Expanding Transgender Health Care Access for Adolescent Youth
The need for specialty medical care is on the rise at hospitals across the country, and at The University of Vermont Children’s Hospital referrals to the Transgender Youth Program continue to increase. Since opening in 2016, the Transgender Youth Program, part of the Division of Adolescent Medicine, has served as the primary multidisciplinary gender care program available to young people and families in Vermont and northern New York.
A recent boost in funding for the division is aimed at increasing capacity to meet the ever-growing demand for adolescent medicine specialty services and ensure patient access to the Transgender Youth Program and other adolescent medicine clinics. To date, the Transgender Youth Program has cared for more than 200 families.
Medical professionals have found consensus that gender-affirming care is crucial for transgender youth – that’s why the UVM Children’s Hospital program is committed to creating an inclusive environment for care. In a 2018 policy statement the American Academy of Pediatrics defined the gender affirming care model as “developmentally appropriate care that is oriented toward understanding and appreciating the youth’s gender experience through a strong non-judgmental partnership with youth and their families that can facilitate exploration of complicated emotions and gender-diverse expressions while allowing questions and concerns to be raised in a supportive environment.” The UVM Children’s Hospital provides this care through the integration of medical, mental health and social services as recommended by professional guidelines. Without such care, transgender youth may face troubling challenges like gender dysphoria, depression and anxiety, or tragic outcomes like suicide.
Despite the mounting evidence that gender-affirming care creates positive outcomes for transgender youth, some state legislatures are moving to ban it. In Vermont and several other states, including our neighboring states of Massachusetts and New York, lawmakers have done the opposite and passed bills to protect access to legally protected gender affirming care.
That’s a stark contrast to many other states. According to the Human Rights Campaign Foundation, 21 states have passed laws or policies banning gender-affirming care for people under 18. Seven other states are considering such bans. As a result, 35% of transgender youth live in states where such care is banned.
“The fact that our legislature took the initiative to create legislation to protect young people, families, care providers and volunteers to access this legally protected health care in our state is incredible,” says Erica Gibson, MD, the Division Head of Adolescent Medicine and the medical director of the Transgender Youth Program at the UVM Children’s Hospital.
"At this time we are getting at least a few inquiries each month from families that are moving to Vermont from other states where they do not feel they can keep their children and families safe and access the care they need to keep them healthy and well," says Dr. Gibson.
Gibson says she and other gender care providers, as well as their patients and families, “are very lucky” to live in Vermont where officials are “supportive of gender diverse youth and their families.” In Vermont, providers can continue to “follow the evidence-based guidelines for care from our major professional medical organizations” just like all other pediatric care.
"When families contact our program or are referred to our program they are looking for a range of information from very basic information about how to provide psychosocial support to the young people they care for to being ready to gather more information about possible future medical interventions after a child starts puberty," says Dr. Gibson.
Currently, the program only meets one day per week, and all program staff are part time. Due to its small size the program has primarily served young people and families that are interested in learning more about possible future medical interventions. Families seeking just psychosocial supports are referred to a variety of community providers and community-based organizations that specialize in supports for gender diverse youth and families.
"As referrals continue to rise and access to supports in the community become more challenging, we hope to expand our program to provide a wider variety of supports," says Dr. Gibson.
A budget increase of more than $1 million over the next two years will allow the Division of Adolescent Medicine to add another physician, as well as additional multidisciplinary providers such as social workers, psychologists and support staff to meet referral and access demands within the division. The funding proposal was developed through a collaboration between the Department of Mental Health and the UVM Health Network.
Gibson says she expects referrals to continue increasing and the limited access to broader community based psychosocial supports to continue to be challenging – so the additional funding is critical. It also means families that currently have to travel out-of-state for care will have the option to stay closer to home and families moving to the state will be assured access to more timely care. The wait time for patients and families could also be substantially reduced.