December 15, 2015 (Toronto) - CAMH is announcing plans to change the gender identity services it provides to children and youth, following an independent clinical review of its Child Youth and Family (CYF) Gender Identity Clinic released today.
The external review of the CYF Gender Identity Clinic (GIC)’s practices and operations, first announced on February 5, 2015, was conducted by two independent clinicians. While the reviewers identified some strengths in the clinic, they found the CYF GIC’s approach to providing services to be out of step with current and evolving clinical and operational approaches. The reviewers recommended that CAMH engage with the community to determine future directions.
“At CAMH, excellence is our starting point-- we expect CAMH’s services to reflect the latest and best practices in the field. We want to apologize for the fact that not all of the practices in our childhood gender identity clinic are in step with the latest thinking,” said Dr. Kwame McKenzie, Medical Director of CAMH’s Child, Youth & Family Program, today.
The reviewers found that the CYF GIC appeared to operate as a fairly insular entity, with a focus on providing intensive assessment and treatment. Instead, current and emerging best practice favours watchful waiting, and educating and supporting the parents to accept the child’s gender expression.
CAMH has responded immediately with a three point plan to update and improve our services. The plan includes winding down the CYF GIC, engaging with key community and academic organizations, clients and families in determining future directions, and exploring the best role for CAMH.
“CAMH is looking forward to working with the community to determine how we can make the most positive contribution going forward. We want to help create a sustainable system to meet the growing need for evidence-based clinical services for this population,” said Dr. McKenzie.
The review was triggered when CAMH met with community partners in late 2014 and early 2015. Knowledge of gender identity and expression has advanced significantly and continues to evolve, and society has also shifted in its understanding and acceptance of gender variance.
The independent clinical review looked at the clinic’s operations and pathways of care. It examined them in the broad context of newly emerging best practices and clinical guidelines in the field of gender identity, and assessed the extent to which the CYF GIC functioned in accordance with these guidelines as well as national and international practice.
“We decided to release the full report because we are committed to transparency, to building trust, and to working closely with the community,” said Dr. McKenzie.
The clinical review of the CYF Gender Identity Clinic was conducted by Dr. Suzanne Zinck, a Child and Adolescent Psychiatrist with 9 years experience working with gender variant, gender-questioning and transgender youth, who practices in Halifax and was hired as an independent contractor, and Dr. Antonio Pignatiello, a local Toronto Child and Adolescent Psychiatrist with 23 years of expertise in system of care with children and youth presenting with complex needs.
“CAMH agrees with the reviewers that this is an opportune and somewhat natural time for re-visioning of our child and youth gender identity services. There is a tremendous need for services such as this, clinically and academically.”
“CAMH wishes to thank all of those who participted in the review process,” added Dr. McKenzie. “We apppreciate the candour and input of the stakeholders and clients who contributed to this review, and look forward to participating in a process, in partnership with the communty, that will allow CAMH to better address the needs of this important population.”
Correction and Apology:
The Centre for Addiction and Mental Health (CAMH) has removed from its public website the Report of the External Review of the Gender Identity Clinic (GIC) of the Child Youth and Family Services (CYF) in the Underserved Populations Program at CAMH dated November 26, 2015. We have been advised that it includes an erroneous statement. CAMH was recently made aware that an individual who had participated in the review process had mistakenly attributed comments to Dr. Ken Zucker which were not made by him. We regret that this statement was included in the report and apologize for the error. A formal letter of apology has been sent to Dr. Zucker. The Report has been replaced by an Executive Summary developed by CAMH
The Centre for Addiction and Mental Health (CAMH) is Canada's largest mental health and addiction teaching hospital and a world leading research centre in this field. CAMH combines clinical care, research, education, policy development and health promotion to help transform the lives of people affected by mental illness and addiction. CAMH is fully affiliated with the University of Toronto, and is a Pan American Health Organization/World Health Organization Collaborating Centre. For more information, please visit camh.ca or follow @CAMHnews on Twitter.
Centre for Addiction and Mental Health (CAMH)