At least one legal guardian who can consent for treatment must attend the first medical visit.

Transcription

1 Dear Parent/Guardian: Thank you for scheduling a medical appointment in the Trans Health Clinic for a minor child. You are receiving this packet to help with the first visit for this minor child at Fenway Health. At least one legal guardian who can consent for treatment must attend the first medical visit. There is information about the minor child s medical and mental health and the family that we ask for at the first visit. This information packet tells you what information is needed. Gender affirming medical care of minors at Fenway Health involves several appointments. A legal guardian and the minor child can ask the provider questions, talk about care, and create a treatment plan. Treatment plans are unique to the person. No single treatment plan applies to all gender diverse people. The medical provider will talk about behavioral health and medical history, needs, and expectations with the parent/guardian and the minor child. The care team will offer resources and support recommendations if needed. All gender diverse minors will be required to have a referral from a mental health professional who is experienced with assessing gender issues before starting medical treatments for gender. Bring the information below to the first visit. The information asked for is to help with care planning. The care team will work with you to gather any information you are unable to bring to the first visit. Missing information may delay treatment. Thank you, Fenway Transgender Health Program Trans Youth Clinical Team & Family Medicine Team transhealth@fenwayhealth.org Web: ALL legal guardians must consent to any puberty suppression and/or hormone treatment. Legally emancipated or mature minors cannot consent to this treatment under Massachusetts general law. All legal guardians must be present at a visit with the medical provider to consent to puberty suppression and/or hormone treatment. (Discuss any extenuating circumstances with the provider.) TYFM

2 Documentation Requested Trans Youth Clinic Initial Medical Appointment Please bring in or be prepared to discuss the following information for the minor child. A. MEDICAL INFORMATION Name, address, and phone number for the minor child s primary care provider/pediatrician Provider Name: (Copy/Print and complete one Disclosure of information form (attached) for this provider) Any medications prescribed by this provider Medication Name Dose and How Often Taken Reason for Medication (Please write any additional medications on another page or bring in a list from the provider s office.) Any current medical conditions (Bring in a list or be prepared to discuss these.) Be prepared to discuss history of childhood illnesses, accidents, hospitalizations, vaccines, allergies, etc. B. BEHAVIORAL HEALTH INFORMATION Name, address, and phone number for the minor child s psychiatrist, if there is one. Provider Name: (Copy/Print and complete one Disclosure of information form (attached) for this provider. NOTE: The legal guardian must also sign the additional portion (section 4) of the release that authorizes sharing of behavioral health treatment. This area appears highlighted in yellow on the form. List of medications and dosages prescribed by this provider Medication Name Dose and How Often Taken Reason for Medication (Please write any additional medications on another page or bring in a list from the provider s office.) List of diagnoses currently being treated by this provider (Bring in a list or be prepared to discuss these.) TYFM

3 Name, address, and phone number for the minor child s individual therapist Provider Name: (Copy/Print and complete one Disclosure of information form (attached) for this provider. NOTE: The legal guardian must also sign the additional portion (section 4) of the release that authorizes sharing of behavioral health treatment. This area appears highlighted in yellow on the form. Be prepared to discuss any hospitalizations, emergency department visits, or self-harming behaviors Name, address, and phone number for the family therapist and/or other provider(s) Provider Name: (Copy/Print and complete one Disclosure of information form (attached) for this provider. NOTE: The legal guardian must also sign the Sensitive Information section of the release that authorizes sharing of behavioral health treatment. This area appears highlighted in yellow on the form. C. FAMILY STRUCTURE & GUARDIANSHIP Whom does the child live with? Name Relationship to minor child If the child lives outside the parent/guardian home, provide contact details for the place of residence. Residence Name: Primary Contact: Name(s) and contact information for all adults who have legal right to consent or object to treatment. Guardian #1 Guardian #2 Name: Relationship: You must provide a copy of the court documentation assigning guardianship for medical decisions to anyone other than the biological parents of the minor child. (i.e., adoption, divorce, separation, etc.) TYFM

