About our service

This specialist service is unique to the NHS. We are commissioned to work with children and young people up until their 18th birthday. We have a multidisciplinary staff, with experts in child and adolescent psychiatry, psychology, social work, psychotherapy, family therapy and paediatric endocrinology. We aim to understand the nature of the obstacles in the development of gender identity, and to try minimise their negative influence.

We think that relationships are as important as other factors in contributing to the patient's difficulties. We therefore pay attention in our work to what is happening within the patient's relationship with the family, school and other social agencies. We also understand that young people experiencing difficulties in this area (and their families) may not feel ready to accept help from us directly. In some cases it might also be impractical to attend. In these situations, we make ourselves available to consult with professionals already involved in the case, such as the patient's GP, mental health professionals, teachers or social workers.

Children and young people who have disorders of sex development or intersex conditions and other endocrine conditions may be referred if there are associated concerns with gender identity development. If not, other services are available which local services can refer to.

Our intake team

How we screen referrals

Our Intake Administrator carries out an initial screen of referrals and will request any information that is clearly missing.

The information received about the child or young person is then reviewed and discussed by clinicians in our intake team. Before we are able to accept a referral, the intake team may also request further details, especially information concerning level of risk and about whether the child is experiencing gender-related distress.

 

When do we need more information?

Our referral form requests details about different aspects of the child or young person's life.

Help us avoid delays. One of the most common reasons for delays in us being able to accept referrals is when there is very limited information about the child or young person's gender identity development. It therefore helps if you can provide as much detail as possible.

If it is unclear whether a child is showing any distress around their gender and their interests and preferences, we might call parents to gather more information and to offer brief advice.

Occasionally, we receive referrals which appear to be related specific to sexual orientation rather than gender identity. We are unable to accept referrals if the concerns relate solely to distress about sexual orientation where there is no evidence of concerns around gender identity development.

 

Evidence of plans to manage risk locally

Young people’s safety is our first priority. If there is evidence of risk, we need to make sure plans are in place to manage this risk through local services. If there no evidence that risk is being managed locally, we must ask referrers to arrange this before we accept a referral.

If a young person is engaging in self-harm or is experiencing thoughts of ending their own life, we recommend that they are referred to their local Child and Adolescent Mental Health Service (CAMHS).

Read more about our information for parents who are worried that their child may harm themselves.

 

What happens next?

Once a referral has been accepted, we write to both the referrer and the young person / the family to confirm this.

We will write again in due course with details of the first appointment. Read more about our current waiting times.

Options for 17 year olds

As a child and adolescent service, we are commissioned to see young people until their 18th birthday. Adult services are commissioned to see those who are 18 years of age and above. 

Options for 17 year olds are therefore slightly different from those for people who are either younger or older.

If you are considering referring a 17 year old to a gender identity service, there are broadly speaking two options available:

 

Referral to an adult service

Some young people prefer to be referred directly to adult services where possible. There are several different adult gender identity clinics in England.

The Tavistock and Portman NHS Foundation Trust is the interim provider of the Gender Identity Clinic. The Gender Identity Clinic is the largest and oldest gender clinic in the UK, dating back to 1966. They accept referrals from all over the UK for adults (over 17 years and nine months) with issues related to gender. Visit the Gender Identity Clinic website

As adult services are nationally-funded, patients living in England can be referred to any of the adult gender services across the country.

There are separate adult services in Scotland and Northern Ireland.

We are aware that some adult gender services accept referrals for 17 year olds. Their waiting times vary, as do their policies about when they will offer a first appointment. Adult services do not usually meet with the whole family.

We recommend you contact adult services directly to enquire about their current policies and waiting times.

If - following assessment - hormonal intervention is felt to be appropriate, adult services do not routinely require all patients to start with 12 months of hormone blocking treatment. Indeed, adult services have and do commence people on cross-sex hormones without having first taken hormone blockers.

 

Referral to our child and adolescent service

We differ from adult services in that we often meet and work with the whole family.  Our process of assessment usually involves between three and six meetings over a period of between three and six months, after which we write a report with recommendations.  Recommendations might include further therapeutic support, which would usually be provided through local services.

Sometimes we would recommend a referral to one of our endocrinology clinics for consideration of a physical intervention.  As a child and adolescent service we take a staged approach to physical intervention meaning that young people must currently be on hormone blocking treatment for 12 months in our service before they can be considered for cross-sex hormones.

We would not usually accept a referral for someone who is shortly due to turn 18. If this is the case, we would generally recommend referring to an adult service instead.

Funding arrangements

England

If your referral comes from England it will be funded via our national contract with NHS England and there is no need to seek local funding approval.

 

Northern Ireland and Scotland

There are local services available in Northern Ireland (for under 18s) and Scotland (for those aged 12 to 18). You may wish to consider these options as an alternative to our service. 

However, our national contract also covers referrals from Scotland and Northern Ireland. As with referrals from England, no local funding approval is required.

 

Wales and other countries or territories

If your referral comes from Wales, or from any other country or territory not mentioned above (including overseas), we will need to establish funding confirmation before we can offer an appointment.

We are usually not able to make applications for funding ourselves. These requests normally have to come from the referring clinician. We strongly recommend that you apply for funding as soon as possible. This helps to avoid delays in the young person accessing our service.

If our contracts team let us know there is no funding in place, we will get in touch to let you know this.

Referral form

Our referral form requests details about different aspects of the child or young person's life.

Our preferred route of referral is through a local Child and Adolescent Mental Health Service (CAMHS), who will have completed their own holistic assessment. 

However, we do also accept referrals from other health, social care, and education professionals, including directly from GPs. Unfortunately, we are unable to accept self-referrals from young people or their families.

Professionals, as well as young people and their families, are welcome to contact us directly to discuss a possible referral.

Completed referral forms should be returned to our Intake and Discharge Administrator at our usual address. For further information or advice on completing our referral form, please contact us

Download the referral form