Table 4 Recommendations for service providers with supporting quotations

Discuss connections between physical & mental health

Give equal weight to physical and mental health during clinic appointments

“I feel it's important because in general, people don't really see mental health as something as important as physical health. But I think especially if people realize that they're so connected and intertwined, especially with people who do have both mental health issues, and physical health issues, that one affects the other. So I feel like they pay more attention to mental health issues.” (108)

“I really do think that it is essential, that that is understood. Because for so many times, I felt like I was losing my mind. I thought I was going crazy and insane. And I wasn't able to make that connection because I was so young. Right? I wasn't able to make that connection that my physical health and my mental health, they went hand in hand. They go together. And it is important to make both of them a priority. I think having that information and giving it out to people would be so beneficial.” (107)

Ensure service providers/clinics have adequate knowledge in health & mental health to discuss connections

“I'm not sure what training therapists, psychiatrists or mental health providers go through? And same with doctors who deal with physical illness, but having both parties knowledgeable in both areas. I know that's a lot to ask. Because there is so much to know. I know there's some family doctors who wouldn't even touch mental health medication because they don't know much on it.” (104)

Tailor services to the needs of TAY with co-occurring chronic health and mental health conditions using interprofessional teams and/or innovative clinical approaches (e.g., combined clinics)

“I think you should have specific care for them, maybe a specific clinic where you can receive both. Yeah. It'll make it easier and not only easier for me and also easier for the doctor, because if you have all my history and the follow up even will be much easier.” (105)

Offer strengths-based, validating care to TAY

Bolster TAYs’ capacities

“Yes, it does suck, yes, my life is a lot harder than maybe some other kids my age, but I'm also still capable. And I already experience so much of, ‘oh, you poor thing’, and the ‘why me?’ type of mentality from my parents and from myself—that's not what I need. I need to be told that I'm capable of being able to stand up and [advocate for myself] and I wish that I saw that more from my healthcare providers.” (101)

Validate TAYs’ experiences

“Believe the patient’s experience, the extent of their pain.” (101)

“I think one of the big struggles, especially with working with mental health conditions in particular with minors is that the doctors there, they tend to migrate towards what the parent wants or needs, because the kid has a mental condition. Right? There's, I don't want to say a bias. But it could be just in the back of their mind, subconsciously they think this kid isn't able to make a choice for themself because of this condition. Which isn't the case. Sometimes the kid knows exactly what they need.” (107)

“It's hard for someone to understand the pain you go through unless you're in that pain or unless you deal with that illness. But I feel like just honestly, just being kind of understanding because, I know I do complain about my hand a lot. And in the past my therapists would kind of just brush it off.” (104)

Speak directly to TAY in clinical encounters (with or without caregivers present)

“Make sure for healthcare providers, when you're talking with someone who's coming up on transitioning, turn and look at them and ask them what they think, and what options they're considering, and what things they aren't comfortable with. Because if healthcare providers always turn to the parent, that kid is never going to be ready. That kid is going to get thrown into this very scary, new transition thing where the doctor’s going to ask them what want to do, because there's no parent in the room. And that kid is going to freeze up. That kid has never had to make a decision regarding their own health before.” (107)

“I think also regularly, making it more normalized to send the parents out of the room every visit. Just in case the minor in question has anything that they want to bring up, or if they need some support and they can't tell their parents, or are too embarrassed for whichever reason. Because that was an issue a lot for me—I wanted to bring things up, but I couldn't.” (108)

Make mental health services accessible to TAY with chronic health conditions

Bolster the availability of low-cost mental health services for TAY

“I'm currently trying to get diagnosed with like autism and, and other mental health issues and that's been a struggle because it's intense in trying to find people and I'm also low income.” (102)

“I think more resources on counseling for minors who can't pay for therapy, or their parents can't, or won't pay for therapy, or stuff like that. Just so they can get the mental health help that they need.” (108)

Ensure TAY have a point of contact during service transitions

“I've accessed a lot of the healthcare system and I’ve fallen through the cracks and stuff like that. I'm with the gender program, which has a psychiatrist or a psychologist who does referrals and checks up on me every once in a while, but I'm trying to find someone who will be like, ‘Yes, I got you’.” (102)

“One program was just like, ‘okay, bye’. And I'm just like, wait? I still need trauma therapy because I’m messed up, you know? And because it took me a long time to get that therapist that I have now.” (104)

Send adult mental health referrals early given wait times for services

“I actually have the appointment [with an adult psychiatrist]. It's just a long wait until the actual appointment.” (104)