“This seems crazy to me,” said former chief psychologist Laura Edwards-Leeper. Boston Child Gender Clinictwo hour evaluation period.

However, psychologist Kerry McGregor, who is now co-director of the clinic, said it was appropriate to shorten the evaluations.

“We were able to access all the information in a much shorter time,” he said.

Although the basis of the hearing was the employees’ lawsuit for discrimination against Children, the lawsuit nevertheless provides that: At a time when the growing field of medicine is facing challenges, it is an extraordinary window into the inner workings of perhaps the most influential pediatric gender clinic in the United States. intense scrutiny, legislative bans in some states and a turning point Supreme Court case It will be discussed in December.

The subject of the hearing in Suffolk Superior Court is a lawsuit filed against Boston Children’s Hospital by Amy Tishelman, 68, a psychologist and former research director of the hospital’s gender clinic. She claims her bosses and colleagues discriminated against her because of her gender and age and fired her in retaliation after she filed a lawsuit. The hospital denies the allegations and says Tishelman was fired for violations of the Health Insurance Portability and Accountability Act, which protects patient privacy. (A Children’s spokesperson said, “The hospital cannot comment on pending litigation.”)

The length of assessments was a point of contention at the clinic and contributed to the workplace tensions at the center of the case. According to testimony at the hearing, Tishelman and at least one other psychologist, Peter Hunt, opposed the decision to reduce the duration of in-person evaluations from four hours to two hours.

Tishelman called the shortened evaluation period “reckless” and said more time was needed with patients and their parents before making recommendations about medical treatments that could have lasting effects, including affecting infertility. He argued that two hours did not leave enough time to assess all of the patient’s needs, which sometimes included support for psychiatric diagnoses, trauma or autism. “Recommendations needed to go beyond a simple up or down, yes or no for medication,” he said.

Children did not have comprehensive data on long-term outcomes, such as following the clinic’s patients into adulthood.Tishelman testified. He was working to develop such a study before he was fired. in question.

The split at Boston Children’s Clinic reflects a broader disagreement in the field about how long evaluations should last and what steps they should include.

When a team of Dutch researchers and clinicians pioneered gender transition care for minors in the 1990s, they conducted intensive, long-term evaluations before allowing patients to proceed with medical transition treatments. The Dutch team sometimes eliminated potential patients if they had serious mental health diagnoses or if their parents were not supportive of their wishes to transition.

In the US it is common for evaluations to be much shorter. in 2022 Reuters interviewed doctors and staff 18 in the USA gender clinics and found that “(n)one described something similar to the months-long assessments adopted in their study (the Dutch team).” Seven of the clinics said they sometimes prescribe puberty blockers or hormones “based on the first visit.”

This faster approach to evaluation has been a subject of debate among experts in the field. Critics argue that providers sometimes rush children toward medical interventions before fully discovering the source of the child’s gender-related distress through assessment and therapy. They say that sometimes this leads to dire consequences, including the passing of minors who regret their decisions. Supporters of current practices say remorse rates are too low and that long, skeptical evaluations can amount to a form of persecution for transgender children who know who they are and need medical care. treatment.

Transgender rights advocates and leaders in the field of gender-affirming care, including some who recommend a more cautious approach to evaluation, say there is ample scientific evidence showing that such treatments are beneficial for transgender youth’s well-being. But there is a divide between some U.S. leaders in this field and health authorities in Europe; where five countries sharply restricted access to gender-affirming care after concluding that the scientific research supporting it was weak or of low quality.

In December, the Supreme Court will hear arguments in a case that could have far-reaching effects on access to gender-affirming care. The case stems from a Tennessee law banning some medical transition treatments for minors that the Biden administration and the American Civil Liberties Union have challenged.

Discussion of the assessments was conducted at the Boston Children’s Gender Clinic, known as the Gender Multispecialty Service, or GeMS.

Psychologist Kerry McGregor, now co-director of GeMS, said that when she joined the clinic in 2016, the time allotted for face-to-face evaluations was four hours. Then in 2017 or 2018, “we increased that time from four hours to two hours,” he said.

“Some people weren’t happy about it,” he said. “I thought it was appropriate.”

Evaluations were shortened in the 2010s because of the increasing number of children seeking care at gender clinics, including GeMS, according to multiple clinicians.

“So it made sense to make that time more efficient to see to our growing patient population,” McGregor said. A children’s advocate referred to the type of session in question as a “hormone readiness assessment.”

McGregor added: “We can also always ask for more time. … It’s pretty rare. But I can do it if I need to.”

Edwards-Leeper, the founding psychologist of GeMS, the first hospital-based pediatric gender clinic in the United States, called the two-hour evaluation period “extremely concerning” in an interview with the Globe Thursday.

He designed the original evaluation protocol for GeMS in 2007 after traveling to the Netherlands to learn the Dutch team’s methods.

When he returned to Boston, he adapted these methods to the more limited resources of GeMS, then a fledgling clinic.

His protocol is “still a very comprehensive psychological evaluation,” he said. It took about 20 hours, he said, including about five hours of face-to-face meetings with a patient and their parents. He also recorded psychological measurements through questionnaires and interviewed other people in the patient’s life, including outside therapists and school staff.

“It is not possible” to make a comprehensive assessment in such a short time, he said.

GeMS evaluation now includes an initial intake, a two-hour meeting with a psychologist, review of medical records and collection of psychological measures based on written questions, according to trial testimony. Tishelman testified that when he was fired in 2021, the practice of calling outsiders was reduced or eliminated.

Edwards-Leeper said he has found in his own practice that he needs to spend more time on evaluations, not less, than he did when he helped found GeMS 17 years ago. Since then, she said, cases of young people experiencing gender dysphoria, sometimes described as a deeply distressing feeling of being born in the wrong body, have become more “complicated.” “Kids coming out (today) often have a lot more in terms of mental health issues that are not always a direct result of gender dysphoria and often contribute to gender dysphoria.”

“That makes things even more complicated because you have to figure out the chicken and the egg,” he said.

In an interview, a psychologist at a gender diverse clinic in New England pushed back against the criticism. He said shortening evaluations was not only appropriate but also a sign of progress.

“There has been a shift in this field towards an informed consent model, which requires informing families about the possible risks and benefits of treatment and trusting them to make decisions, rather than asking children to prove that they are transgender,” said this psychologist. He spoke on condition of anonymity out of fear for the safety of himself, his family and his patients. Boston Children’s Hospital and GeMS employees were targets of attack Death threats and bomb threats in 2022 after conservative activists criticized the clinic.

“I also think in terms of barriers to care, these comprehensive assessments mean that a lot of kids won’t be able to access care because their parents can’t take all that time away from work or they can travel to a lot of appointments themselves,” she said.

Mike Damiano can be reached at [email protected].