(PS4-9) Evaluating Clinicians’ Perceptions on the Utility of Child Diagnostic Tools in Assessing Gender Expansive Youth

Abstract Text: In general, society is becoming more accepting of gender expansive youth; shown by an increase in resources for LGBTQ+ youth leading to safety in coming out and full expression, which in turn leads more children and adolescents to wholly express themselves as they desire. In a population-based study of more than 80,000 ninth and eleventh graders in Minnesota, 3% of youth viewed themselves as transgender, genderqueer, gender fluid, or unsure of their gender identity, (Rider, McMorris, Gower, Coleman, et al., 2018). Other studies estimated that, in 2012, 1-2% of secondary school aged students in New Zealand and, in 2016, 2-7% in the USA identified as gender expansive. As more gender expansive youth feel safe and affirmed in living authentically, it becomes increasingly important that clinicians find the most efficacious method of providing care for this community. Evidence suggests using an integrated Gender Affirming Care (GAC)model results in gender expansive young people having fewer mental health concerns regardless of their ultimate identification, (Rafferty, et al., 2018). To function as a clinician utilizing affirming care, it is important to consider the inclusiveness of treatment from all angles. Clinical assessment norms for many psychological measures have been validated primarily for cisgender individuals. These individuals are defined as people whose sense of personal identity and gender corresponds with their assigned sex at birth. The only exception to this is if a measure has been created specifically to investigate transgender populations, (Webb, Heyne, Holmes, & Peta, 2016). As assessment norms have been created for specific gender identification (males and females), there is a challenge when assessing, treating, and researching gender expansive youth. This qualitative study explored clinicians’ perceptions of the utility of clinical assessments with gender expansive youth. Twelve clinicians with these assessment experiences completed a written survey to provide insight into the utility of clinical assessment tools when working with gender expansive youth. Items on the survey included participants indicating commonly used assessments, adjustments that have been made to the assessments when working with gender expansive youth, norms used for interpreting scores, as well as recommended adjustments that should be made on assessments for clinicians working with this demographic. The completed surveys were then coded and analyzed using the coding method for qualitative data analysis by MacQueen, McLellan-Lemal, Bartholow, & Milstein (2008) to gather common themes and relevant observations. Results indicated that there is a lack of consensus amongst clinicians when scoring and administering clinical assessments with gender expansive youth. The present study has revealed that without assessment standardization, clinicians will continue to practice as they see fit which may directly contradict gender affirming care. A summary of the creative ideas clinicians had for the scoring of child assessments is included.