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Caregiver Perspectives on Receiving Gender-Affirming Care with Their Transgender and Gender Diverse Adolescents via Telemedicine
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Background:
Access to virtual care has increased since the beginning of the COVID-19 pandemic, yet little is known about transgender and gender diverse (TGD) youth's experiences and perspectives on receiving care via telemedicine.
Objective:
The purpose of this study was to explore these experiences to 1) inform necessary changes to the provision of pediatric gender-affirming care and 2) help providers and health systems determine if and how telemedicine should be made available post-pandemic.
Methods:
Youth (14-17) who completed a telemedicine visit in the Seattle Children's Gender Clinic were invited to participate in a semi-structured interview exploring perceived advantages/disadvantages of telemedicine and preferred visit modalities. Interview transcriptions were analyzed by two research team members using an inductive thematic analysis framework.
Results:
Fifteen TGD youth completed an interview. Commonly cited advantages of telemedicine were convenience and comfort with having visits in their own environments. Reported disadvantages included technical issues, discomfort with the impersonal nature, lack of familiarity with the platform, and privacy concerns. Overall, slightly more youth preferred in-person visits over telemedicine, referencing both specific characteristics of the clinical visit (i.e., initial vs. return, complexity) and proximity to the clinic as reasons for this preference. Although a plurality of TGD youth preferred in-person visits, they also recognized the value of telemedicine and the impact it may have in facilitating access to care.
Conclusions:
Given variations in needs and visit complexity, our study supports the provision of both in-person and telemedicine modalities as options for pediatric gender-affirming care.
OBJECTIVES:
Geographic barriers limit access to clinical care in the United States for transgender and gender-diverse (TGD) youth. Some factors differentiating access to care are variability in state laws/policies, the number of available clinical care programs and mental health providers for TGD youth.
METHODS:
We aggregated data from the Human Rights Campaign for pediatric clinical care programs for TGD youth, the Movement Advancement Project for state-by-state assessment of gender identity laws and policies, and Psychology Today for mental health providers for TGD youth by state. Current prevalence rates for TGD youth were applied by state with 2020 Census data. Findings were summarized as a whole and per capita by state, region, and country overall.
RESULTS:
The South has the highest number of TGD youth per clinic (36 465–186 377), and the lowest average equality score in gender identity laws and policies (1.96). The Midwest has the highest number of TGD youth per mental health provider (278–1422). The Northeast has the lowest number of TGD youth per clinic (11 094–56 703), the highest average equality score in laws and policies per state (17.75), and the highest average number of TGD youth per mental health providers (87–444).
CONCLUSIONS:
Findings support there are barriers to TGD youth care throughout the United States, especially the South and Midwest. Increasing medical and mental health care for TGD youth is likely to improve their health and well-being. Enacting gender identity protective laws/policies would allow for equal treatment and access to care among TGD youth.
Objective: Transgender and gender diverse youth (TGD) are seeking psychological and medical care at an increased rate. Psychologists and other mental health providers, both on multidisciplinary teams and in the community, are being called upon to support these youth and their families. Evidence-based comprehensive care is imperative, which includes involving parents and caregivers. Moreover, parental and caregiver acceptance and support are one of the most important protective factors against anxiety, depression, and suicidality. By supporting parents and caregivers along their own journey, mental health providers can improve outcomes for the whole family. Method: This article summarizes key practices for mental health providers in working with parents and caregivers of gender diverse youth. Results: Best practices for working with parents and caregivers include (a) using a comprehensive, individualized, dynamic process for assessment, psychoeducation, and intervention; (b) assisting families in taking an informed and shared decision-making approach to care; (c) addressing parent and caregiver concerns from a risk/benefit perspective; and (d) understanding the parent and caregiver journey, including complex emotions and experiences of loss and grief. Conclusions: Working with parents and caregivers of TGD youth is an integral part of competent gender affirming care. While there is no one path that will be best for all families, using these best practices will assist mental health providers in supporting parents and caregivers as they adapt and support their TGD children and teens.
Implications for Impact Statement
Pediatric psychologists and other mental health providers are well-positioned to work with parents and caregivers of transgender and gender diverse youth (TGD). This article summarizes some of the best practices for mental health providers when working with caregivers of TGD youth, which is an integral part of competent gender affirming care.
