An appraisal of current service delivery and future models of care for young people with gender dysphoria

2021 ◽  
Author(s):  
Stephanie McCallion ◽  
Simon Smith ◽  
Heather Kyle ◽  
M. Guftar Shaikh ◽  
Gordon Wilkinson ◽  
...  
Keyword(s):  
Young People ◽  
Service Delivery ◽  
Gender Dysphoria ◽  
Models Of Care

The Experiences and Perspectives of African-Australian Community Service Providers Who Work with At-Risk and Justice-Involved Youth

2021 ◽  
pp. 0306624X2110226
Author(s):  
Stephane Shepherd ◽  
Aisling Bailey ◽  
Godwin Masuka
Keyword(s):  
Risk Factors ◽  
At Risk ◽  
Young People ◽  
Service Delivery ◽  
Community Service ◽  
Service Providers ◽  
Professional Staff ◽  
Youth Justice ◽  
Complex Needs ◽  
Australian Community

African-Australian young people are over-represented in custody in the state of Victoria. It has been recognized in recent government and stakeholder strategic plans that African-Australian community service providers are well placed to help address the increasing complex needs of at-risk African-Australian youth. However little is known about the capacities of such providers to effectively contend with this growing social concern. In response, this study aimed to explore the perspectives and operational (service delivery and governance) experiences of African-Australian community organizations which provide services to at-risk young people in Victoria. Through a series of in-depth interviews with the leadership of eight key African-Australian service providers, we aimed to identify their perceived strengths, obstacles faced and proposed strategies to realize key objectives. Perspectives on key risk factors for young African-Australian justice system contact were also gathered. Several themes were extracted from the interviews, specifically (i) Risk factors for African-Australian youth justice-involvement (school disengagement, peer delinquency, family breakdown, intergenerational discord, perceived social rejection), (ii) The limitations of mainstream institutions to reduce African-Australian youth justice-involvement (too compliance focused, inflexible, business rather than human-centered, disconnected from communities and families), (iii) The advantages of African-Australian community service providers when working with African-Australian youth (community credibility, client trust, flexibility, culturally responsive), (iv) The challenges faced by African-Australian service providers (lack of funding/resources, professional staff shortages, infrastructural/governance limitations), and (v) “What works” in service provision for at-risk African-Australians (client involvement in program design, African staff representation, extensive structured programming matched with client aspirations, prioritizing relationship building, persistent outreach, mental health and legal literacy for clients and families). Implications for service delivery and social policy are discussed within.

scholarly journals Gender Dysphoria in looked-after and adopted young people in a gender identity development service

2018 ◽  
Vol 24 (1) ◽  
pp. 112-128
Author(s):  
Tom Matthews ◽  
Victoria Holt ◽  
Senem Sahin ◽  
Amelia Taylor ◽  
David Griksaitis
Keyword(s):  
Young People ◽  
Identity Development ◽  
Gender Identity ◽  
Gender Dysphoria ◽  
Case File ◽  
Clinical Notes ◽  
Birth Family ◽  
To Receive ◽  
Overall Functioning ◽  
Development Service

This research investigated the prevalence of looked-after and adopted young people within a case file review of 185 young people referred to a UK gender identity development service over a 2-year period (1 April 2009 to 1 April 2011). Data were extracted from referral letters, clinical notes and clinician letters. Looked-after young people were found to represent 4.9% of referrals in this cohort, which is significantly higher than within the English general population (0.58%). Adopted young people represented 3.8% of referrals. In addition, the findings showed that looked-after young people were less likely to receive a diagnosis of gender dysphoria compared with young people living within their birth family. There were no statistically significant differences in the gender ratio or age of first gender dysphoric experience between groups. Looked-after and adopted young people were also not found to be experiencing greater impairment in overall functioning compared to other young people referred to the gender identity development service. In conclusion, there are a substantial proportion of referrals pertaining to looked-after or adopted young people, and it appears the referral route and process through the service may be distinct, particularly for looked-after young people. This may be understood by considering the possible complexities in the presentation of these groups, alongside the established higher levels of complexity generally for those experiencing feelings of gender dysphoria.

scholarly journals Transgender adolescents and genital-alignment surgery: Is age restriction justified?

