Thread by @ShahrarAli

Today's @thecassreview Interim Report for gender identity services for child & young people sets out:
👉 Lack of robust evidence base
👉 Need for more specialist services
👉 More comprehensive care, including psychological & social support
cass.independent-review.uk/publications/i…
#CassReview

Link to full Interim Report cass.independent-review.uk/wp-content/upl…
👉"The care of this group of children and young people is everyone’s business."

1.16. Another significant issue raised with us is one of diagnostic overshadowing – many of the children & young people presenting have complex needs, but once they are identified as having gender-related distress, other important healthcare issues.. can sometimes be overlooked.

Service standards for consideration: "From point of entry to GIDS there appears to be predominantly an affirmative, non-exploratory approach, often driven by child and parent expectations and extent of social transition that has developed due to the delay in service provision."

For consideration: "There is limited evidence of mental health or neurodevelopmental assessments being routinely documented, or of a discipline of formal diagnostic or psychological formulation."

Safeguarding review: "[In] a number of cases there were specific safeguarding concerns. There do not appear to be consistent processes in place to work with other agencies to identify children & young people & families who may be vulnerable, at risk & require safeguarding."

Actual Review finding: 1.25. There has not been routine and consistent data collection within GIDS, which means it is not possible to accurately track the outcomes and pathways that children and young people take through the service.

1.27. There has been research on the short-term mental health outcomes and physical side effects of puberty blockers for this cohort, but very limited research on the sexual, cognitive or broader developmental outcomes.

Interim advice: Each [proposed] regional centre will need to work collaboratively with range of local services to ensure that appropriate clinical, psychological and social support is made available to children & young people in early stages of experiencing gender distress.

Any child or young person being considered for hormone treatment should have a formal diagnosis and formulation, which addresses the full range of factors affecting their physical, mental, developmental and psychosocial wellbeing.

Sex ratio in children and adolescents referred to GIDS in the UK (2009-16)

3.30. In the short-term, puberty blockers may have a range of side effects such as headaches, hot flushes, weight gain, tiredness, low mood and anxiety, all of which may make day-to-day functioning more difficult for a child or young person who is already experiencing distress.

3.32. A closely linked concern is the unknown impacts on development, maturation and cognition if a child or young person is not exposed to the physical, psychological, physiological, neurochemical and sexual changes that accompany adolescent hormone surges.

A sound interim report, well worth closer read, setting out options for its subsequent work.

Validates & reinforces number of concerns any reasonable observer could have about service standards in this area & well-being & future best interest of child or young person.