The purpose of this study was to investigate the feasibility, acceptability, and preliminary outcomes of an online self-compassion intervention for transgender adolescents, with the aim of improving mental health. Participants identified as transgender or gender expansive, were between the ages of 13 and 17, and lived in the U.S. or Canada. The empirically-based self-compassion program, Mindful Self-Compassion for Teens (formerly Making Friends with Yourself) was implemented in eight 1.5 hour sessions on the Zoom platform by two trained instructors. Surveys were administered pre-, post-intervention, and at 3 months follow-up, and qualitative data were collected through end-of-program interviews and open-ended questions on the post-survey. All protocols were approved by the university IRB. Quantitative data analysis included repeated measures ANOVAs, and qualitative data were analyzed via both inductive and deductive methods. Results indicated that all but one psychosocial measure significantly improved from pre- to post-intervention, which then significantly improved at 3-month follow-up; most other improvements were maintained at follow-up. Four themes emerged from the qualitative data: virtual safe space; connection to body; personal growth; and recommended course changes and are discussed. Results suggest that self-compassion interventions can be incorporated into therapy programs to support and improve mental health for transgender adolescents.
This article is a call to action for outcomes research on telemedicine-delivered gender-affirming health care (GAH) for transgender youth. Transgender youth, especially rural youth, are severely underserved and face many obstacles to GAH. Telemedicine reduces access barriers for underserved populations, but telemedicine for this population can be complex. Our literature search identified only five studies exploring the use of telemedicine for GAH for transgender youth. Coronavirus disease 2019 (COVID-19)-related regulatory and reimbursement changes for telemedicine may have increased transgender youths' access to such care. Research is urgently needed to increase understanding regarding access, satisfaction, safety, and health-related outcomes of telemedicine-delivered GAH for transgender youth.
Purpose: We sought to expand telehealth at an academic multidisciplinary pediatric gender center to increase access to gender-affirming care without compromising communication, privacy, or patient satisfaction. Materials and Methods: Patient needs assessments were performed from January 2019 to March 2020. The severe acute respiratory syndrome coronavirus 2 pandemic accelerated implementation of the quality improvement project, and clinically appropriate patients were scheduled for video visits starting March 16, 2020. From September 8, 2020 to October 2, 2020, caregivers of transgender and gender diverse (TGD) minors or TGD young adults pursuing gender-affirming medications completed 9-item surveys evaluating communication quality and privacy, access to care, and quality of services for video and clinic visits. Answers were rated via Likert scales (1 = strongly agree, 5 = strongly disagree; 1 = less travel time, 4 = more travel time). Results: Needs assessment (n = 69) showed that 63.8% felt that video visits would improve follow-up. Survey participants (n = 91) reported statistically significant differences (p < 0.05) in several areas. Compared with clinic visits, video visits were more convenient, 1.21 ± 0.435 versus 2.36 ± 1.207, took less time from other activities, 4.55 ± 0.522 versus 2.93 ± 1.281, required less travel time, 1.03 ± 0.180 versus 2.63 ± 0.901, and were more acceptable, 1.35 ± 0.545 versus 1.65 ± 0.736. Participants were more likely to choose video visits in the future, 1.32 ± 0.555 versus 1.57 ± 0.732. There were no statistically significant differences in communication quality, privacy, or overall satisfaction. Conclusion: An integrated clinic-video visit model increases access to gender-affirming care for TGD youth while maintaining excellent communication, privacy, and patient satisfaction.
In recent years, there has been a proliferation of research regarding transgender and gender nonconforming (TGNC) people. The stigma and legal discriminations that this population faces have obvious and documented repercussions for mental health. In 2015, the American Psychological Association (APA) published Guidelines for Psychological Practice with TGNC People. The APA noted that due to the nuances of working with TGNC youth and the dearth of related literature, the guidelines focus primarily on TGNC adults. To date, there has not been a systematic review of risk and resilience factors for mental health among TGNC children, adolescents, and young adults under the age of 25. Forty-four peer-reviewed articles met inclusion criteria for this systematic review, and were evaluated for their methodological rigor and their findings. Common risk factors for negative mental health variables included physical and verbal abuse, exposure to discrimination, social isolation, poor peer relations, low self-esteem, weight dissatisfaction, and age. Across studies, older children and adolescents tended to report higher rates of psychological distress. Resilience-promoting factors for mental health were also documented, including parent connectedness, social support, school safety and belonging, and the ability to use one’s chosen name. By synthesizing the existing literature using a resilience-focused and minority stress framework, the present review provides clinicians and researchers with a coherent evidence-base to better equip them to promote psychological adaptation and wellbeing among TGNC youth.
