A Waitlist Intervention for Transgender Young People and Psychosocial Outcomes

Abstract

BACKGROUND: Recent referrals of transgender young people to specialist gender services worldwide have risen exponentially, resulting in wait times of 1-2 years. To manage this demand, we introduced an innovative First Assessment Single-Session Triage (FASST) clinic that provides information and support to young people and their families and triages them onto a secondary waitlist for subsequent multidisciplinary care. Although FASST has been shown to substantially reduce initial wait times, its clinical impact is unknown.METHODS: FASST was evaluated by analysis of clinical surveys and qualitative interviews. A total of 142 patients were surveyed before and after FASST, and comparison was made to a historical control group of 120 patients who did not receive FASST. In-depth interviews were also held with FASST attendees (n 5 14) to explore experiences of FASST, and inductive content analysis was performed.RESULTS: After FASST, there were improvements in depression (standardized mean difference [SMD] 5 À0.24; 95% confidence interval [CI]: À0.36 to À0.11; P < .001), anxiety (SMD 5 À0.14; 95% CI: À0.26 to À0.02; P 5 .025) and quality of life (SMD 5 .39; 95% CI: 0.23 to 0.56; P < .001). Compared with historical controls, those attending FASST showed reduced depression (SMD 5 À0.24; 95% CI: À0.50 to 0.01; P 5 .065) and anxiety (SMD 5 À0.31; 95% CI: À0.57 to À0.05; P 5 .021). FASST attendees qualitatively described an increased sense of agency, which was related to improved outlook, validation, sense of self, and confidence.CONCLUSIONS: Given burgeoning waitlists of pediatric gender services worldwide, this study suggests FASST may prove a useful model of care elsewhere.

Gender-Affirming Treatment of Gender Dysphoria in Youth: A Perfect Storm Environment for the Placebo Effect—The Implications for Research and Clinical Practice

“…Furthermore, the suicidality of GD youth presenting at CAGCs, while markedly higher than non-referred samples, has been reported to be relatively similar to that of youth referred to generic child and adolescent mental health services (Carmichael, 2017 ; de Graaf et al, 2022 ; Levine et al, 2022 ). A recent study reported that 13.4% of one large gender clinic’s referrals were assessed as high suicide risk (Dahlgren Allen et al, 2021 ). This is much less than conveyed by the often cited 50% suicide attempt figure for trans youth (Tollit et al, 2019 ).…”

Thinking Time, Shifting Goalposts and Ticking Time Bombs: Experiences of Waiting on the Gender Identity Development Service Waiting List

“…To investigate whether waiting could be more of a positive experience, researchers in Australia trialled the First Assessment Single-Session Triage (FASST) clinic [ 25 ]. The FASST was found to be successful in its aims “to decrease wait time into the service, provide initial assessment and triage, and deliver information, education and support to patients who5are TGD and their families” [ 25 ] (p. 2). Young people who were able to access FASST showed an “increased sense of agency, contributed to by changes to outlook, validation, sense of self, and confidence” [ 25 ] (p. 7).…”

“…The FASST was found to be successful in its aims “to decrease wait time into the service, provide initial assessment and triage, and deliver information, education and support to patients who5are TGD and their families” [ 25 ] (p. 2). Young people who were able to access FASST showed an “increased sense of agency, contributed to by changes to outlook, validation, sense of self, and confidence” [ 25 ] (p. 7). In addition, Mulcahy and colleagues [ 6 ] highlighted the positive interactions many of their participants had with a cancer support group as a source of knowledge and comfort.…”

Integrating transgender care into mainstream medicine—an essay by Guy T’Sjoen and Joz Motmans

“…These decisions have been partly determined by the long waiting lists. In some countries the waiting times for specialised gender clinics are now up to three to five years, 13 14 15 making it necessary to rethink the organisation of care. 15 Our centre in Ghent, Belgium, for example, saw 487 patients for an initial appointment in 2021.…”

“…In some countries the waiting times for specialised gender clinics are now up to three to five years, 13 14 15 making it necessary to rethink the organisation of care. 15 Our centre in Ghent, Belgium, for example, saw 487 patients for an initial appointment in 2021. But a further 863 people contacted our service (an increase of 170% compared with 2016) and had to be put on the waiting list.…”