The study sites’ approaches to gathering information on sexual orientation and gender identity include asking direct questions on intake and assessment forms and relying on youths’ self-disclosure during less formal conversations with staff. Staff at all agencies reported that they consider sexual orientation and gender identity information, when it is available, in planning services for individual clients.
Collection of sexual orientation and gender identity data. Two of the four study sites systematically collect and record data on the sexual orientation of youth enrolling in shelter programs, using questions specified on agency forms. The format and placement of questions differ between the two agencies. One agency collects this information through an item on its intake form (see Box II.1, Agency A). The form does not specify question phrasing but does indicate response categories: (1) heterosexual, (2) bisexual, (3) gay, (4) lesbian, (5) questioning, and (6) self-identified orientation.
Sources: Intake and assessment forms provided by study sites and RHYMIS forms for entrance to basic shelter and transitional living programs.
Note: One of four study sites does not collect information on sexual orientation or gender identity on intake forms.
RHYMIS = Runaway and Homeless Youth Management Information System.
The second agency includes a single, combined question on sexual orientation and gender identity on its health risk assessment form (Box II.1, Agency B): “What is your sexual orientation and/or gender identity?” Response options for this question include (1) heterosexual (straight), (2) homosexual (gay or lesbian), (3) bisexual, (4) transgender, or (5) gender confused.8 All options that apply can be selected.
Three agencies gather gender identity information (including transgender status) on intake or assessment forms. In addition to the agency that uses a combined sexual orientation/transgender status question, two agencies ask separate questions about gender identity (Box II.1, Agencies A and C). Response categories are similar for these two agencies’ questions and include (1) male; (2) female; (3) male-to-female transgender; (4) female-to-male transgender; and (5) other, don’t know, or refusal. In general, these categories align with the gender identity item in RHYMIS.
One agency (Agency C) that collects information on gender identity does not collect information on sexual orientation. Staff at this agency indicated that they prefer not to ask about sexual orientation at intake, allowing youth to provide that information later if they choose. Agency staff do inquire about transgender status, however, to ensure that they offer appropriate housing options to clients.
In all sites, agencies developed phrasing for questions and response categories internally, rather than using outside resources for guidance. The phrasing includes nonspecific response options, such as self-identified orientation and other, to accommodate the wide range of replies youth provide to these questions.
In general, staff offer clients the option to refuse to answer questions about sexual orientation and gender identity, but some reported taking special steps to collect the information when appropriate. For example, one staff member noted that she would ask youth to mark the appropriate box on an intake form (rather than completing it herself) if the youth seemed reluctant to respond verbally. Other staff noted that they conducted intake interviews in private offices to offer confidentiality for potentially sensitive topics.
Staff from agencies not collecting information on sexual orientation at intake noted that, with this approach, youth can share this information later, or not at all. Study participants at all agencies concurred that some youth discuss their sexual orientation or gender identity only after building a relationship with a staff member. Referrals from partner organizations may also suggest that a youth is LGBTQ (for example, when youth are referred to shelter services by an LGBT community organization).
Use of information on sexual orientation and gender identity. Many staff providing direct services indicated that they consider the sexual orientation or gender identity of individual youth as they create service plans. Staff use this information to tailor some services (such as referrals for counseling). In addition, staff use information on sexual orientation and gender identity (1) to determine housing and bathroom accommodations, (2) for assignment to case managers, and (3) in making appropriate health care referrals. We describe these approaches to service tailoring further in Chapter IV.
Staff consider information on the sexual orientation and gender identity of individual youth to be sensitive but reported they would discuss it internally when it was pertinent to planning or coordinating services. Staff in one agency also noted that information on LGBTQ identity might be communicated between partner agencies when considered relevant to a referral. In contrast, another agency took a stricter approach to information disclosure, emphasizing that clients should be in control of whether such information is shared. Staff at this agency typically do not reveal clients’ sexual orientation or gender identity to providers outside the agency, unless legally required to do so.
Agencies also use data on sexual orientation and gender identity for grant and annual reporting, including reporting to FYSB through RHYMIS. The two agencies that systematically collect sexual orientation information at intake present summaries of this information, along with other client demographics, in annual or evaluation reports.
No sites reported assessing patterns of service use or outcome by sexual orientation and gender identity. Agencies do not conduct these analyses because they do not record client-level sexual orientation or gender identity information in the agency’s MIS or other records, or because it is not their general practice to break down service use data by demographic group. Some staff members expressed interest in demographic analyses but noted that limited resources constrain their agencies’ capacity for data analysis and management. Others questioned whether exploring potential differences in service experiences among demographic groups could promote segmenting of services for specific RHY populations, in contrast to efforts to meet the needs of all RHY or identify and address the unique circumstances and needs of each individual youth.
8 We did not determine the criteria used to identify gender-confused clients.