As a group, the agencies we studied offer examples of methods for tailoring a variety of services to make them accessible and potentially effective for LGBTQ youth. We discussed with staff their approaches to providing seven types of services to LGBTQ RHY: (1) street outreach; (2) housing, including emergency shelter and transitional living; (3) drop-in centers; (4) physical health care; (5) mental health care; (6) education and employment assistance; and (7) counseling to promote family acceptance or reunification. Table IV.2 presents examples of approaches to tailoring services in each category.
Street outreach. According to staff reports, agencies’ approaches to providing street outreach services generally do not differ markedly for LGBTQ and non-LGBTQ youth. However, outreach staff at one agency reported that they display pink triangles or rainbow flags (widely recognized symbols of the gay rights movement) on buttons or clothing to communicate that they are LGBTQ-friendly.
Emergency shelter and transitional living. Agencies tailored housing programs to the needs of LGBTQ youth by assigning shared accommodations based on self-reported gender identity and providing private accommodations, when available, to address youths’ concerns about safety. These approaches were perceived to be especially helpful for transgender youth who could be concerned about sleeping in male or female dormitories. One agency provides private rooms to all youth receiving emergency shelter housing; staff saw this arrangement as important to promoting safety and respect in accommodations for all clients. Case managers at two agencies reported helping shelter-housed youth organize discussion groups on LGBTQ issues, including sexual identity development, internalized homophobia, and relevant current events. In addition, two agencies offered services specifically for LGBTQ youth in housing programs. One agency employs an LGBTQ case manager who develops individual service plans for LGBTQ-identified youth in its housing programs and creates opportunities for youth to participate in social and educational programs, including a performance group. In addition, one agency operates a host home program specifically for LGBTQ youth, matching these youth with LGBTQ-supportive adults who offer youth transitional housing in private homes.
Drop-in center. Two case study agencies operate a drop-in centers for RHY. Neither center targets LGBTQ youth specifically, but staff at one agency described efforts to maintain a safe environment for all youth. These include mediating conflicts and quickly addressing incidents of harassment based on sexual orientation or gender identity. Staff at this agency have also organized ad hoc discussion groups to help youth educate one another about issues of sexual orientation and gender identity.
Physical health care. Agencies’ partnerships with other providers helped them access physical health services relevant to LGBTQ youth. For example, one site maintains a referral relationship with an organization offering support groups for transgender people and a shot clinic where health care providers can help clients with hormone injections. Staff in two agencies reported that they have identified community providers that are culturally competent in addressing the health care needs of LGBTQ youth.
Table IV.2. Tailoring of RHY Services for LGBTQ Youth in Study Sites
|Service||Approaches to Tailoring Services||Number of Sites Reportinga|
|Street Outreach||Street outreach workers may display symbols/buttons communicating that they are welcoming to LGBTQ youth||1|
|Emergency Shelter and Transitional Living||A limited number of private rooms or other separate accommodations are available in the emergency shelter to accommodate youth who do not wish to be housed in male or female dorms||3|
|An LGBTQ-identified case manager works with LGBTQ youth receiving services, conducting individual case planning and organizing social and support programs||2|
|Youth are assigned to shelter dorms based on self-reported gender identity. A written policy provides guidance on serving transgender youth in shelter programs||1|
|All residents of the emergency shelter have private rooms||1|
|Agency operates a host-home program specifically for LGBTQ youth||1|
|Drop-in Center||Drop-in center staff intervene to resolve conflicts or instances of harassment related to sexual orientation or gender identity||1|
|Center hosts occasional discussion groups for youth on LGBTQ issues||1|
|Physical Health Care||Agency refers LGBTQ youth to culturally competent providers for health care, including such services as hormone therapy for transgender youth||2|
|Agency provides access to LGBTQ-culturally-competent health care providers on site at its emergency shelter and drop-in center||1|
|Counseling and Treatment Related to Mental and Behavioral Health||Agency employs mental health professionals who are able to assist LGBTQ youth with concerns about sexual orientation or gender identity||3|
|Staff refer LGBTQ youth to local mental health providers with the appropriate expertise||3|
|Staff make referrals to a partner agency providing mental health and substance abuse treatment programs designed for LGBTQ youth||1|
|Education and Employment Assistance||Agency or partner staff make efforts to identify employment and volunteer opportunities in organizations that welcome LGBTQ people||3|
|Agency staff inform potential employers that some youth seeking jobs identify as LGBTQ to increase employer awareness of this population||1|
|Staff counsel youth, including gender-nonconforming youth, on personal presentation when interviewing for a job with a “mainstream” employer||1|
|Family Acceptance/Reunification Counseling||Staff work with youth and families on issues of acceptance and reunification, addressing issues of sexual orientation and gender identity if relevant, to the extent that youth wish to engage with their families||2|
Source: Discussions with agency staff during site visits conducted April-June 2012.
