Transgender youth: implementation of a specialized multidisciplinary team care

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Proceedings Chapter

Reference

Transgender youth: implementation of a specialized multidisciplinary team care

DIRLEWANGER, Mijam, et al.

DIRLEWANGER, Mijam, et al . Transgender youth: implementation of a specialized

multidisciplinary team care. In: Joint Annual Meeting Swiss Society of Paediatrics, Swiss Society of Paediatric Surgery and Swiss Society of Child and Adolescent Psychiatry and Psychotherapy . 2018. p. 67S

Available at:

http://archive-ouverte.unige.ch/unige:130473

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Swiss Medical Weekly

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Joint Annual Meeting

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Supplementum 228 ad Swiss Med Wkly 2018;148

May 17, 2018

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POSTER FLASH 2 67 S

PF38 A MULTIDISCIPLINARY APPROACH OF CHRONIC

OSTEOARTICULAR PAIN IN CHILDREN AND ADOLESCENTS: THE LAUSANNE EXPERIENCE M. Mejbri¹, C. Schnider^1,*, N. Lutz², A.-E. Ambresin³, A. Deppen⁴, S. Vaucher⁵, M. Hofer¹

1Unité Romande d’Immuno-Rhumatologie pédiatrique DFME;

2Unité Pédiatrique de Chirurgie Orthopédique et Traumatique DFME;

3Division Interdisciplinaire Santé des Adolescents DFME; ⁴Service Universitaire de Psychiatrie de L’Enfant et de l’Adolescent, DFME;

5Service de physiothérapie, Centre Hospitalier Universitaire Vaudois CHUV, Lausanne, Switzerland

Introduction: Chronic pain disorder is a common and under- recognized problem who is increasing in the pediatric population.

Osteoarticular pain is one of the most common symptoms.This is a significant problem leading to a decrease in quality of life,school absenteeism and social withdrawal.A multidisciplinary approach is essential to evaluate and manage those patients who have an unsatisfactory evolution despite primary medical care.Starting In 2014, a group of 4 medical specialists(pediatric rheumatologist, pediatric orthopedist, child psychiatrist and pediatrician specialist in adolescent) and one physiotherapist started a joint outpatient clinic assessing such children.The aim of this study was to describe and outline some characteristics of all patients seen at this platform up to now.

Methods: A retrospective descriptive study was performed based on medical records of patients seen at our center in Lausanne between November 2014 and January 2018. Epidemiological,clinical and therapeutic data was collected and analyzed accordingly.

Results: A total of 35 patients were reviewed.The patients were in most cases(82%)referred by the pediatric rheumatologic or orthopedic surgeon.The sex ratio F/H was 3.3 (27 girls for 8 boys).The average age at the time of consultation was 12.8 years(9 to 18 years). A triggering event was found in 48% of our patients with the notion of trauma in 35% of these cases.The average duration of symptoms was 3.6 years prior to referral to the platform (1–11 years).Chronic pain affected more than 5 joints in 75% of the cases.School absenteeism was noted in 22% of the children with 2 cases of withdrawal.The platform revealed in 52% a primary pain disorder,in 28% an associated orthopedic problem,in 25% a difficult psychosocial situation and in 5% a rheumatologic problem.Therapeutic proposals were mainly personalized physiotherapy or mind body approaches such as hypnoses and depending on the findings,follow-up in

orthopedics,rheumatology,child psychiatry or adolescent specialist consultation.

Conclusion: A long delay before children with chronic pain reach the platform was noticed.This could explain the severity of the presentation and the significant impact on school attendance and social life.The integrative clinical approach highlighted the multifactorial aspects of chronic pain and led to the development of an adapted multidimensional treatment to improve the prognosis and reduce the negative impact of chronic pain.We encourage pediatricians to detect and refer such patients early.

NaCHwuchs Prize: I wish to apply

I have read and understand application rules: No Disclosure of Interest: None declared

PF39 TRANSGENDER YOUTH: IMPLEMENTATION

OF A SPECIALIZED MULTIDISCIPLINARY TEAM CARE M. Dirlewanger^1,*, A. Merglen², A. Edan³, J. Benard⁴, P. Klee⁵, C. Girardin⁵, M. Yaron⁶, V. Schwitzgebel⁵

1Child and Adolescent Department, Pediatric Endocrine and Diabetes Unit; ²Child and Adolescent Department, General Pediatrics Division;

3Child and Adolescent Department, Child and Adolescent Psychiatry Division, Children’s University Hospital; ⁴Gynecology and Obstetrics Department, Centre Unit for Reproductive Medicine and Gynecological Endocrinology, Geneva University Hospitals; ⁵Child and Adolescent Department, Pediatric Endocrine and Diabetes Unit, Children’s University Hospital; ⁶Gynecology and Obstetrics Department, Child and Adolescent Department, Pediatric and Adolescent Gynecology, Geneva University Hospitals, Geneva, Switzerland

Introduction: Gender dysphoria (GD) refers to discomfort or distress caused by a discrepancy between gender identity and sex assigned at birth. Over the last decades, many clinics have reported an increase in the number of youths seeking medical help for GD. However, few clinicians are trained to take care of these adolescents.

