Read standard 10: Gender identity services for young people

Gender identity healthcare: Adults and young people
Healthcare Improvement Scotland

Standard statement

Young people have timely access to safe, high-quality and person-centred gender identity services which understand, respect and uphold their rights.

Rationale

Young people accessing gender identity services may have additional care and support needs. This standard sets out additional requirements which services should provide. Young people’s services should also be delivered in line with standards 1-9.

Delivering healthcare services for young people requires effective communication and multidisciplinary and multi-agency working between services. The implementation of local and national protocols and evidence based integrated clinical and care pathways will ensure young people can access the right care, from the right person at the right time.17, 42, 53 This may include CAMHS, social work, support through educational establishments and support for family and representatives.

All young people have rights under the UN Convention of Rights of a Child (UNCRC) Article 1 and other healthcare policy frameworks, which outline the responsibilities for organisations and staff.31, 54 This includes, but is not limited to, that young people should be informed of their rights, including the right to privacy and the right to confidentiality, and the circumstances where information may be shared in order to keep them safe or protect them from harm.

Staff working with young people are trained in their professional and legal obligations in safeguarding, obtaining consent and supporting decision making.26 Young people, and their families/representatives, are informed and involved in discussions and decisions where appropriate and with consent. Young people are supported to understand when information may be shared.

Trans and non-binary young people are more likely to experience discrimination and bullying at school, poor family and caregiver relationships, and to have experience of the care system. All these factors may impact on their health and wellbeing. There is evidence that trans and non-binary young people also experience higher rates of mental health issues, adverse childhood events and is more neurodivergent.55 A holistic initial assessment and ongoing care planning should consider all relevant medical, social, developmental and other factors to support the young person in their decision making.

Young people should be actively involved in the way services are planned and be listened to and taken seriously. Organisations should undertake Children’s Rights and Wellbeing Impact Assessments to understand the needs of their populations and ensure these are addressed.

Young people may move from young people’s to adult gender identity services as they get older. The transfer to adult services will be determined by personal circumstances, choice and local arrangements for service provision and age boundaries. The move between young people’s and adult services should be as seamless as possible, maintaining continuity of care, with early planning and collaborative working relationships between services to support the move.30 The original referral date should be applied by the adult service in the event that the young person reaches the relevant age for adult services whilst waiting to access the young people’s service.

Who is responsible for meeting this standard?

All organisations and staff providing a gender identity service for young people in line with their roles, responsibilities and workplace setting.

Criteria

10.1

Young people:

  • are listened to, their experience is acknowledged and taken seriously
  • are supported to make fully informed decisions about their gender identity healthcare and wellbeing
  • understand the consent process
  • are supported to understand and uphold their legal rights
  • are supported to understand privacy, confidentiality and who will be involved in decisions at all stages of their care.
10.2

Initial assessment at the young people’s gender identity service should:

  • be holistic, person-centred and trauma informed
  • go at a pace that supports and is informed by the young person
  • involve a full history of the young person’s medical, psychological, social, education, family, welfare and other relevant history
  • include a mental health assessment with screening for neurodevelopment conditions, including autism spectrum disorder, where appropriate
  • include other sources of information including family, where appropriate
  • include assessment and review of any medication history
  • include an assessment of the young person’s current health and wellbeing
  • cover capacity for decision making and consent
  • involve discussion of future pathways where appropriate.
10.3

Young people receive care, information and support that is based on evidence and good practice. It should be appropriate to their stage of emotional development, age and specific needs, for example care-experienced young people.

10.4

Families/representatives, where appropriate:

  • are informed of young people’s rights
  • are supported to understand and uphold their own rights
  • are informed and involved in discussions, decisions and care planning
  • can access mental health support and advice
  • are signposted to relevant support organisations.
10.5

Gender identity services for young people work in partnership with staff with specialist skills including paediatrics, specialist pharmacists and paediatric endocrinology, where required.