In February 2020, CDC issued guidance advising persons and health care providers in areas affected by the coronavirus disease 2019 (COVID-19) pandemic to adopt social distancing practices, specifically recommending that health care facilities and providers offer clinical services through virtual means such as telehealth.* Telehealth is the use of two-way telecommunications technologies to provide clinical health care through a variety of remote methods.† To examine changes in the frequency of use of telehealth services during the early pandemic period, CDC analyzed deidentified encounter (i.e., visit) data from four of the largest U.S. telehealth providers that offer services in all states.§ Trends in telehealth encounters during January-March 2020 (surveillance weeks 1-13) were compared with encounters occurring during the same weeks in 2019. During the first quarter of 2020, the number of telehealth visits increased by 50%, compared with the same period in 2019, with a 154% increase in visits noted in surveillance week 13 in 2020, compared with the same period in 2019. During January-March 2020, most encounters were from patients seeking care for conditions other than COVID-19. However, the proportion of COVID-19-related encounters significantly increased (from 5.5% to 16.2%; p<0.05) during the last 3 weeks of March 2020 (surveillance weeks 11-13). This marked shift in practice patterns has implications for immediate response efforts and longer-term population health. Continuing telehealth policy changes and regulatory waivers might provide increased access to acute, chronic, primary, and specialty care during and after the pandemic.
Family support and acceptance are protective for transgender and gender diverse (TGD) youths’ mental health and identity development. Although some studies have examined the role of supportive family relationships for TGD youth, prior research has not fully explored how TGD youth and their caregivers understand or characterize these relationships within the family system. In this qualitative study, we explored perspectives of TGD youth and their caregivers regarding youth–caregiver and caregiver–caregiver relationships within the family system. We recruited a community-based sample of 20 families (20 TGD youth, ages 7 to 18 years, and 34 caregivers) from 3 U.S. geographic regions. TGD youth represented multiple gender identities; caregivers included mothers (n = 21), fathers (n = 12), and 1 grandmother. Each family member completed an individual semistructured interview that included questions about family relationships. Interviews were transcribed verbatim and transcripts were analyzed using a thematic analysis approach. Analyses revealed complex bidirectional family relationships, highlighting 5 contextual factors influencing these relationships: school, community, workplace, religion, and extended family. TGD youths’ identity development was inextricably linked to how caregivers respond to, adjust to, and learn from their children, and how caregivers interact with one another. Findings illustrate how caregiver acceptance and family cohesion may be linked and how youth and caregivers identified shared contextual factors impacting the family system. This research highlights the importance of situating TGD youth and caregivers as equal partners in family level approaches to affirm and support TGD identity development.
Despite recent notable advances in societal equality for lesbian, gay, bisexual, and transgender (LGBT) individuals, youth who identify as trans* or gender nonconforming, in particular, continue to experience significant challenges accessing the services they need to grow into healthy adults. This policy perspective first offers background information describing this population, their unique healthcare needs, and obstacles when seeking care, including case study examples. The authors then provide recommendations for medical education, health systems, and insurance payers, as well as recommendations for school systems and broader public policy changes to improve the health and well-being of gender nonconforming youth.
Thematic analysis is a poorly demarcated, rarely acknowledged, yet widely used qualitative analytic method within psychology. In this paper, we argue that it offers an accessible and theoretically flexible approach to analysing qualitative data. We outline what thematic analysis is, locating it in relation to other qualitative analytic methods that search for themes or patterns, and in relation to different epistemological and ontological positions. We then provide clear guidelines to those wanting to start thematic analysis, or conduct it in a more deliberate and rigorous way, and consider potential pitfalls in conducting thematic analysis. Finally, we outline the disadvantages and advantages of thematic analysis. We conclude by advocating thematic analysis as a useful and flexible method for qualitative research in and beyond psychology.