4 Directions & Parking Appointments at 1340 Boylston Street: The main Fenway Health clinic is located at 1340 Boylston Street, Boston, MA This clinic is across the street from Fenway Park. Red Sox games disrupt parking and traffic patterns during and for two hours before and after any home games. Please plan travel with this in mind. There is very limited metered parking on Boylston Street. Public parking lots are available underneath the building (entrance is on Jersey Street under 1330 Boylston Street), under the City Target building (entrance on Richard B. Ross Way), and under the Trilogy Building (entrance on Kilmarnock Street). All lots charge by the hour. During home games, all lots charge a flat fee of $40 or higher starting two-hours before the game start time. The closest MBTA train and bus stops include the D-Riverside Green Line Fenway Station stop, the C, D, and B lines Kenmore Station stop, and the #55 Bus Boylston Street & Jersey Street stops. Train stops are at least a 15-minute walk from the clinic. Plan your route and timing of bus and train services in advance. Main number: Appointments line: Appointments at 142 Berkeley Street: The Fenway: South End clinic is located at 142 Berkeley Street, Second Floor, Boston, MA 02116, at the corner of Columbus Avenue and Berkeley Street. This clinic is a couple blocks from the back of the MBTA Back Bay Station on the Orange Line and Commuter Rail. The entrance of the building is near the Mitchell Gold + Bob Williams store. There is a parking garage located around the corner on Clarendon Street, as well as metered parking on Columbus Avenue or Berkeley Street. The #9 Bus has a stop across the street at Berkeley Street & Columbus Avenue. Main number: Appointments line: Appointments at 75 Kneeland Street: The Sidney Borum Jr. Health Center (ages only) clinic is located at 75 Kneeland Street, Second Floor, Boston, MA in Chinatown near the Tufts Medical Center. If you are traveling to the Borum on the MBTA, the nearest subway stations are South Station on the Red Line, Chinatown on the Orange Line, and Boylston on the Green Line. Main number for appointments and information: For appointments at the 1340 Boylston Street location, check the Red Sox schedule and plan for transportation and parking disruptions so you do not miss your appointment. Increased parking fees begin at least two hours prior to game times. Red Sox schedule information can be located at TYFM

5 Resources & Supports Fenway offers two parent drop-in groups. The first group is the 1 st Thursday evening of each month at 7PM at the Sidney Borum, Jr. Health Center location at 75 Kneeland Street, 2 nd FL, Boston, MA This group provides a place for parents/guardians of any age gender diverse child to ask a medical provider and licensed mental health professional questions. The second group is on the 2 nd Tuesday evening of each month at 6:30PM at 1340 Boylston Street, 9 th floor, Boston, MA This group is a facilitated discussion group with special attention to concerns of parents/ guardians of young gender diverse children all parents/guardians welcome. Peer community supports for parents The Greater Boston PFLAG can connect parents to peer groups around the greater Boston area. Call for information at Supports for youth age 22 and under, including mental health services, are available at Boston Alliance of Lesbian, Gay, Bisexual, Transgender, and Queer Youth, Inc. (BAGLY). They hold weekly meetings and drop-in programs between 5PM and 9PM at the Community Church of Boston, 565 Boylston Street in Copley Square, directly across from the fountain. For more information visit Supports for families may be available through the services of a youth and family educational and empowerment support organization. Boston GLASS (Gay and Lesbian, Bisexual and Transgender Adolescent Social Services) provides a continuum of services, including mental health services to youth of color (ages 13-25) and their families and allies in the greater Boston area. They have a daily drop-in space M-F as well as other supports and events. Find more information on A community-based gender creative playgroup for young children can be located at For further resources and information check or contact one of the following: Transhealth@fenwayhealth.org Patient Advocate: TYFM

6 Fenway Health Authorization for Disclosure/Receipt of Protected Health Information Patient Name: Date of Birth: 1) I give permission to my Fenway provider: Name of Fenway Provider Phone Fax Address 2) To: (Check one box below) Receive Information from: Send Information to: Send and receive information with: Name Title Agency Address Fax Phone 3) I give permission to share: All Records Records for (circle selection): Pap smear, Mammogram, Colon Cancer Screening, Immunizations, Pathology Reports, ER/Hospital Discharge Reports, Dental, Optometry Treatment received between these dates: From To Other (specialty care, etc) 4) I give permission to share the following specially protected records (please Initial next to each type to be released): Alcohol/ Drug Abuse Treatment: Behavioral Health Treatment: Genetic Test Information: HIV/AIDS Test Results or Related Care: Intimate Partner Violence Counseling: Sexually Transmitted Diseases: Sexual Violence Counseling: 5) Reason(s) for the Release: To share medical records with another provider To transfer all care To allow ongoing communication about this patient s care with an outside provider Other (please specify): 6) This authorization is valid for this request only and will not be honored for any subsequent requests. This authorization for disclosure (unless expressly revoked earlier) will remain valid for one year from the date signed below. I understand that I may revoke this authorization at any time by making a request in writing to the Privacy Officer of Fenway Health. I understand that substance abuse records are protected by 42 CFR, Part 2 and may not be disclosed without my specific authorizations. Those same federal regulations also protect any substance abuse records from re-disclosure by any third party. I hereby acknowledge that I have read, or have had read to me, and fully understand the above statements as they apply to me, and do voluntarily consent to disclosure. X Patient s signature, or, if authorized agent signature, please specify relationship to patient Date Fenway Health Medical Records Department Phone #:

