External factors: Political climate, funding, legislation, stigma, attitudes towards gender diversity, health and healthcare.

Objective: To provide a family centered approach that entails a multidisciplinary assessment, support and treatment to children, adolescents and their families who are accessing the RCH Gender Service.

Target group: Children and adolescents who experience GD, reside in Victoria and access the RCH GS prior to their 17th birthday.

Funding

RCH supportPharmacyIT including databasesPathology

Outpatient clinic A5Nurse led clinic

Outpatient specialty clinic DAppointmentsClinical space

Skilled multidisciplinary teamPsychiatristsPaediatriciansEndocrinologistPsychologistClinical Nurse ConsultantGynecologistSpeech PathologistGeneral SurgeonAdministrationClinical EthicsLegal Services

Phone consultsInformationSecondary consults

RMS IntakeTriage, book initial appointment and link into the relevant GS clinic.

LeadershipIn child and adolescent GD care.

ResearchGS program evaluationData collectionResearch projects

EducationTo children, adolescents and their families, health service providers and community.

SystemsLiaisonReportsSecondary consults

AdvocacyLegal issuesDiscrimination issues

Specialty clinics< 8yr mental health assessment and follow up> 8yr HEADSS and support needs assessment – CNC and psychologist> 8yr medical assessment – psychiatrist and paediatrician > 8yr mental health follow up> 8yr paediatrician follow-up> 17yr begin transition to community services

ResearchData collectionEvaluationPublicationPresentationDissemination

EducationTo children, adolescents and their families and health professionals.Regarding support, pathways, diagnosis and treatment options.

GD Diagnosis

Interventions, treatments and follow-upLetters of supportMental health second opinionPuberty blockadeCross hormone treatment

EducationTo children, adolescents and their families and GPS.Regarding consent and medications including their use, effects and administration.

Referral toGynecologySurgeryBioethicsEndocrinologySpeech TherapyLegalGPs

New referralsAssessed within 4 months

Patients and familiesUnderstand options for managing GD.Provide informed consent.Participate in self-care e.g. medication administration.

10 Community cliniciansConfidently manage post GD assessment and treatment care including medication management and ongoing mental health support.

Evidence/researchPublicationsProgram evaluationContribute to international research

LeadershipTeach, train and mentor professionals working in the sector.

5. Improved quality of life for people who are gender diverse.

4. Reduced mental health burden among children and adolescents with GD.

3. Ongoing care of adolescents with GD is co-managed by community providers.

2. Children and adolescents with GD are provided pathways to support, assessment and treatment in a timely manner.

1. The RCH GS are leaders in health care provision for children and adolescents with GD.

Resources Activities Outputs 1 Outputs 2Outputs 3

BehavioursOutcomes/Goals

GS Goal: To improve the physical, social and mental health and wellbeing outcomes of children and adolescents who experience GD and access the RCH GS.

Rationale:

A multidisciplinary GS that employs a comprehensive, family centered approach and is located within The Royal Children’s Hospital platform, is well positioned to meet the health and wellbeing needs of children and adolescents with GD and their families.

Provision of respectful, quality early intervention will improve mental health outcomes (quality of life, reduce suicide risk) for children and adolescents experiencing GD.

Problem statement: Children and Adolescents with GD are at greater risk for mental health issues and have inadequate health service access compared to their cisgender peers.

Assumptions:

Families of children and adolescents with GD are aware of the RCH GS via the:RCH website (Department of Adolescent Medicine),mental health services, GPs, schools, community services, support groups, media and word of mouth.