177 Dealing with moral challenges in treatment for transgender children and adolescents: evaluating the role of moral case deliberation 9 with the steering group. Together, they decided to make adjustments to the MCD sessions themselves (e.g., focusing more on ‘who will do what’ at the closure of each session) and to see to a deeper embedding of MCD in the work processes of the Centre of Expertise for Gender Dysphoria at the Amsterdam University Medical Centres, location VUmc in Amsterdam (Hartman et al., 2019; Hartman et al., 2020). The quantitative results from the Euro-MCD questionnaire, in which 26 possible outcomes of MCD are described (Svantesson et al., 2014), showed participants’ preferences for MCD outcomes and which MCD-related outcomes the participants actually observed during and after the MCD sessions. The results confirmed that the clinicians expressed a particularly strong wish to see ‘mutual understanding’, ‘more open communication’, and a greater ability to ‘decide on concrete actions’ as MCD outcomes. Most participants indeed noted an improvement in ‘mutual understanding’ and ‘open communication’ after participating in the MCD sessions. Furthermore, after participating in the MCD sessions, a majority of the team members experienced an ‘enhancement in mutual respect among the team members’ and ‘became more aware of the stakeholders’ different perspectives’ and of ‘recurring, ethically difficult situations’. Participants reported that spending more time reflecting on other team members’ thinking gave them a greater awareness of other stakeholders’ perspectives on the MCD case in question, which enhanced the trust within the team. These results are in line with other studies, which show that MCD can help teams more effectively deal with moral challenges and enhance collaboration and mutual trust (Hem et al., 2015; Janssens et al., 2014; Molewijk et al., 2008c; Weidema et al., 2015). Besides the developments in the field of MCD, research also focuses on developing other new and innovative forms of CES. For example, forms of CES which can be used by sole practitioners. Such as ethics consultation (Aulisio, Arnold, & Youngner, 2000; Molewijk, Slowther, & Aulisio, 2015) and a moral compass which can be used individually (Hartman et al.,2018). Ever since the research for this study was conducted, CES has become a standard part of transgender care and MCD has been added to the CES toolbox. MCD is now part of policy days, in ad hoc situations, and occasionally in educational settings such as one-day professional courses on decision-making competence. In addition to MCD, several other methods have been added to the CES toolbox as well (Hartman et al., 2019; Hartman et al., 2020). Moreover, since this research was conducted one member of each team has been trained as an MCD facilitator, which enables the teams to use MCD in an ad hoc fashion whenever so desired. As such, this evaluation study enabled the professionals at the Amsterdam and Leiden teams to shape and embed CES as they themselves saw fit. This can be seen as part of an ‘integrative approach’ to CES (Hartman et al., 2019).