SHINE: Supporting Healthy IdeNtitiEs for Gender Non-Conforming Youth

Statement of Problem

For most children, biological sex, gender identity, and gender expression are aligned in the way that our society expects (this type of gender expression is called “cis-gender”). However, for some children, their gender identity and/or expression may be different from the sex on their birth certificate. These children are called “gender non-conforming,” or GNC. We do not know exactly how many people in the world are gender non-conforming, but data from the National Center for Gender Equality suggest that the prevalence may be as high as 1% of the general population.

Challenges for GNC youth exist at every turn in our society. They experience a range of reactions from family members, school officials and classmates, and others in their communities, ranging from a lack of understanding to outright rejection, isolation, discrimination, and victimization. In addition to these societal challenges, there are many barriers in our health care system to ensuring the best health outcomes for GNC youth. For example, many GNC youth experience significant obstacles to accessing appropriately trained health care providers and needed health and psychosocial services. Additionally, many GNC youth are denied insurance coverage for certain health services such as puberty-blocking medications, cross-gender hormones, and, in some cases, gender reassignment surgery.

Comprehensive Care and Support for Gender Non-Conforming Youth

Ensuring Comprehensive Care and Support for Gender Non-Conforming Youth
Ensuring Comprehensive Care and Support for Gender Non-Conforming Youth

Inclusive health care systems, supportive laws and policies, and LGBT-competent youth-serving professionals can intersect to ensure comprehensive care and support for gender non-conforming youth.

An interdisciplinary team from The Children’s Hospital of Philadelphia, including staff from PolicyLab and the Gender and Sexuality Development Clinic, and the Philadelphia Department of Public Health Division of Maternal, Child and Family Health, has formed with the goal of providing comprehensive health care for GNC children and adolescents. With a vision that goes beyond providing direct care, the goal of the SHINE (Supporting Healthy IdeNtitiEs for GNC) program is to augment these clinical activities by addressing the health needs of this population of children on a broader level. The team aims to offer education, training, and consultation to community physicians and other partner organizations around providing culturally-appropriate medical homes for this group of underserved youth as well as improving access to care and health outcomes through identifying local resources including support for groups for patients, families, and friends, assistance with obtaining health insurance, and advocating with insurers for coverage of needed medical services.

Specifically Project SHINE includes the following activities:

  1. Identify key, local provider and patient/family stakeholders for individual in-depth qualitative interviews and development of an advisory board in order to better define the needs, strengths, and challenges for improving the health of GNC youth in the Philadelphia.
  2. Survey local pediatric health providers about knowledge, attitudes, and skills in identifying and providing care for GNC children and adolescents.  We will then develop and test an educational intervention for local pediatricians based on these findings.
  3. Develop documents that help to address the specific policy and health care systems challenges and successes that affect health outcomes for GNC youth.

By implementing training and consultation with community pediatric providers in an effort to establish culturally competent medical homes for GNC youth, we will foster advocacy efforts to ensure that GNC youth have access to health insurance and address issues of insurance coverage for gender-affirming health care services. Additionally, by partnering with local organizations, policymakers, schools, and religious institutions, we will ensure supportive community environments for GNC children and adolescents and their families. We hope our community partnership in Philadelphia will serve as a model for other communities. Finally, we hope to conduct groundbreaking research and complete quality improvement projects for this underserved population.

Suggested Citation

The Children's Hospital of Philadelphia, PolicyLab. SHINE: Supporting Healthy IdeNtitiEs for Gender Non-Conforming Youth [Online]. Available at: http://www.policylab.chop.edu [Accessed: plug in date accessed here].