Gender Identity Services for Children & Young People in Wales 2018

Gender Identity Services for Children & Young People in Wales

What is gender dysphoria ?

Gender dysphoria in children or gender identity disorder in children (GIDC) is a formal diagnosis used by psychologists and physicians to describe children who experience significant discontent with their biological sex, assigned gender or both.

How is the service commissioned ?

• Currently commissioned by Welsh Health Specialised Services Committee (WHSSC) on behalf of the seven Health Boards • Service commissioned from one NHS England provider – Tavistock & Portman NHS Foundation Trust • National Specialist service based in London but they have an outreach clinic in Llandough, Cardiff for welsh patients.

• Gender Identity Development Services (GIDS) website gids.nhs.net • Current waiting time is approximately 1 year • Referral pathway for funding is thorough local CAMHS services

19 89 /1 19 990 90 /1 19 991 91 /1 19 992 92 /1 19 993 93 /1 19 994 94 /1 19 995 95 /1 19 996 96 /1 19 997 97 /1 19 998 98 /1 19 999 99 /2 20 000 00 /2 20 001 01 /2 20 002 02 /2 20 003 03 /2 20 004 04 /2 20 005 05 /2 20 006 06 /2 20 007 07 /2 20 008 08 /2 20 009 09 /2 20 010 10 /2 20 011 11 /2 20 012 12 /2 20 013 13 /2 20 014 14 /2 20 015 15 /2 20 016 16 /2 01 7

Rapid increase in referral rate to GIDS since 2009

Total referrals 1989/90 – 2016/17

2000

0

2016

1800

1600

1400

1419

1200

1000

800

600

697

400

468

200

4 7 15 13 7 139 97 85 64 12 12 24 28 14 21 26 32 41 50 50 29 50 208 314

Referrals in Wales increasing year on year 2009/10 to 2016/17 80

75

70

60

50

42

40

30

19

20

10

0

1

2009/2010

3 2010/2011

6 2011/2012

23

8 2012/2013

2013/2014

2014/2015

2015/2016

2016/2017

Increased referrals in Wales match the national trend Comparison using standardized scores

2009/2010

2010/2011

2011/2012

2012/2013

2013/2014

NHS Wales

Total

2014/2015

2015/2016

2016/2017

Changing demographics Referrals to GIDS by gender assigned at birth April 2009 to March 2016

Male

Female

65%

61% 60% 42% 58%

47% 53%

57% 43%

2009/2010

2010/2011

2011/2012

61% 39%

40%

2012/2013

2013/2014

35% 39% 2014/2015

2015/2016

Gender ratio by gender assigned at birth

2009 - 10

2015 - 16 35%

42% 58%

Assigned male

Assigned female

65%

Assigned male

Assigned female

GIDS Referrals by Age April 2009 to Mar 2016 (3253 Referrals)

3 0%

4 1%

5 1%

6 1%

17 15%

7 3%

8 9 2% 3% 10 3% 11 3% 12 4% 13 6%

16 26%

14 13%

15 19%

Associated difficulties (N=218 : Assigned Female = 137, Assigned Male = 81)

Recorded LGBT hate crime is increasing Police are recording increasing levels of hate crime:

LGBT hate crimes recorded in England and Wales 2011/12 to 2015/16 8000

1000 900 800 700 600 500 400 300 200 100 0

7000 6000

•

greater prevalence?

5000

•

improved reporting?

3000

4000 2000 1000

More hate crimes recorded against sexual orientation than transgender

0 2011/12

2012/13

2013/14

Sexual orientation

2014/15 Transgender

Sexual orientation: left; Transgender: right

2015/16

What next • AWGIPG will look at the pathway for children services and work with the provider in improving services • Understand that NHS England are going to undertake a consultation of gender identity service for children and young people –NHS wales will be part of that.

• Some of that work will look at ages of accessing both children and adult services • Continue to improve the transition arrangements to adult services

Future Welsh Pathway ( Draft ) HB

All Wales Gender Identity Partnership

Gender Task & Finish Group

HB HB

Collaborative GID & Welsh Gender Service Hub

HB HB Each HB: CAMHS Gender Lead; Paediatric Endocrinologist Lead; GP/ Primary Care Lead

HB HB

WHSCC Tavistock Gender Identity Service

Current Welsh Pathway

Child presents to Referring Practitioner Referral to local CAMHS

Assessment by local CAMHS

Current Wait 8-9 months

Assessment in outreach clinic at Llandough by Team Wales from GIDS Currently every 3 - 4 months

Prescribe Hormone blockers/cross sex hormones if appropriate, supported by endocrinologist from Royal Free

Referred into adult GIC at point of transition

Invite Family to Open Day

GP prescribes hormones & monitors bloods with support from GIDFS

GID = Gender Identity Dysphoria Service Tavistock & Portman ( London )

Proposed Welsh Pathway ( Draft )

Collaborative Assessment Phase & Early Intervention (Less Emphasis on Gatekeeping)

Child presents to Referring Practitioner Referral to local CAMHS

Assessment by local CAMHS

Joint Assessment in outreach clinic at Llandough by CAMHS & GIDS

Prescribe Hormone blockers/cross sex hormones if appropriate, supported by endocrinologist from Royal Free Referred into adult GIC at point of transition

Referral to GIDS

by CAMHS

GP prescribes hormones & monitors bloods with support from GIDFS

Thank you – any questions ?