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 = 14) to explore experiences of FASST, and inductive content analysis was performed. RESULTS After FASST, there were improvements in depression (standardized mean difference [SMD] = −0.24; 95% confidence interval [CI]: −0.36 to −0.11; P < .001), anxiety (SMD = −0.14; 95% CI: −0.26 to −0.02; P = .025) and quality of life (SMD = .39; 95% CI: 0.23 to 0.56; P < .001). Compared with historical controls, those attending FASST showed reduced depression (SMD = −0.24; 95% CI: −0.50 to 0.01; P = .065) and anxiety (SMD = −0.31; 95% CI: −0.57 to −0.05; P = .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.