7 BACKGROUND 1. A growing number of youth are realizing that they are transgender a person whose gender is different from their birth sex (often called the sex that they were assigned at birth. ) 2. For some parents/guardians, it is a big surprise to learn that a child is transgender, while for others, it makes sense right away. 3. Some parents/guardians feel confused, sad, or disconnected when they first learn that a child is transgender and feel that they need to get to know their child again. 4. Even when parents/guardians are not surprised or sad, many feel worried about their child s safety, happiness, and future. Most parents/guardians feel unprepared to help their child navigate life as a different gender, particularly in relation to peers, siblings, school administrators, family, and faith communities. 5. You, your child, and your family deserve love and support. Many families are uncertain about how to find knowledgeable, affirming health care, counseling resources, friends and role models for their child, and support for themselves especially early on after learning that a child is transgender. Many families find that the beginning of this journey is the hardest and that, with time and support, life gets easier. THINGS TO SAY TO YOUR CHILD 1. I don t understand this yet, but I am trying, and, I love you. 2. What name do you want me to call you? What gender pronouns do you use (he/him/his, she/ her/hers, they/them/theirs or another pronoun)? I might mess up sometimes, but I will try. 3. You deserve to be loved and respected; I love and respect you. If anyone hurts or disrespects you, come to me and we will figure it out together. 4. You deserve to feel good about yourself, and I support you. If you feel sad or worried, come to me and we will figure it out together. 5. You will always have a place to live, even if we argue. 6. How do you feel the same? How do you feel different? What worries do you have? 7. You may have known for a while that you are transgender, and you may be in a rush to start living as your true gender, but this is new for me. Please try to be patient while I catch up because I want to and I will. 8. Let s remember to have fun together even when things are hard. What things would you like to

8 do together? Maybe something we used to do together or maybe something new? 9. Many communities of faith affirm a universal love and respect for everyone, believing that we are all loved by a higher power (or God) and that we all have value regardless of our gender and whether it changes. 10. Is it okay for me to tell other people about your gender? 11. If you want to tell other people about your gender, when and how would you like to do that and what I can I do to support you in that? 12. We are on this journey together. THINGS TO SAY TO OTHERS 1. My child is transgender and should be treated as a [Boy, Girl, Another Gender] when they are here. Please call my child [Preferred Name] and use the pronouns [Gender Pronouns] as this is how they identify and feel best about themselves. 2. I love my child and want them to feel happy and comfortable at this [School, Church/Mosque/ Temple, Family]. Please look out for my child, and let me know if anyone acts in a disrespectful manner towards them. 3. If you see that my child is struggling, please let me know right away. Many transgender children feel depressed, anxious, and suicidal when they are not recognized or respected for who they are. Research shows that transgender kids are resilient when they are accepted for who they are, and, that trying to change them causes them harm. 4. I realize that this may be hard or different for you (or your organization), but you can only imagine how hard this has been for my child. 5. This [School, Church/Mosque/Temple, Family] is really important to us, and we hope that you will still embrace us with this change in our lives. We are under a lot of stress right now and could use your love and support. RESOURCES Massachusetts The Sidney Borum, Jr. Health Center, Fenway Health (LGBTQ youth health center and counseling; support group for parents) sidneyborum.org Fenway Health: Ansin and Fenway: South End (LGBTQ-compentent care and services for adults and youth) fenwayhealth.org BAGLY (LGBTQ youth programs across the state) bagly.org/programs/youth-group/find-an-agly Boston GLASS, JRI Health (LGBTQ youth drop-in center, family therapy) jri.org/services/health-andhousing/health/boston-glass Greater Boston PFLAG (support groups for parents) gbpflag.org Massachusetts Safe Schools Program for LGBTQ Students (If your child s school doesn t have a GSA Gender and Sexuality Alliance, a nearby school might) MA Commission on LGBTQ Youth (general resources) mass.gov/cgly Massachusetts Transgender Political Coalition (MTPC) (resources, organizing, personal stories) masstpc.org and transpeoplespeak.org GLAD (info about legal rights) glad.org/locations/massachusetts National Trevor Project 24/7 Suicide Hotline for LGBTQ youth thetrevorproject.org Family Acceptance Project familyproject.sfsu.edu PFLAG pflag.org pflag.org/publications Gender Spectrum (varied resources, particularly related to a nonbinary/gender expansive, identity) genderspectrum.org Human Rights Campaign hrc.org This tipsheet was developed by Kerith Conron with support from the Massachusetts Commission on LGBTQ Youth. Special thanks to Melissa MacNish, LMHC, sayftee.com, for reviewing this resource. State agencies that wish to replace Massachusetts resources with local resources should contact kconron@post.harvard.edu to access a modifiable PDF of this tipsheet. TF-21 MA Jan

