123 - Current Practices for the Health Care Transition of Gender-Diverse Youth Receiving Gender Affirming Care to Adult Care: Results of a Provider Survey

Publication Number: 123.4531

Janis L. Sethness, Seattle Children's, Seattle, WA, United States; Gina Sequeira, Seattle Children's, Seattle, WA, United States; Nicole F. Kahn, University of Washington School of Medicine, Seattle, WA, United States; Laura Richardson, University of Washington School of Medicine, Seattle, WA, United States

Background: Health care transition (HCT) is the planned and purposeful process of transferring from a child to an adult health care model. HCT planning leads to improved health outcomes among adolescents and young adults (AYAs). For transgender and gender-diverse (TGD) youth seeking gender-affirming care (GAC), the medical treatment required is often lifelong. Interruptions in care could exacerbate the burden of health disparities among TGD populations. Despite this, little is known about the HCT supports currently employed by pediatric GAC providers in the United States (US).

Objective: Understand the current HCT processes in pediatric GAC settings and the barriers pediatric GAC providers perceive to the successful transition of TGD AYAs to adult care.

Design/Methods: A cross-sectional national survey of US pediatric GAC providers was distributed to the Pediatric and Adolescent Transgender Health Interest Group listserv in May 2023 and at the US Professional Association for Transgender Health Scientific Symposium in November 2023. Content was adapted from a HCT survey created by a multidisciplinary, multi-specialty group and included 35 questions divided into four categories: (1) clinic demographics, (2) respondent demographics, (3) HCT self-management skills assessment and education, and (4) transfer to adult care.

Results: Fifty-two medical (73.1%) and mental health (26.9%) providers offering GAC to patients < 18 years old responded to the survey. Providers practiced in 24 states plus the District of Columbia. Most providers described their clinic as a specialty care practice (55.8%), followed by academic (44%). Most clinics were in urban settings (69.4%).
Only 42.9% of respondents indicated their clinic had a HCT policy. 38.8% of providers reported that their clinic offered HCT self-management skills assessment, although formal questionnaires were used in only 23.8% of those clinical settings. Most providers (75.5%) thought their patients would benefit from a HCT readiness program.
Providers identified numerous barriers to transitioning TGD youth to adult care, with patient’s lack of interest in transfer, patient’s attachment to their pediatric provider, and patient’s attachment to the clinic cited as the most common concerns.

Conclusion(s): There are limited HCT supports in place for TGD youth accessing GAC, and providers report numerous barriers to a successful transition to adult care for TGD AYAs. Some of these barriers can be overcome with additional resources dedicated to promoting adolescent autonomy by regularly assessing HCT readiness skills and encouraging AYAs to assume more health care responsibilities.