Methods: This is the report of our new program for transgender children and adolescents. The aim is to highlight the needs of this specific population and to provide specialized multidisciplinary care.

Results: Our team consists of pediatric and adolescent medicine specialists, child psychiatrists, pediatric endocrinologists, pediatric gynecologists and specialists of reproductive medicine. The diagnosis of GD is confirmed according to the DSM-V criteria by a child psychiatrist from our clinic. GnRH analogs in order to block puberty are considered at age >12 years and/or pubertal stage Tanner 2.

Gender-affirming steroids are considered for patients >16 years of age.

We are currently following 7 pediatric patients with confirmed GD. Four out of 7 (57%) present a female-to-male (FtM) GD and 3/7 (43%) a male-to-female (MtF) GD. Close to half (43%) reported having felt they belonged to the opposite gender before the age of 5 years (early onset). Mean age at first endocrinologic evaluation was 14.7 years, with a puberty stage Tanner 4–5. GnRH analog injections were started at a mean age of 15.4 years. Only one patient (MtF) was interested in fertility preservation. A majority of adolescents (86%) presented with severe anxiety, depression, and suicide attempts. Two reported a sexual abuse during childhood. Five reported to be bullied at school (71%) and 3 patients had to be hospitalized in a psychiatric unit despite having started medical care.

Conclusion: We successfully implemented a specialized

multidisciplinary team for transgender children and adolescents with coordination of care for assessment, treatments, and follow-up. The vast majority of these patients with GD also suffered from severe mental health issues and school bullying that required child psychiatric and adolescent specialist support. GnRH agonist treatment to block puberty is a cornerstone of today’s treatment. However, our patients were referred quite late with an engaged puberty. These results show the importance of raising awareness and the need for early detection and referral of GD patients to a specialized multidisciplinary team.

Disclosure of Interest: None declared

PF40 HEALTH CARE USE OF UNACCOMPANIED MINORS

RESETTLED IN THE CANTON OF GENEVA: A ONE-YEAR FOLLOW-UP STUDY

M. Patseadou^1,*, C. Chamay-Weber¹, D. Haller-Hester¹, F. Narring¹

1Adolescent & Young Adult Program, Child and Adolescent

Department & Department of Community Medicine and Primary Care, Geneva University Hospital, Geneva, Switzerland

Introduction: Unaccompanied minors (UM) are considered as the most exposed and vulnerable group among the entire refugee population. The number of UM applying for asylum in Switzerland grew rapidly during the period 2015–2016. All UM between 11 and 18 years who arrived in the canton of Geneva were referred to our university adolescent outpatient clinic for a systematic post-arrival health assessment. Follow-up appointments were offered for both physical and mental health concerns. The aim of this study was to describe health services access and use among UM following their initial 12 month post-arrival period.

Methods: We conducted a retrospective chart review of all UM who were assessed at the Geneva University Adolescent Outpatient Clinic between 01.01.2015 and 30.06.2016. We investigated data concerning visits to the primary care provider, the emergency department and the subspecialty outpatient clinics. We considered a follow-up duration of 12 months for each patient. We also examined hospitalizations during the same follow-up period. We computed descriptive statistics using the IBM SPSS Statistics Program.

Results: We identified 163 UM (males 89%, mean age: 16.4 years).

Two thirds of them were from Eritrea (37%) or Afghanistan (35%).

The median number of visits to the primary care physician was 3 (visit range: 1–13). Almost one third of the UM returned multiple times (≥3) to their primary care clinician after the initial assessment appointment.

Ninety percent of them had consultations with a nurse for immunization and growth follow-up (median visit: 4, range: 0–15).

One quarter of them were referred to a mental health professional for emotional disorders. Almost two thirds of them were referred to see at least one subspecialist, mostly a dermatologist or a cardiologist.

Twenty-two percent of them visited multiple subspecialists (≥3). Nearly half of them visited at least once the emergency department because of trauma (33%), psychological distress (29%), miscellaneous symptoms (24%) and infectious diseases (14%). Nine patients (12%) visited the emergency room multiple times (≥3). One out of ten UM had to be hospitalized, mainly for a surgical intervention or alteration of emotional status.

Conclusion: UM represent a vulnerable population group with high need of health care services. Health care providers should be aware of the particular health concerns of this population in order to appropriately address their needs.

Disclosure of Interest: None declared

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