At our center for Trans-youth Help and Development we practice a model that really fits the individual child. And some centers do some different things but in our center we really feel we get people from all different places. We get referrals from teachers, we get referrals from psychologist, we get referrals from other pediatricians, parents, people find us on the internet. And when the child comes in we actually have them do intake process which is about an hour or 2 hours. For our intake coordinator really understands what their experience has been up until the point when they are coming in contact with our clinic. That includes is the child socially transitioned? Has there been any legal name change, gender change? Has the child sought help elsewhere, is the child actively in therapy? Because every child is going to be on a different place in this journey. that's why It's so difficult to put into place protocols that fit every single person. Because this is relatively new field they were thinking about this for younger kids. There aren't protocols that are going to meet everybody's needs it has to be an individual approach. So generally young people have started some kind of therapy. They've been lured into the world of mental health somehow. Teachers, school psychologist, may be they've found a therapist on their own. Got referred to a specific gender specific therapy center. We work with that therapy centers to find out how's that child doing. Find out if that child has been damaged from the response of their authentic gender and that expression kind of see where they are on that road. And then a lot of the medical decision making after that comes where they are in their developmental process physically. So how close are they to puberty, have they started puberty are they in the middle of it, are they through puberty? Because that happens at different ages for different kids.