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RECOMMENDED
PRACTICES

To Promote the Safety and Well-Being of Lesbian, Gay,
Bisexual, Transgender and Questioning (LGBTQ) Youth and
Youth at Risk of or Living with HIV in Child Welfare Settings
May 2008
Child Welfare League of America

This publication consolidates and summarizes
recommended practices derived from previous
publications
of the Child Welfare League of America,
the American Bar Association Center on Children and
the Law: Opening Doors for LGBTQ Youth in Foster
Care Project, Diane E. Elze, the Family Acceptance
Project, Lambda Legal, Legal Services for Children,
Gerald P. Mallon, Robin McHaelen, the National Alliance
to End Homelessness, the National Center for Lesbian
Rights, the National Center for Transgender Equality,
the National Network for Youth and the Sylvia Rivera
Law Project, among others. We encourage agencies
to refer to the original publications for additional
contextual information about LGBTQ youth in foster
care as well as detailed commentary supporting the
practices recommended in the following pages


Family Acceptance in Adolescence and the Health
of LGBT Young Adults

Caitlin Ryan, PhD, ACSW, Stephen T. Russell, PhD, David Huebner, PhD, MPH, Rafael Diaz, PhD, MSW,
and Jorge Sanchez, BA

ISSUE: The role of family acceptance as a
protective factor for lesbian, gay, bisexual, and
transgender (LGBT) adolescents and young
adults has not been established.

METHODS: A quantitative measure with items
derived from prior qualitative work
retrospectively assessed family accepting
behaviors in response to LGBT adolescents’
sexual orientation and gender expression and
their relationship to mental health, substance
abuse, and sexual risk in young adults
(N = 245).

FINDINGS: Family acceptance predicts greater
self-esteem, social support, and general health
status; it also protects against depression,
substance abuse, and suicidal ideation and
behaviors.

CONCLUSIONS: Family acceptance of LGBT
adolescents is associated with positive young
adult mental and physical health. Interventions
that promote parental and caregiver acceptance
of LGBT adolescents are needed to reduce health
disparities.


Helping Families Support Their Lesbian, Gay,
Bisexual, and Transgender (LGBT) Children

BY CAITLIN RYAN, Ph.D., A.C.S.W.
Director, Family Acceptance Project™ – San Francisco State University

This practice brief was developed for families,
caretakers, advocates, and providers to:

      • Provide basic information to help families
support their lesbian, gay, bisexual, and
         transgender (LGBT) children;
      • Share some of the critical new research from
the Family Acceptance Project TM (FAP) at
        San
Francisco State University. This important
new research shows that families have

         a
major impact on their LGBT children’s health,
mental health, and well-being; and
      • Give families and LGBT youth hope that
ethnically, religiously, and socially diverse

         families, parents, and caregivers can become
more supportive of their LGBT children.

This practice brief reports on specific findings
from FAP research.


Aspects of Psychological Resilience among Transgender Youth
Arnold H. Grossman; Anthony R. D’augelli; John A. Franka
Department of Applied Psychology, New York University,

New York, New York, USA
College of
Health and Human Development, Pennsylvania State University, University Park, Pennsylvania, USA


Fifty-five transgender youth described their gender development
and some of the stressful life experiences related to their gender
identity and gender expression. More than two-thirds of youth reported
past verbal abuse by their parents or peers related to their
gender identity and nonconformity, and approximately one-fifth
to one-third reported past physical abuse. The more gender nonconforming
the youth were, the more abuse they reported. Four
aspects of psychological resilience were examined: a sense of personal
mastery, self-esteem, perceived social support, and emotionoriented
coping. A regression model of the selected aspects of resilience
accounted for 40%–55% of the variance in relation to
depression, trauma symptoms, mental health symptoms, and internalizing
and externalizing problems. Emotion-oriented coping
was a significant predictor of negative mental health as determined
by each of the mental health variables.

Transgender Youth:
Invisible and Vulnerable

Arnold H. Grossman, PhD
New York University
Anthony R. D’Augelli, PhD
The Pennsylvania State University

SUMMARY. This study used three focus groups to explore factors that
affect the experiences of youth (ages 15 to 21) who identify as transgender.
The focus groups were designed to probe transgender youths’
experiences of vulnerability in the areas of health and mental health.
This involved their exposure to risks, discrimination, marginalization,
and their access to supportive resources. Three themes emerged from an
analysis of the groups’ conversations. The themes centered on gender
identity and gender presentation, sexuality and sexual orientation, and
vulnerability and health issues. Most youth reported feeling they were
transgender at puberty, and they experienced negative reactions to their
gender atypical behaviors, as well as confusion between their gender identity and sexual orientation. Youth noted four problems related to
their vulnerability in health-related areas: the lack of safe environments,
poor access to physical health services, inadequate resources to address
their mental health concerns, and a lack of continuity of caregiving by
their families and communities.

Early Childhood Development – Your Options – How Do
I Know If My Child Is Transgender?

By Stephanie Brill and Caitlin Ryan, PhD, ACSW

Discussed:
What Is transgender?
Can a Child Be Transgender?
What Makes a Child Transgender?
Why Can’t My Child Be “Normal”?
How Should I Respond?
How Can I know If It’s a Phase?
Where Do I Get Help, Support, and More Information?
Resources for Families & Providers


Family Rejection as a Predictor of Negative Health Outcomes in White and
Latino Lesbian, Gay, and Bisexual Young Adults

Caitlin Ryan, David Huebner, Rafael M. Diaz and Jorge Sanchez

OBJECTIVE. We examined specific family rejecting reactions to sexual orientation and
gender expression during adolescence as predictors of current health problems in a
sample of lesbian, gay, and bisexual young adults.
METHODS. On the basis of previously collected in-depth interviews, we developed quantitative
scales to assess retrospectively in young adults the frequency of parental and caregiver
reactions to a lesbian, gay, or bisexual sexual orientation during adolescence. Our survey
instrument also included measures of 9 negative health indicators, including mental health,
substance abuse, and sexual risk. The survey was administered to a sample of 224 white and
Latino self-identified lesbian, gay, and bisexual young adults, aged 21 to 25, recruited
through diverse venues and organizations. Participants completed self-report questionnaires
by using either computer-assisted or pencil-and-paper surveys.
RESULTS. Higher rates of family rejection were significantly associated with poorer health
outcomes. On the basis of odds ratios, lesbian, gay, and bisexual young adults who
reported higher levels of family rejection during adolescence were 8.4 times more likely
to report having attempted suicide, 5.9 times more likely to report high levels of
depression, 3.4 times more likely to use illegal drugs, and 3.4 times more likely to report
having engaged in unprotected sexual intercourse compared with peers from families
that reported no or low levels of family rejection. Latino men reported the highest
number of negative family reactions to their sexual orientation in adolescence.
CONCLUSIONS. This study establishes a clear link between specific parental and caregiver
rejecting behaviors and negative health problems in young lesbian, gay, and bisexual
adults. Providers who serve this population should assess and help educate families about the impact of rejecting
behaviors. Counseling families, providing anticipatory guidance, and referring families for counseling and support
can help make a critical difference in helping decrease risk and increasing well-being for lesbian, gay, and bisexual
youth.