The Yale School of Medicine established the Gender Program in October 2015 to provide clinical assistance to children and their families experiencing gender identity issues. Today, the program has worked with dozens of families and remains the only comprehensive center of its kind in Connecticut combining mental health services and medical care.

According to Susan Boulware, medical director of the Gender Program and a clinician in pediatric endocrinology at the Yale New Haven Children’s Hospital, the program has seen 37 patients since its foundation 16 months ago. Boulware added that the Gender Program hosts a clinic for a day and a half roughly once a month, and is now booked through October 2017.

According to Christy Olezeski, director of the Gender Program and a Yale Medicine clinical psychologist, the idea for the Program began during the fall of 2014 when she developed an interest in healthcare for transgender youth in Connecticut. She was then put in touch with the three other co-founders of the Program, who were interested in creating an interdisciplinary team for trans healthcare.

“[Between 2014 and 2015], we consulted with other clinics around the country who had been providing trans health care for youth, learned about their policies and procedures, and then we made our own policies and procedures and got all the documentation and planning done that year,” Olezeski said.

According to Olezeski, a family that brings their child into the Gender Program would first meet with the full interdisciplinary team of the clinic, including an endocrinologist and mental health specialist, who would learn more about the family and their needs.

Following that, she added, a medical and social history are created before determining the next step in the process. According to Boulware, that next step may include medication including puberty blockers and cross-sex hormone therapy, although medication is not always necessary.

“We don’t try to push any agenda on a family or on a youth,” Olezeski said. “We want to make sure that they have the time and space to be able to really explore their gender.”

Boulware noted that what makes the Gender Program unique is its comprehensive combination of interdisciplinary staff members, which include pediatric endocrinologists, clinical psychologists, psychiatrists, a child advocate lawyer and a medical ethicist.

She added that other gender programs are not as “intimately involved” as Yale’s. Their program includes a mental health provider present at the first visit, as well as comprehensive “readiness evaluation” that also evaluates for co-occurring diagnoses such as anxiety and depression. These occur in about 40 percent of individuals with gender dysphoria, Boulware said.

“Most centers with pediatric endocrinologists will see patients for gender identity issues, just not in this tapestry of a multidisciplinary clinic,” she said.

According to Alice Rosenthal, who has worked with five to 10 families at the Gender Program as a child advocate lawyer, most legal concerns surround school issues, insurance coverage and gender markers on documents like birth certificates. Rosenthal is a staff attorney at the Center for Children’s Advocacy, an organization that represents vulnerable low-income children across Connecticut. She leads a medical-legal partnership with Yale New Haven Hospital.

Rosenthal added that the goal of a medical-legal partnership is to create collaborations between nonprofit legal services with medical providers in medical settings to provide representation for low-income families for legal issues that impact their health.

“The collaboration with the gender center has been great because their work is in line with the Center for Children’s Advocacy, in providing a voice for the voiceless children of Connecticut and making sure that they have the services they need and are not being discriminated in schools, medical settings, and jobs,” Rosenthal said.

She noted, however, that the Center for Children’s Advocacy represents low-income youth and their families. Rosenthal said that because many of the families at the Gender Program are of higher income, she has not yet represented families in court but has provided legal consultation and guidance for gender-nonconforming youth.

Olezeski noted that the program sees a significant number of youth who are nonbinary.

“I think it’s important to make sure that we help families understand [nonbinary identities],” Olezeski said. “Sometimes, they aren’t as equipped in being OK with the ambiguity that comes along with being non-binary.”

Olezeski acknowledged that ultimately it is up to the parents to bring their child in for care, which is covered by insurance under the Affordable Care Act. She added that the Program misses a portion of the population whose parents are not supportive — a phenomenon she said she was unsure how to manage.

Moving forward. Olezeski added that one of their long-term goals is to develop into a comprehensive center.

“What this means is that we are able to provide services throughout the lifetime,” Olezeski said. “We hope to be able to have services that include primary care services done in a gender-affirming way.”

According to a Yale News press release, there are about 20 programs nationwide for transgender youth.