Attendees gather at a public forum Tuesday to discuss a newly proposed health center based at Gardiner Area High School. Ethan Horton/Kennebec Journal

GARDINER — Some parents said at a public forum Tuesday they were concerned about a potential lack of parental involvement in gender-affirming care offered as part of a newly proposed school-based health center.

The center, according to its organizers, would help combat chronic absenteeism, substance use, mental health issues and other health concerns at Gardiner Area High School by providing primary care services on-site and regardless of insurance status or ability to pay.

But Michelle Tucker opened up the forum’s question-and-answer period with her concerns about care for transgender students: “Is this health center in alignment with keeping secrets from parents from transgender treatments?” Tucker chose to run for the Maine School Administrative District 11 school board this fall partially because she hopes to prevent transgender students from using the school bathroom of the gender they identify with.

Joanne Joy, who is a senior program manager at Healthy Communities of the Capital Area, a sponsor of the center, said every health center complies with state law around confidentiality and gender-affirming care. Joy helped moderate the forum, which was held at the Johnson Hall Opera House and attended by about 40 people.

Under Maine law, minors who are at least 16 years old can legally consent to gender-affirming hormone therapy without a parent’s involvement only when:

• A minor has been officially diagnosed with gender dysphoria by a medical professional;

• A medical professional determines the minor is or will experience harm if they do not receive gender-affirming hormone therapy;

• A minor tells the medical professional that they have discussed their gender identity with their parents or guardian, and the parents or guardian declined to support treatment of the minor’s gender dysphoria;

•  The minor provides written consent after the medical professional determines they are mentally and physically competent to give the consent.

The stipulations apply to any health care provider in the state, including Maine’s other 27 school-based health care centers, such as those at Cony High School in Augusta and Maranacook Community High School in Readfield.

Students even younger than 16 may receive confidential care in other areas after a medical professional determines their ability to consent, according to state law.

According to a 2024 survey by the Trevor Project, a suicide prevention nonprofit for LGBTQ+ youth, only 13% of transgender youth in the U.S. had access to gender-affirming hormone care, and 61% of those youth were concerned about losing access to that care. Nearly half of transgender and nonbinary youth said they had considered suicide in the past year, and three-fifths said they had recent symptoms of depression.

A 2022 study published by an American Medical Association-affiliated journal and by the National Institute of Health found transgender youth who had access to gender-affirming care had 60% lower odds of moderate or severe depression and 73% lower odds of suicidality over the course of a year.

Additional studies cited by the U.S. Department of Health and Human Services’ Office of Population Affairs have found familial and peer support are crucial for facilitating and arranging this gender-affirming care. A lack of support, the office said in a 2022 report, “can result in rejection, depression and suicide, homelessness, and other negative outcomes.”

Diandra Staples, the assistant director of operations at HealthReach, said only seven of the 181 students served in total at Lawrence High School’s school-based health center in Fairfield received confidential services — or services given without the consent or knowledge of a parent or guardian. Staples fielded many of the questions from concerned community members Tuesday.

“And I’ll tell you, those seven kids, they don’t have that support system — they generally don’t have parents,” Staples said. “They generally are living on somebody’s couch. They don’t have that, and it’s kind of a dangerous situation to get that information out to others.”

Katie Gillihan, a registered nurse who works in the Lawrence High School health center in Fairfield, said the medical professionals try to involve parents at every turn, almost always calling and asking parents if they can see their child before a visit.

But, Gillihan said, the providers sometimes need to build up trust with a student to involve parents on more sensitive issues, including mental health, sexual activity or gender identity.

“A lot of those kids, after a few visits, after they build trust with me and also trust in the medical system — nine times out of 10, those kids let me involve their parent or their guardian,” she said. “But I wouldn’t be able to help persuade that child to involve other support, I wouldn’t be able to prevent pregnancies or access to services if I didn’t have that opportunity to even talk and let them know how to access them.”

Tucker responded that she agreed that more people should be involved in students’ care, but that parents should be the primary point of decision-making, not the medical professionals. In fact, she said, she often refused when medical professionals asked her to step out of an exam room to discuss a concern alone with her child.

Presenters pointed out that use of the health center was optional, and that parents should discuss use of the facility and its services with their children beforehand.

Tucker also said she was concerned that teachers and administration would be involved in medical decisions. But Joy, in response, said the health center would simply be located within the school building and would be entirely separate from school administration. Decisions would only be made by medical providers, parents and students — not by school staff, she said.

The MSAD 11 board has not yet scheduled a vote to approve the facility.