2019 ◽  
Vol 14 (2) ◽  
pp. 94-103
Author(s):  
Edmund Horowicz
Keyword(s):  
Young People ◽  
Clinical Guidelines ◽  
Gender Dysphoria ◽  
Evidence Base ◽  
Cultural Norms ◽  
Evidence Based ◽  
Professional Issues ◽  
Standards Of Evidence ◽  
Current Concerns ◽  
Evidence Based Care

In the case of controversial interventions there is a need for clinical guidelines to be founded on ‘expert opinion’ and an evidence base, in order to minimise individual clinicians making subjective decisions influenced by bias or cultural norms. This paper considers international clinical guidelines that through recommendation effectively prohibit the provision of genital-alignment surgery for competent adolescents with gender dysphoria. I argue that although the rationale for this particular guideline is based on serious concerns, these need to be better understood to allow reconsideration of this unilateral prohibitive recommendation. I do not propose that genital-alignment surgery should be prima-facia provided for any adolescent with gender dysphoria. Instead I argue that by developing our understanding of the current concerns, we can allow guidelines to incorporate a margin of clinical discretion, to allow clinicians to provide genital-alignment surgery to some adolescents, where clinically appropriate. In facilitating this we can move towards establishing a solid evidence-base. The basis of this position is that clinical guidelines and medical practice should treat these young people with the same standards of evidence-based care as others who have less controversial conditions. Whilst this paper uses English law and UK professional regulation for context, many of the ethical, legal and professional issues highlighted are applicable to other jurisdictions.

The Relationship between the Delivery of Day Care Services for Older People and the Design of Day Unit Premises

1997 ◽  
Vol 17 (1) ◽  
pp. 41-64 ◽  
Author(s):  
VALERIE BACON ◽  
CHRISTOPHER LAMBKIN
Keyword(s):  
Service Delivery ◽  
Older People ◽  
Day Care ◽  
Community Care ◽  
Models Of Care ◽  
Care Services ◽  
New Models ◽  
Effective Delivery ◽  
Design Factors ◽  
The Relationship

In response to recent community care policies in Britain, co-ordinated, needs-led models of care have been introduced into day care services for older people. Whilst their introduction has prompted detailed consideration of the changes required in the organisation and management of these services, less attention has been paid to their implications for the design of day care premises. Yet design factors impinge on all aspects of service delivery and any shortcomings in design may undermine the effective delivery of new models of care. This article uses findings from recent research to explore how design factors may facilitate or constrain service delivery, focusing on two aspects of the new models of care – that services should meet the needs of individual users and be locally-based.

Residential care in Australia, Part I: Service trends, the young people in care, and needs-based responses

2008 ◽  
Vol 33 (2) ◽  
pp. 6-17 ◽  
Author(s):  
Howard Bath
Keyword(s):  
Young People ◽  
Service Delivery ◽  
Residential Care ◽  
The Past ◽  
Care Services ◽  
The Future

This is the first of a two-part discussion of the place of residential care services in Australia, which highlights the issues that are likely to influence the development of these services into the future. This paper explores service trends over the past few decades, the current place and focus of residential care services, the nature of the young people being placed into such services, and the imperative for developing a more needs-based approach to service delivery. It concludes with a review of recent calls for the development of therapeutic or treatment-orientated models and the initial steps in this direction that have been taken around the country.

scholarly journals Challenging Neo-Colonialism and Essentialism

2019 ◽  
Vol 15 (1) ◽  
Author(s):  
June Ying Yee ◽  
Zack Marshall ◽  
Tess Vo
Keyword(s):  
Young People ◽  
Gender Identity ◽  
Service Delivery ◽  
Evaluation Research ◽  
Immigrant Youth ◽  
Diverse Range ◽  
Services Sector ◽  
Intersecting Identities ◽  
Settlement Services ◽  
Improve Service Delivery

The settlement services sector in Toronto, Canada has faced difficulties in responding to lesbian, gay, bisexual, trans, and queer (LGBTQ) immigrant youth in ways that respect their specific experiences. One way agencies have taken up this challenge in Toronto has been to develop LGBTQ-specific settlement services. Housed within a diverse range of organisations, these services are intended to engage and support LGBTQ immigrant youth. In this article, we report on evaluation research conducted with LGBTQ immigrant young people from Griffin Centre’s reachOUT Newcomer Network where we asked about their experiences accessing settlement services in Toronto. Our findings suggest that LGBTQ immigrant youth are deeply influenced by intersecting identities linked to racialization, sexuality, gender identity, education, employment, and immigration status. Participants expressed overwhelming interest in accessing support, but remain disconnected from settlement services. A reconceptualization of LGBTQ settlement services within a framework of hybridity that challenges essentialism and neo-colonialism would improve service delivery. This shift would allow for more integrated settlement services that acknowledge LGBTQ newcomer youth and their experiences of (un)belonging.

scholarly journals Personalized Service Delivery for Young People and Families: A Synthesis Review

2021 ◽  
Author(s):  
Carol Stuart ◽  
Kiaras Gharabaghi
Keyword(s):  
Young People ◽  
Service Delivery ◽  
Personalized Service

Personalized Service Delivery for Young People and Families: A Synthesis Review

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