Purpose:
Telemedicine can improve access to adolescent health care, but adolescents may experience barriers to accessing this care confidentially. Gender-diverse youth (GDY) may especially benefit from telemedicine through increased access to geographically limited adolescent medicine subspecialty care but may have unique confidentiality needs. In an exploratory analysis, we examined adolescents' perceived acceptability, preferences, and self-efficacy related to using telemedicine for confidential care.
Methods:
We surveyed 12- to 17-year-olds following a telemedicine visit with an adolescent medicine subspecialist. Open-ended questions assessing acceptability of telemedicine for confidential care and opportunities to enhance confidentiality were qualitatively analyzed. Likert-type questions assessing preference for future use of telemedicine for confidential care and self-efficacy to complete components of telemedicine visits confidentially were summarized and compared across cisgender versus GDY.
Results:
Participants (n = 88) included 57 GDY and 28 cisgender females. Factors affecting the acceptability of telemedicine for confidential care related to patient location, telehealth technology, adolescent-clinician relationships, and quality or experience of care. Perceived opportunities to protect confidentiality included using headphones, secure messaging, and prompting from clinicians. Most participants (53/88) were likely or very likely to use telemedicine for future confidential care, but self-efficacy for completing components of telemedicine visits confidentially varied by component.
Discussion:
Adolescents in our sample were interested in using telemedicine for confidential care, but cisgender and GDY recognized threats to confidentiality that may reduce acceptability of telemedicine for these services. Clinicians and health systems should carefully consider youth's preferences and unique confidentiality needs to ensure equitable access, uptake, and outcomes of telemedicine.
Purpose: Gender-diverse youth (GDY) face significant health disparities, which can be mitigated by gender-affirming medical care. Understanding parents' experiences seeking care for their GDY can identify barriers to care and improve access. This study sought to understand parents' experiences accessing gender-affirming medical care with their GDY. Methods: We asked parents of GDY in the United States to describe their experiences with gender-affirming medical care through a single open-ended item on an online survey disseminated through social media in February of 2020. Open-ended survey responses were analyzed through inductive thematic analysis by two authors using an iteratively developed codebook adjudicated by consensus. This codebook was used to identify key themes. Results: We analyzed 277 responses from majority White (93.9%) parents from 41 U.S. states. Themes included (1) Experiences accessing care: finding a provider, financial and insurance-related considerations, the impact of geography on care access; (2) Experiences receiving care: factors in successful or unsuccessful patient-provider interactions, differing approaches to initiating care, sense of community with other families; and (3) Outcomes related to receiving care: how care for their child was perceived to be lifesaving or helped their child thrive. Conclusions: Parents highlighted how access to gender-affirming medical care improved their GDY's health and wellbeing, and described numerous barriers they experienced with finding and receiving this care. Given the evidence that gender-affirming medical care mitigates health disparities, providers, policymakers, insurance companies, and health systems leaders should urgently address these challenges to ensure equitable receipt of care for all GDY.
Introduction: Little is known about how expansion of telemedicine services during the COVID-19 pandemic has affected access to gender-affirming care for transgender and gender-diverse (TGD) youth. The purpose of this study was to explore differences in demographic characteristics and visit completion rates at a multidisciplinary gender clinic before and after telemedicine implementation in March 2020 and among telemedicine users and nonusers. Methods: Data were from electronic health records of Seattle Children's Gender Clinic (SCGC) patients seen between April 2019 and February 2021. We assessed differences in demographic characteristics and care utilization (i.e., encounter type and status) between April 2019 and February 2020 (pre-telemedicine) and April 2020 and February 2021 (post-telemedicine). Results: Of the 1,051 unique patients seen at SCGC during this time period, majority groups were as follows: 62% identified as transmasculine/male, 68% were non-Hispanic White, and 76% resided within 50 miles of the clinic. Statistically significant differences were observed in patient pronouns and insurance type when comparing the pre- and post-telemedicine periods (p < 0.01). Half (52%) of post-telemedicine period encounters were conducted through telemedicine, and telemedicine encounters were significantly more likely to be completed (72% vs. 50%) and less likely to be canceled (21% vs. 46%) compared with in-person encounters. Conclusions: Telemedicine services facilitated continued access to gender-affirming care services for TGD youth during the COVID-19 pandemic. Although the introduction of telemedicine did not exacerbate demographic disparities in access to this care, further research and interventions are warranted to address the ongoing disparities in access to gender-affirming care for youth of color and rural youth.
