The Single Session for transgender and gender variant children and teenagers

The Single Session for transgender and gender variant children and teenagers

As awareness of gender diversity increases, the number of children and adolescents presenting to gender variance services in Australia and overseas increases (Chen et al., 2016; Wren et al., 2016), with a consequent increase in waiting times to access the necessary assessment for medical transition paths (hormonal and / or surgical therapy).

Innovative approaches are needed to reduce waiting times, enable timely clinical support and provide education to patients and their families. 

In the article Implementing a Single-Session Nurse-Led Assessment Clinic into a Gender Service (2018), Drs Eade, Telfer and Tollit describe the practice developed within the Royal Children’s Hospital Gender Service (RCHGS) in Melbourne, Australia. It is a great starting point to see a useful application of Single Session Therapy within a hospital and such a specific service.

Context

RCHGS is currently the largest multidisciplinary service in Australia for transgender and gender variant children and adolescents (TGV), with the aim of improving their physical and mental health and general well-being. 

Since 2003, it has seen TGV children and teenagers with an exponential increase in requests over the past 5 years: from 18 in 2012 to 220 in 2016. 

Thus, in 2015, it formalized the Single Session service, with a dedicated multidisciplinary team: the aim was to respond to the growing waiting list, also characterized by young TGVs, who have rates of :

  • Depression
    • Anxiety
    • Self-harm
    • Attempted suicide

considerably taller than their cisgender peers (Hillierd et al., 2010; Marshall et. al, 2016) and who can, in part, be mitigated by accessing services related to gender variances (Hyde et al., 2014; Murad et al. al., 2010).

The Single Session Clinic for direct evaluation by nurses

In 2016 , the waiting time at the RCHGS for a first session was up to 14 months .
Thus, the Single Session Clinic for Nurse Managed Assessment (SSNac), an access point to the RCHGS model of care, was introduced. 

The SSNac is directed by the Clinical Nurse Consultant , who undertakes a biopsychosocial evaluation (Goldering et al., 1998, 2004) of new patients, sorting them according to their clinical urgency and providing individualized support, information and links to other services, useful to satisfy their and their families’ needs.

The meeting (from access to the conclusion of the Single Session) lasts 90 minutes .

The Single Session

During the meeting, the CNC spends 30-40 minutes alone with the patient and conducts a confidential biopsychosocial assessment to identify appropriate triage pathways and provide appropriate health information and immediate interventions. 

After the assessment follows a joint consultation with the patient and parents or caregivers, where information and recommendations are provided, including:

  • links to local community support
    services • mental health services
    • school supports
    • services related to TGV populations
    • peer support groups and events

An email summarizing the recommendations is then sent to the patient and his referring general practitioner.

Results in the introduction of the NHS

  • Reduced waiting time
    The introduction of NHS has significantly reduced waiting times. The waiting time for an interview was 14 months , while they are now seen  within 4 months of being referred. Furthermore, as a result of the Single Session counseling, patients who need an urgent referral are introduced within 2 months to the multidisciplinary assessment necessary for the medical pathway.
  • Timely Sorting System
    The Head Nurse can confidentially meet with patients and refer them based on pubertal assessment and their possibilities for hormone therapy and / or surgery. This system allows patients who will benefit most from puberty blocking treatment to be rapidly introduced into the multidisciplinary assessment pathway to access treatment.

Conclusions

Although Single Session Therapy is a method that was born precisely as psychological therapy and counseling, in the last thirty years, given its easy flexibility and ability to integrate with other models of assistance (both in the sense of different forms of psychotherapy, and in the sense of forms of assistance belonging to different professional figures), was also used by other professional figures . These obviously do not do “psychotherapy” or “psychological counseling” in Single Session, but use SS to maximize the effectiveness of their working relationship with the patient.

SSNac can be a useful addition to other gender services that work to improve the distress experienced by TGV children and adolescents on the waiting lists for multidisciplinary gender services.

Flavio Cannistrà
Psychologist, Psychotherapist
Founder of the Italian Center
for Single Session Therapy

Bibliographical references

Chen M., Fuqua J., Eugster EA (2016). Characteristics of referrals for gender dysphoria over a 13-year period . J. Adolesc. Health, 58: 369–371.
Eade, DM, Telfer, MM & Tollit, MA (2018). Implementing a Single-Session Nurse-Led Assessment Clinic into a Gender Service. Transgender Health , Volume 3.1, 2018, DOI: 10.1089 / trgh. 2017.0050
Goldenring J., Rosen D. (2004). Getting into adolescent heads: an essential update. Contemp Pediatr. , 21:16.
Hillier L., Jones T., Monagle M., et al. (2010) Writing Themselves In 3 (WTi3): The Third National Study on the Sexual Health and Wellbeing of Same Sex Attracted and Gender Questioning Young People. Melbourne, Australia: (ARCSHS), La Trobe University.
Hyde Z, Doherty M, Tilley P, et al. (2014). The First Australian National Trans Mental Health Study: Summary of Results. Perth, Australia: School of  Public Health, Curtin University.
Marshall E., Claes L., Bouman WP, et al. (2016). Non-suicidal self-injury and suicidality in trans people: a systematic review of the literature. Int. Rev. Psychiatry , 28: 58–69.
Murad MH, Elamin MB, Garcia MZ, et al. (2010). Hormonal therapy and sex reassignment: a systematic review and meta-analysis of quality of life and psychosocial outcomes. Clin Endocrinol (Oxf) , 72: 214–231.
Wren, DB(2016). Gender identity clinic for young people sees referrals double. BBC Radio 4’s Woman’s Hour. United Kingdom: BBC News.

 

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