender Diverse Young People: Findings from Trans Pathways

Purpose: Trans and gender diverse (TGD) young people have reported high levels of mental distress in research studies, specifically depression, anxiety, self-harming, and suicidal behaviors. Rates of abuse are also high in TGD populations, but little is known about how this relates to mental health in populations of TGD young people. This study sought to examine associations between experiences of abuse and mental health outcomes. Methods: A cross-sectional study design was used. An anonymous online questionnaire was conducted to determine rates of abuse among Australian TGD young people (N = 859) and the potential association with poor mental health. Primary outcomes of interest were self-reported psychiatric diagnoses, self-harm and suicidal behaviors, and current anxiety and depressive symptoms. Results: Exposures to six forms of abuse are reported in this article: extrafamilial physical abuse, familial physical abuse, extrafamilial sexual abuse, familial sexual abuse, abuse within an intimate relationship, and other familial abuse (including emotional or verbal abuse and neglect). All six forms of abuse measured were associated with poor mental health overall; risk estimates for some forms of abuse were much stronger than others. Conclusion: The current findings have wide-ranging implications for clinical practice. Those working in TGD health care need to be aware of the high prevalence of violence and abuse among TGD young people and the association with poor mental health outcomes. The findings also have implications for broader societal change and interventions targeting increasing parental support to reduce familial violence against TGD young people.

The voice of young people – contribution for their involvement in the school

ABSTRACTThe purpose of this action research project was to gain an understanding of, and to mobilise the voices of diverse young people enrolled in a Portuguese secondary school. A case study methodology, in conjunction with action research methodology, was used for this study. The action research data indicated that projects conceived throughout the study were successful in mobilising the voices of 14 young secondary school students in decision-making processes. The young people engaged democratically, made informed decisions about themselves and their peers, managed conflicts, and reinforced the importance of interpersonal relationships. These changes took place at the individual, as well as group levels.

“It was Just One Less Thing that I Had to Worry about”: Positive Experiences of Schooling for Gender Diverse and Transgender Students

ABSTRACT While a range of studies have explored the difficulties and negative experiences that transgender and gender diverse young people face at school, there has so far been a dearth of research that investigates their positive experiences. Through interviews with three transgender youth, this study explores transgender and gender diverse students’ positive experiences of schooling. Positive experiences centering around “significant people,” “relationships and dialogue” and “groups and materials” were found to contribute to a safer and more supportive learning environment for each participant. While it is a small-scale study, the findings are hoped to provide educators with examples of positive teaching practices that they can draw from to support transgender and gender diverse students within their own classrooms.

What are the health outcomes of trans and gender diverse young people in Australia? Study protocol for the Trans20 longitudinal cohort study

IntroductionBeing transgender is frequently accompanied by gender dysphoria, which often coexists with mental health concerns. Increased referrals of transgender and gender diverse (TGD) youth to gender clinics have been observed...

How social media discourses organize communication online: a multi-level discursive analysis of tensions and contradictions in teens’ online experiences

Media reports frequently frame youth as foolish but also uniquely vulnerable when it comes to social media. However, adult framings of teen online activities and teens’ reported experiences regularly differ due to the privileging of adult concerns. In this paper, we take a youth-centered approach to teen online activities exploring the constitutive processes of social media and the micro-, meso-, and macro-level discourses associated with youth social media use. Through in-depth interviews with 55 culturally and socio-economically diverse young people, we examine the contradictions and tensions that organize teens’ experiences online, as well as the discursive resources they draw on to navigate online life. Our research showcases a multi-level discursive analysis that enables scholars to see how discourses intertwine to organize communication online, foregrounding theoretical implications about how young people resist and reify certain discourses about social media, as well as how identity and imagined audiences are maintained online.

Mental Health Correlates of Autism Spectrum Disorder in Gender Diverse Young People: Evidence from a Specialised Child and Adolescent Gender Clinic in Australia.

Research suggests an overrepresentation of autism spectrum diagnoses (ASD) or autistic traits in gender diverse samples, particularly in children and adolescents. Using data from the GENTLE (GENder identiTy Longitudinal Experience) Cohort at the Gender Diversity Service at the Perth Children’s Hospital, the primary objective of the current retrospective chart review was to explore psychopathology and quality of life in gender diverse children with co-occurring ASD relative to gender diverse children and adolescents without ASD. The Social Responsiveness Scale (Second Edition) generates a Diagnostic and Statistical Manual of Mental Disorders (DSM-5) score indicating a likely clinical ASD diagnosis, which was used to partition participants into two groups (indicated ASD, n = 19) (no ASD indicated, n = 60). Indicated ASD was far higher than would be expected compared to general population estimates. Indicated ASD on the Social Responsiveness Scale 2 (SRS 2) was also a significant predictor of Internalising behaviours (Anxious/Depressed, Withdrawn/Depressed, Somatic Complaints, Thought Problems subscales) on the Youth Self Report. Indicated ASD was also a significant predictor of scores on all subscales of the Paediatric Quality of Life Inventory. The current findings indicate that gender diverse children and adolescents with indicated ASD comprise an especially vulnerable group that are at marked risk of mental health difficulties, particularly internalising disorders, and poor quality of life outcomes. Services working with gender diverse young people should screen for ASD, and also provide pathways to appropriate care for the commonly associated mental health difficulties.

Trans and gender diverse young people's attitudes towards game-based digital mental health interventions: A qualitative investigation

BackgroundTrans and gender diverse (TGD) young people are at high risk for mental health difficulties. Previous research has shown that three in four TGD young people have been diagnosed with an anxiety disorder and/or depression and almost one in two have attempted suicide. TGD young people experience barriers to traditional mental health services, commonly faced with inexperienced providers and discrimination. Video and computer games, as well as online spaces, are sources of resilience for TGD young people. Digital mental health interventions are a feasible, but understudied, approach to consider for this population. MethodsN = 14 TGD young people aged 11–18 years were recruited to take part in focus groups as part of a multistage project. The focus groups were transcribed verbatim and analysed using a general inductive thematic analysis approach. This paper reports on their attitudes towards digital games and game-based digital mental health interventions. DiscussionAspects of game-based digital mental health interventions should be inclusive of diverse genders and sexuality, moderated appropriately and include content such as storylines and characters who are of diverse sexualities and/or gender. Participants were of the opinion that games should be preventative rather than treatment-focused; however, considering the high rate of mental health difficulties in this population, interventions should ideally address symptoms along the continuum from sub-clinical to clinical.