Research has demonstrated that systemic transphobia and cissexism harms transgender youth in terms of social, educational, and health outcomes. All too often, research and policy emphasizes vulnerability among trans youth in a way that denies their capabilities as agents of change or active participants in their liberation. This article analyzes the development of Trans Youth Justice Project, a political education and youth leadership development program for trans youth ages 15–22. Based in principles of gender minority stress and social justice youth development, the 6-week remote program aims to increase the capacity and resilience of trans youth, develop youth leaders, and contribute to addressing social, educational, and health inequalities. We conducted a formative program evaluation of 2 cycles of the program with a total of 25 youth. Pre- and post-test surveys indicated increased feelings of belongingness to a trans community. Follow-up interviews highlighted the impact the program had on skills for social justice, self-efficacy, and community connection. We offer suggestions for implementing the open-source program more broadly.
Access to equitable health care, including gender-affirming medical care (eg, pubertal blockers, sex hormones), continues to be a struggle for transgender and nonbinary youth, especially those who are in racial and ethnic minority groups.¹,2 Barriers to accessing comprehensive health care may contribute to the many health disparities transgender and nonbinary youth face, such as higher rates of substance misuse, burden of sexually transmitted infections, bullying, being bullied, anxiety, depression, suicidal ideation, and suicidal behaviors compared with their aged-matched cisgender peers.³ Looking at 1 disparity, mental health, there is clear evidence that access to pubertal suppression and gender-affirming hormones can be lifesaving.⁴,5 Yet, barriers to this care continue to exist, and many transgender and nonbinary people avoid accessing health care because of experiences of discrimination and/or fear of breaches in confidentiality.
Gender-affirming care (GAC) is critical to the well-being of transgender and gender diverse youth and was limited by COVID-19 stay-at-home orders. Telehealth created opportunities for youth to continue receiving lifesaving care. We examined the attitudes of patients (n=21) and caregivers (n=38) receiving telehealth-delivered GAC (TGAC) from May to July 2020. Participants completed surveys after telehealth visits. Descriptive statistics compared telehealth with in-person visits across key domains. Overall, 86.5% of patients and 95.4% of caregivers were satisfied with medical TGAC and 94.3% and 93.3% were satisfied with behavioral health TGAC. Future research should determine the effectiveness of TGAC and identify areas for improvement.
Purpose:
Telemedicine holds potential to improve access to gender-affirming care for gender-diverse youth (GDY), but little is known about youth's perspectives regarding its use. The purpose of this study was to explore GDY's experiences and satisfaction with telemedicine for gender-affirming care during the COVID-19 pandemic.
Methods:
An online, cross-sectional survey was completed by 12-17-year-old GDY after a telemedicine gender clinic visit. Demographic characteristics, responses to a 12-item telemedicine satisfaction scale, and items assessing interest in future telemedicine use were analyzed using descriptive statistics. Open-ended items exploring GDY's experiences were coded qualitatively to identify key themes.
Results:
Participants' (n=57) mean age was 15.6 years. A majority were satisfied with telemedicine (85%) and willing to use it in the future (88%). Most GDY preferred in-person visits for their first gender care visit (79%), with fewer preferring in-person for follow-up visits (47%). Three key themes emerged from the open-ended comments: (1) benefits of telemedicine including saving time and feeling safe; (2) usability of telemedicine such as privacy concerns and technological difficulties; and (3) telemedicine acceptability, which included comfort, impact on anxiety, camera use, and patient preference.
Conclusions:
Despite their preference for in-person visits, a majority of GDY were satisfied and comfortable with telemedicine, and expressed their interest in continuing to have telemedicine as an option for care. Pediatric gender care providers should continue services through telemedicine while implementing protocols related to privacy and hesitation regarding camera use. While adolescents may find telemedicine acceptable, it remains unclear whether telemedicine can improve access to gender-affirming care.