9 Transgender Health Program Patient Rights & Responsibilities You have the right to: Be heard and understood by your provider and care team Be fairly evaluated for treatment and referrals Access an equal standard of care as any other patient Be provided with assistance or referrals to manage psychological and physical health issues If appropriate, to be given access to gender affirming medical treatment You have the responsibility to: Accurately convey your symptoms (story and history) of gender dysphoria, gender identity development, medical and mental health history to your provider Follow your treatment plan and take your medications as prescribed Work to manage your medical and mental health conditions and concerns Follow up with care as recommended Communicate your concerns and questions about your treatment to your provider Review & Steps Make an appointment in the Trans Youth Clinic Have your medical records transferred Communicate your goals with your provider Move forward with your care! To Schedule an Appointment in the Trans Youth Clinic, Contact: Fenway Health: Ansin Building 1340 Boylston Street Boston, MA TEL Fenway: South End 142 Berkeley Street Boston, MA TEL Sidney Borum Jr. Health Center 75 Kneeland Street Boston, MA TEL Resources Visit fenwayhealth.org/transhealth to download informed consent forms for review: (These forms are available in English and Spanish) Masculinizing Hormone Therapy Feminizing Hormone Therapy Puberty Blockers for Minors Have More Questions? Contact your care team at Fenway if you are a patient. Everyone else contact: transhealth@ fenwayhealth.org. Affirming Care for Gender Diverse Youth Gender affirmative health care for transgender and gender non-binary youth up to age 18 TH-38 Content adapted from The Medical Care of Transgender Persons, 2015 with input from Fenway Health's Transgender Health Program clinical team

10 Gender affirming treatment for transgender and gender diverse youth at Fenway Health is managed through Family Medicine primary care teams. Youth and their parent(s)/ guardian(s) work together with the medical provider to develop a treatment plan based on the goals of treatment and any care needs based on age, development, medical and mental health conditions. Understanding the goals and concerns of the patient is important to support the individual and the family or larger support system. Whether and when any gender affirming medical interventions are recommended or initiated depends on the patient s specific situation and needs. Our criteria for puberty suppression and hormone therapy are informed by the WPATH (World Professional Association for Transgender Health) guidelines (2011) as well as the practice guidelines of the American Endocrine Society (2017) for the treatment of gender dysphoric persons. The following are some, but not all of the criteria for puberty suppression and/or hormone treatment. Capacity to give informed assent together with capacity by all legal guardians to give consent and support throughout the treatment process. Demonstrated long-lasting, non-traditional gender identity that results in significant distress or gender dysphoria. Any co-occurring mental health and medical conditions are stable and reasonably well managed to a level that the youth is able to engage in activities of daily living typical for their age. Functional disruptions primarily due to incongruent gender identity or social pressures are assessed individually. Youth is of an age that treatment with puberty suppression and/or hormone therapy is appropriate and recommended. Overview of Initial Appointments in the Family Medicine Trans Youth Clinic First Appointment Your provider will get to know you and your parent(s) or guardian(s). You will review the hormone therapy process and talk with your provider. You will discuss the impact of hormone therapy on fertility, get blood tests (if time permits), review consent forms, and gather your medical history. Behavioral Health Requirement If you have a therapist, we will ask for your permission to contact them for a letter of support. If you do not have a therapist, we will help connect you to one internally or give you resources to find one elsewhere. Helpful to bring to Appointment #1: Contact information for any outside care providers (name, fax, and phone number), copies of last physical and medical records, a list of questions you may have about the treatment process, and insurance information. Second Appointment Your provider will continue getting to know you and your parent(s) or guardian(s). We will review your plan for gender affirming treatment and your expectations and concerns. You may need to have a physical exam and lab work done. Third (or more) Appointment(s) Once we receive relevant past medical information, a letter of support from your therapist, and your case has been reviewed by the transgender health clinical team, we will ask you to come in with your parent(s)/ guardian(s) to review and sign the treatment consent forms. The care team will work with you and your parent(s)/guardian(s) to make a care plan for the rest of the process. From here your care team will review your information and help you schedule necessary follow-up visits. If appropriate, you may be able to initiate hormone therapy and/or puberty suppression treatment at this visit. The process for starting hormones and/or puberty suppression may take more than three visits.