Independent evaluation finds Queensland paediatric gender services safe and evidence-based

• The statewide Queensland Children’s Gender Service has been found to provide safe, evidence-based care that is consistent with national and international guidelines.
• A comprehensive evaluation report includes 25 recommendations to enhance the quality, efficiency and effectiveness of paediatric gender services in Queensland, which will now be implemented.
• To boost services and help deliver the recommendations, an additional $2.6M each year will be added to the service, bringing the total budget to $5.2M.

An independent panel of representatives from across the country has found that the care provided by the statewide Queensland Children’s Gender Service (QCGS) is safe, evidence-based and consistent with national and international guidelines for treatment and care of children and adolescents with diverse gender experiences.

The QCGS provides direct care to 547 children and young people across Queensland, with approximately 40 per cent of those from regional areas. Since the service opened in 2017, demand has grown exponentially year-on-year.

The evaluation, led by Associate Professor John Allan, included clinical representatives from across Australia from disciplines such as psychology, general practice, child and adolescent psychiatry and paediatric endocrinology. It also included representatives of from the Queensland Paediatric Quality Council and a lived-experience representative.

The external evaluation examined clinical service delivery, the adherence to best practice guidelines, care pathways, service funding and workforce profiles, and data collection methods. It also considered international and national evidence.

The panel heard from many people involved with the service including consumers and their families as well as clinicians.

It also explored the existing education and training programs available to Queensland clinicians, referrers and consumers involved in the care of children and adolescents with diverse gender experiences.

The panel delivered a comprehensive report containing 25 recommendations and a working group will be established with representatives from across the department and Hospital and Health Services to guide implementation.

A funding boost of $2.6 million will be added to the service, bringing the total budget to $5.2 million each year.

Key findings include:

• Clinical practice within the QCGS is consistent with current national and international guidelines for treatment and care for children and adolescents with diverse gender experiences.
• Approximately one third of children and young people assessed by the QCGS were discharged safely and connected with community-based services for ongoing care if required; a third underwent further clinical management and assessment; and a further third were managed with prescriptions for puberty blockers and/or gender-affirming hormones along with ongoing support.
• The QCGS works collaboratively as a multidisciplinary team and uses diverse expertise in assessing gender dysphoria and before considering the need for medical intervention.
• Decisions about medical intervention is considered and evidence-based with risks and implications well-explained.  There was no evidence of children, adolescents or their families being hurried or coerced into making decisions about medical interventions.
• Access to care needs to be strengthened through a reduction in the wait list and additional mental health support to children and young people while on the wait list.

Key recommendations include:

• The establishment of a statewide network to deliver services to children and adolescents with diverse gender experiences, in partnership with private providers and NGOs.
• Immediate staffing increases within the QCGS to meet urgent clinical needs of children and young people currently on the wait list.
• Implementation of contemporary systems and process to enhance clinical auditing capabilities, including data collection, monitoring, analysis and reporting.
• Consideration of a specialised credentialling for doctors practising in gender services.
• Long-term investment in training, education and research to increase health worker expertise and understanding of gender diversity and gender dysphoria. 
• Publicly funded information, awareness and education regarding the clinical support and pathways available to Queensland children and young people seeking treatment for gender dysphoria.

A copy of the service evaluation is available here: Queensland Children’s Gender Service (health.qld.gov.au)

Quotes attributable to the Minister for Health, Mental Health and Ambulance Services Shannon Fentiman:

“Queensland is home to a proud and vibrant trans and gender diverse community, and the Miles Government is committed to ensuring that they have access to safe, responsive, contemporary healthcare services.

“We know that the care provided at the Queensland Children’s Gender Service is life‑changing, and, in many cases, life-saving.

“I have heard first-hand from families who have praised the service and expressed how valuable this safe haven is for them and their children.

“I welcome the findings of this report, which shows based on the best available evidence, that our Queensland Children’s Gender Service is considered one of the best in the country.

“Through implementing these recommendations, including by developing a state-wide network service model, we will bring down waitlists and ensure young people get the care they need closer to home.

“I’m so pleased that Queensland Health will fund an initial additional $2.6 million to boost the service, bringing the total budget to $5.2 million each year.”

Quotes attributable to Associate Professor John Allan, Evaluation Panel Chair:

“The panel recognises the challenges faced by children and adolescents with diverse gender experiences and their families and supporters. Equally, we acknowledge the challenges faced by clinicians working to support these young people in today’s dynamic environment.

"While undertaking the evaluation, significant international publications regarding gender identity clinical services were released, including the UK-based The Cass Review: Independent review of gender identity services for children and young people: Final Report.

“The Panel actively considered the findings and ultimately made a number of recommendations that were aligned with The Cass Review findings, particularly in reference to a networked approach to care; appropriate data collection and linkages to research; and improving health worker expertise and understanding of diverse gender experiences to enable expanded service options.

“We wish to acknowledge the cooperation and willingness of Children’s Health Queensland and the Queensland Children’s Gender Service staff to facilitate open access to documents, data and personnel throughout this evaluation, which was instrumental in enabling the panel to conduct a thorough and effective evaluation.

“The insights and recommendations contained within the report are aimed at enhancing the quality, efficiency and effectiveness of gender services for the children and young people of Queensland.

“We are confident these insights will support the Queensland Children’s Gender Service in its ongoing efforts to deliver high-quality health services and focus on supporting a vision for a statewide, networked service.”

Quotes attributable to Children’s Health Queensland (CHQ) Chief Executive Frank Tracey:

“As host of the statewide Queensland Children’s Gender Service, Children’s Health Queensland is committed to improving the health and wellbeing of Queensland children with diverse gender identity through family-centred, multidisciplinary assessment and specialist care.

“We commissioned this external service evaluation as part of CHQ’s ongoing commitment to ensuring trans and gender diverse children and young people continue to receive the safest, evidence-informed care – in a timely way that responds to their unique care and support needs.

“We welcome the findings and recommendations of the evaluation and sincerely thank Associate Professor Allan and the panelists for undertaking such a comprehensive evaluation.

“The assurance that the Queensland Children’s Gender Service is providing safe and evidence-based person-centred care for trans and gender-diverse children young people is welcomed, as is the panel’s acknowledgment of our staff’s dedication, commitment and professionalism in what can be a very challenging field of practice.

“The panel’s recommendations provide a clear road map for enhancing statewide service delivery into the future and Children’s Health Queensland will move swiftly to commence implementation, in partnership with Queensland Health and its statewide peers.   

ENDS

Media contact: healthmedia@ministerial.qld.gov.au

About QCGS: 

The Queensland Children’s Gender Service (QCGS) was established as Queensland’s first multidisciplinary specialist paediatric gender service in 2017, bringing together medical and mental health professionals with expertise in paediatric gender issues to provide a tertiary-level of assessment and treatment, promoting healthy development, mental health and functioning of Queensland children with diverse gender identity.

It is now the second largest multidisciplinary paediatric gender service in Australia and includes four medical specialties - child psychiatry, paediatric endocrinology, sexual and reproductive health, and general practice - that work together with psychology, social work, mental health, medical, nursing and speech pathology.