Transgender and gender-diverse (TGD) youth experience significant health and well-being disparities compared to their cisgender peers. However, disparities experienced at a population level might be mitigated by individual-level factors such as strong family relationships. Discrete aspects of strong family relationships may impact the health and well-being of TGD youth differently. To date, no systematic review known to us has explored the state of the science regarding the association between family relationships and the health and well-being of TGD adolescents and young adults. As such, our review aimed to (1) compile and present the scientific literature addressing the connection between family relationships and the health and well-being of TGD youth in those families; (2) sort results utilizing the Family Strengths Model; and (3) assess the strength of the literature with evidence-based appraisal tools. Sixteen articles met eligibility criteria (10 quantitative and 6 qualitative). These articles discussed family relationship qualities influencing health and well-being outcomes, including mental health, homelessness, sexual health, and substance use. Three of six qualities of strong families-coping ability, appreciation and affection, and positive communication-were represented in the literature. The risk for bias and study strength appraisals suggest that the available literature is moderately strong overall. Certain characteristics of strong families (commitment, enjoyable time spent together, and spiritual well-being) were underrepresented in the literature. Future research should explore these gaps to ensure that health care and community service providers can deliver the most effective support and care for TGD youth and their families.
Purpose:
We aimed to examine transgender youths' interest in receiving gender-affirming care via telemedicine or through primary care with telehealth support.
Methods:
We surveyed 12- to 26-year-old transgender youth receiving care in a multidisciplinary gender clinic. Descriptive statistics and bivariate analyses were used to assess relationships between demographic and gender-related characteristics and interest in receiving care via telemedicine.
Results:
Almost half (47%) of the 204 youth surveyed expressed interest in receiving gender care via telemedicine. Additionally, youth with lower levels of perceived parental support were more likely to express an interest in utilizing telemedicine (p = .001). Approximately half (45%) of youth were interested in receiving gender care in the primary care setting, with a majority expressing willingness to do so if their primary care provider had telehealth support.
Conclusions:
Many transgender youth expressed interest in receiving gender care via telehealth, particularly for ongoing care and monitoring. Increased interest in telemedicine was seen among youth with lower perceived parental support.
Purpose
This study describes the rapid implementation of telemedicine within an adolescent and young adult (AYA) medicine clinic in response to the Coronavirus Disease 2019 (COVID-19) pandemic. While there are no practice guidelines specific to AYA telemedicine, observations made during this implementation can highlight challenges encountered and suggest solutions to some of these challenges.
Methods
Over the course of several weeks in March, 2020, the Adolescent and Young Adult Medicine Clinic at the University of California San Francisco rapidly replaced most in-person visits with telemedicine visits. This required logistical problem-solving, collaboration of all clinic staff members, and continuous reassessment of clinical practices. This article describes observations made during these processes.
Results
Telemedicine visits increased from zero to 97% of patient encounters in one month. The number of visits per month was comparable with that one year prior. While there were limitations to the clinic’s ability to carry out health supervision visits, many general health, mental health, reproductive health, eating disorders, and addiction treatment services were implemented via telemedicine. Providers identified creative solutions for challenges that arose to managing general confidentiality issues as well as specific challenges related to mental health, reproductive health, eating disorders, and addiction care. Opportunities to implement and expand high-quality AYA telemedicine were also identified.
Conclusions
The COVID-19 pandemic is leading to widespread telemedicine implementation. While telemedicine seems to be feasible and acceptable for our clinic patients, unanswered questions remain regarding confidentiality, quality of care, and health disparities. Clinical guidelines are also needed to guide best practices for telemedicine in this patient population.
Objectives:
We characterized referral trends over time at a transgender clinic within an integrated health system in Northern California. We identified the transition-related requests of pediatric transgender and gender-nonconforming patients and evaluated differences in referrals by age group.
Methods:
Medical records were analyzed for all patients <18 years of age in the Kaiser Permanente Northern California health system who were referred to a specialty transgender clinic between February 2015 and June 2018. Trends in treatment demand, demographic data, service requests, and surgical history were abstracted from medical charts and analyzed by using descriptive statistics.
