Assessing Readiness for Transition From Pediatric to Adult Gender Affirming Care

Transitioning from pediatric to adult care is a critical juncture in the health of adolescents. Little is known about how best to optimize transition to adult care among transgender and nonbinary (TGNB) youth. While the Transition Readiness and Assessment Questionnaire (TRAQ) has been validated in other pediatric populations, it has not been studied in TGNB youth. Our aims were to pilot the use of the TRAQ for TGNB patients, describe transition readiness patterns, and identify factors associated with transition readiness.

The TRAQ was introduced into routine clinical care for patients and their caregivers in a large, urban pediatric gender program in the spring of 2021. We performed a retrospective chart review comparing TRAQ responses based on demographic and clinical data.

We collected TRAQs from 153 adolescents (mean age: 19 years [standard deviation 2.36], range: 11-24). The TRAQ demonstrated good internal reliability with a Cronbach alpha of 0.926. Patients scored highest in the TRAQ subdomains of talking with providers and tracking health issues and lowest in the subdomains of managing medications and appointment keeping. Age and presenting to the appointment alone were associated with higher TRAQ scores.

We found that the TRAQ is internally reliable in a sample of TGNB youth. Factors associated with higher TRAQ scores and patterns identified in TRAQ score subdomains provide an insight into the needs of TGNB youth preparing to transition to adult gender-affirming care. Future research should focus on tracking transition readiness longitudinally, developing and evaluating interventions to improve transition readiness, and assessing post-transition outcomes.