Table 5.

Example DSD-related interventions across the Psychosocial Assessment Tool-DSD risk levels

Risk level	Potential interventions
Universal	Connect with peer support Provide high-quality written and verbal education  Specific DSD etiology, course and treatment options  Distinctions between biological sex (sex chromosomes, gonads, internal/external anatomy) and psychosocial differentiation (gender identity, gender role, sexual orientation)  Natural variability in appearance Promote family-centered care and active involvement in shared decision-making Discuss importance of information sharing (particularly to affected child) Offer behavioral health consultation (unless universally involved) Address complex shared-decision making challenges (e.g., prior to child’s ability to participate themselves in irrevocable non-urgent decisions) Explore stigma-related concerns (e.g., distinguish “privacy” vs “shame/secrecy,” problem-solve social challenges) Provide routine clinic follow-up
Targeted	Offer Universal interventions (see above) Meet with in-clinic behavioral health specialist / psychologist for further assessment of identified concerns Practice communication skills (e.g., disclosure to others, developmentally appropriate education to child) Involve other hospital resources to address specific concerns (e.g., Social Work, Chaplaincy, Child Life) Implement behavioral interventions (e.g., medication adherence, healthy food choices/ exercise for weight management) Teach brief emotion regulation strategies (e.g., to assist with coping with medical exams/ procedures, mild/transient mood concerns) Teach problem-solving interventions (e.g., medication management during overnight party) Provide shorter-term follow-up to assess efficacy of interventions and need for more intensive services
Clinical	Offer appropriately timed Targeted and Universal interventions (Note: these may not be effective when families are in acute crisis) Conduct safety assessment & planning Provide immediate crisis intervention Refer for outpatient counseling Involve community services Provide close phone follow-up to support follow-through with additional referrals/services