Results:
We identified 417 unique transgender and gender-nonconforming pediatric patients. The median age at time of referral was 15 years (range 3-17). Most (62%) identified on the masculine spectrum. Of the 203 patients with available ethnicity data, 68% were non-Hispanic. During the study period, the clinic received a total of 506 referrals with a significant increase over time (P < .001). Most referrals were for requests to start cross-sex hormones and/or blockers (34%), gender-affirming surgery (32%), and mental health (27%). Transition-related requests varied by age group: younger patients sought more mental health services, and older patients sought hormonal and surgical services. Eighty-nine patients underwent gender-affirming surgeries, mostly before age 18 and most frequently mastectomies (77%).
Conclusions:
The increase in referrals supports the need for expanded and accessible health care services for this population. The transition-related care of patients in this large sample varied by age group, underscoring the need for an individualized approach to gender-affirming care.
Access to health specialists is difficult for many individuals in rural communities.¹ Telemedicine, health care service delivered remotely through telecommunications, is one potential solution, but its use varies across regions, potentially associated with the availability of high-speed internet (broadband) access.² The Federal Communications Commission (FCC) and Congress have emphasized the need to increase broadband access in rural communities, in part to facilitate the use of telemedicine, and the FCC’s Connect America Fund has set aside billions of dollars to subsidize broadband expansion.³ Our objective was to examine whether broadband availability in local communities is associated with telemedicine use.
Background/aims:
To examine characteristics, including mental health comorbidities, among adolescents presenting to a transgender clinic and to compare these data to previous reports.
Methods:
Retrospective chart review among youth seen at The Hospital for Sick Children between January 2014 and June 2016. Demographic data, clinical characteristics, and mental health comorbidities were assessed. Baseline and repeat blood work were also examined.
Results:
Charts from 203 adolescents aged 12-18 years were reviewed (156 assigned female at birth [AFAB] (77%) aged 16.3 ± 1.63 years, 47 assigned male at birth [AMAB] aged 16.1 ± 1.70 years). There was no statistically significant difference between gender groups except for Tanner stage (AFAB, mean 4.42 ± 0.8 and AMAB, mean 4.03 ± 1.1, p = 0.040). Individuals from racial/ethnic minority populations were under-represented compared to the background population. Self-report and baseline psychological questionnaires showed high levels of gender dysphoria, mood disorders, and suicidal ideation, with higher levels of anxiety detected on questionnaires among AFAB (p = 0.03). Laboratory abnormalities identified on baseline and repeat testing were minor; on cross-sex hormones, hemoglobin levels increased slightly in AFAB (p = 0.002, highest = 166 g/L) and decreased among AMAB (p = 0.02, lowest = 132 g/L).
Conclusion:
Our study supports an evolving demographic trend with more AFAB than AMAB youth now presenting to gender clinics. The data also corroborate studies indicating that extensive laboratory testing may not be a necessary part of caring for these youths. Why more AFAB are now presenting to clinic and racial/ethnic minorities are underrepresented is not clear, but these trends have important implications for clinical care and warrant further study.
The growth and evolution of telehealth are opening new avenues for efficient, effective, and affordable pediatric health care services in the United States and around the world. However, there remain several barriers to the integration of telehealth into current practice. Establishing the necessary technical, administrative, and operational infrastructure can be challenging, and there is a relative lack of rigorous research data to demonstrate that telehealth is indeed delivering on its promise. That being said, a knowledge of the current state of pediatric telehealth can overcome many of these barriers, and programs are beginning to collaborate through a new pediatric telehealth research network called Supporting Pediatric Research on Outcomes and Utilization of Telehealth (SPROUT). In this report, we provide an update on the landscape of pediatric telehealth and summarize the findings of a recent SPROUT study in which researchers assessed pediatric telehealth programs across the United States. There were >50 programs representing 30 states that provided data on their implementation barriers, staffing resources, operational processes, technology, and funding sources to establish a base understanding of pediatric telehealth infrastructure on a national level. Moving forward, the database created from the SPROUT study will also serve as a foundation on which multicenter studies will be developed and facilitated in an ongoing effort to firmly establish the value of telehealth in pediatric health care.