10.6

Gender identity services for young people work collaboratively and in partnership with schools, youth workers, CAMHS, social workers, primary care, and third sector organisations to support and empower young people and to promote good health and wellbeing.

10.7

Gender identity health services and support services working with young people have:

  • training and competencies in child development
  • appropriate referral pathways for young people to local support services
  • knowledge and implementation of child protection and safeguarding guidance26
  • robust information sharing protocols that respect young people’s right to safety and freedom from harm as well as their right to privacy and health.54
10.8

NHS boards ensure that where a young person is moving to an adult gender identity service:

  • the process is robust, seamless and fully documented
  • appropriate treatment pathways are followed, for example, medicines management, mental health support
  • appropriate information is shared between services for continuity of care
  • early preparation and forward planning is undertaken to support the person and, where appropriate, their family/representative.
10.9

A person-centred care plan for moving between young people’s and adult services, will:

  • be developed in collaboration with the young person and, where appropriate, their family or representative
  • include a named healthcare professional’s contact details
  • be informed by the young person’s needs and what matters to them
  • be timely and planned well in advance of any service transition29, 30
  • be reviewed as needs change
  • include a plan for unscheduled care during service transition, for example access to support
  • be documented and shared with relevant services and the young person where appropriate.

What does this standard mean for...

What does the standard mean for young people?

  • You will be listened to and taken seriously.
  • You will be supported and empowered to make choices.
  • You will receive consistency and continuity in care.
  • Staff and organisations will work together to ensure that you can access the right care and support at the right time.
  • You will be given opportunities to provide feedback and to help shape services.
  • Your move between young peoples’ and adult gender identity services will be smooth, seamless and planned well in advance.
  • Your family/representative will be involved if that is right for you.

What does the standard mean for staff?

Staff, in line with their roles, responsibilities and workplace setting:

  • put the best interests of young people at the centre of their work, including respecting their privacy and confidentiality
  • involve young people in decision making and support them to make choices
  • take a person-centred approach to gender identity care for young people
  • are involved in the development of a care plan for a young person, where appropriate
  • can demonstrate knowledge, skills and competencies in working with young people
  • understand social and cultural experiences that may impact on the young person such as being a young carer or care-experienced
  • are proactive in identifying and responding to concerns such as safeguarding
  • can refer to the relevant professional or service to provide initial advice and subsequent assessment, if necessary
  • plan the move between young people and adult services with input from relevant specialties
  • work in partnership with other services and organisations such as gender identity clinics, CAMHS, social work, and third sector partners to ensure the young person is receiving the most appropriate care
  • have a comprehensive understanding of referral pathways into young people’s gender identity services.

What does the standard mean for the organisation?

Organisations:

  • adhere to legislation, evidence based guidance and standards relating to young people
  • provide evidence of alignment with child protection and safeguarding policies
  • ensure that staff are trained and knowledgeable in working with young people including consent and confidentiality
  • ensure that staff maintain their professional registration and participate in training and professional development relating to work with young people
  • promote collaborative working across all agencies who come into contact with young people
  • facilitate and participate in plans for transfer of care between services according to the young person’s care plan
  • respond to concerns such as safeguarding about a young person and follow necessary procedures and protocols.

Examples of what meeting this standard might look like

  • Evidence of alignment of national policies relating to young people and service delivery.
  • Information provided in alternative formats and languages, including videos and online material developed in partnership with young people and representatives.
  • Use of Children’s Rights and Wellbeing Impact Assessments and other impact assessments to inform service design and delivery for young people.
  • A clearly documented referral pathway to young person’s gender identity services.
  • Documented local NHS board referral pathways to other services, including CAMHS and/or family and representative support.
  • Evidence of working with young people, their families or representatives in designing and improving services.
  • Partnership and multiagency working, including education, CAMHS and the third sector.
  • Evidence of responsive and person-centred care, for example, to support care-experienced young people.
  • Consistency in recording of care plans, including details of any treatment and requirements by primary care staff.