Objective:
Social transitions are increasingly common for transgender children. A social transition involves a child presenting to other people as a member of the "opposite" gender in all contexts (e.g., wearing clothes and using pronouns of that gender). Little is known about the well-being of socially transitioned transgender children. This study examined self-reported depression, anxiety, and self-worth in socially transitioned transgender children compared with 2 control groups: age- and gender-matched controls and siblings of transgender children.
Method:
As part of a longitudinal study (TransYouth Project), children (9-14 years old) and their parents completed measurements of depression and anxiety (n = 63 transgender children, n = 63 controls, n = 38 siblings). Children (6-14 years old; n = 116 transgender children, n = 122 controls, n = 72 siblings) also reported on their self-worth. Mental health and self-worth were compared across groups.
Results:
Transgender children reported depression and self-worth that did not differ from their matched-control or sibling peers (p = .311), and they reported marginally higher anxiety (p = .076). Compared with national averages, transgender children showed typical rates of depression (p = .290) and marginally higher rates of anxiety (p = .096). Parents similarly reported that their transgender children experienced more anxiety than children in the control groups (p = .002) and rated their transgender children as having equivalent levels of depression (p = .728).
Conclusion:
These findings are in striking contrast to previous work with gender-nonconforming children who had not socially transitioned, which found very high rates of depression and anxiety. These findings lessen concerns from previous work that parents of socially transitioned children could be systematically underreporting mental health problems.
Objective:
Transgender children who have socially transitioned, that is, who identify as the gender "opposite" their natal sex and are supported to live openly as that gender, are increasingly visible in society, yet we know nothing about their mental health. Previous work with children with gender identity disorder (GID; now termed gender dysphoria) has found remarkably high rates of anxiety and depression in these children. Here we examine, for the first time, mental health in a sample of socially transitioned transgender children.
Methods:
A community-based national sample of transgender, prepubescent children (n = 73, aged 3-12 years), along with control groups of nontransgender children in the same age range (n = 73 age- and gender-matched community controls; n = 49 sibling of transgender participants), were recruited as part of the TransYouth Project. Parents completed anxiety and depression measures.
Results:
Transgender children showed no elevations in depression and slightly elevated anxiety relative to population averages. They did not differ from the control groups on depression symptoms and had only marginally higher anxiety symptoms.
Conclusions:
Socially transitioned transgender children who are supported in their gender identity have developmentally normative levels of depression and only minimal elevations in anxiety, suggesting that psychopathology is not inevitable within this group. Especially striking is the comparison with reports of children with GID; socially transitioned transgender children have notably lower rates of internalizing psychopathology than previously reported among children with GID living as their natal sex.
Telemedicine is a technological tool that is improving the health of children around the world. This report chronicles the use of telemedicine by pediatricians and pediatric medical and surgical specialists to deliver inpatient and outpatient care, educate physicians and patients, and conduct medical research. It also describes the importance of telemedicine in responding to emergencies and disasters and providing access to pediatric care to remote and underserved populations. Barriers to telemedicine expansion are explained, such as legal issues, inadequate payment for services, technology costs and sustainability, and the lack of technology infrastructure on a national scale. Although certain challenges have constrained more widespread implementation, telemedicine's current use bears testimony to its effectiveness and potential. Telemedicine's widespread adoption will be influenced by the implementation of key provisions of the Patient Protection and Affordable Care Act, technological advances, and growing patient demand for virtual visits.
Copyright © 2015 by the American Academy of Pediatrics.
Research electronic data capture (REDCap) is a novel workflow methodology and software solution designed for rapid development and deployment of electronic data capture tools to support clinical and translational research. We present: (1) a brief description of the REDCap metadata-driven software toolset; (2) detail concerning the capture and use of study-related metadata from scientific research teams; (3) measures of impact for REDCap; (4) details concerning a consortium network of domestic and international institutions collaborating on the project; and (5) strengths and limitations of the REDCap system. REDCap is currently supporting 286 translational research projects in a growing collaborative network including 27 active partner institutions.
Dedoose web application for managing, analyzing, and presenting qualitative and mixed method research data
- SocioCultural Research Consultants LLC