aNumber is based on staff responses to open-ended questions and may not include all agencies implementing each practice.
Mental and behavioral health counseling and treatment. Agencies offer tailored mental health care services by employing professionals with expertise in counseling LGBTQ youth and establishing referral relationships with outside providers. In three agencies, staff reported that some in-house staff are qualified to provide psychological counseling to RHY who express concerns about sexual orientation or gender identity development. In addition, staff at three agencies reported that they regularly refer RHY to outside providers with experience offering mental and behavioral health services to LGBTQ youth. For example, one agency connects youth to an agency providing substance abuse treatment and an empowerment and social networking program aimed at reducing sexual risk-taking among LGBTQ youth.
Education and employment assistance. Staff in all sites reported offering tailored assistance for seeking employment to LGBTQ youth, by working with youth, employers, or both. Staff in one agency reported that they advise some LGBTQ youth to consider personal presentation when applying for job opportunities with employers that are “mainstream.” This approach reflected circumstances in a socially conservative service area. Staff in three other agencies reported that they or their agency partners work proactively to identify LGBTQ-friendly work environments by gauging employers’ comfort in hiring LGBTQ youth. For example, job development staff might inform potential employers that the RHY agency’s clientele includes LGBTQ youth. Staff in one agency reported providing education to both employers and youth on how to address potential or actual coworker conflicts related to sexual orientation or gender identity.
Staff in three sites indicated that securing employment for LGBTQ RHY of color and transgender RHY can be especially challenging. According to these staff members, racial or ethnic minority youth and transgender youth may confront multiple types of stigma and prejudice that generally increase the difficulties they face in achieving self-sufficiency. Staff reported using strategies similar to those described above to serve these youth populations.
Counseling for family acceptance/reunification. Staff in two agencies reported that they aim to facilitate reconciliation between LGBTQ youth and families when possible, but that such assistance is offered only to the extent a youth wishes to engage with her or his family. Agency staff did not report that efforts at family acceptance for LGBTQ youth are based on a formal intervention model. Rather, staff use more generalized counseling strategies and techniques for reaching out to families. Staff highlighted challenges inherent in this work, including difficulties accessing family members and some families’ reluctance to pursue reunification. In an agency that serves both minors and young adults, staff reported that many older youth are not interested in engaging with their families. In that case, staff work with youth to explore the possibility of reconnecting with their families in the future.
Two factors that appear to be linked to agencies’ tailoring of services to LGBTQ youth are the presence of staff with LGBTQ expertise and the perceived proportion of youth served who identify as LGBTQ. LGBTQ specialists appear to help agencies remain attentive to LGBTQ youths’ specific needs, offering case management services, facilitating discussion groups, organizing social or recreation opportunities, and coordinating housing services that focus on LGBTQ youth. They also consult with other staff members on issues related to serving this population. A perceived demand for tailored services may also prompt agencies to consider how to better address the needs of LGBTQ youth. In a case study agency with a small estimated proportion of LGBTQ-identified youth, fewer types of services are tailored. Staff at this agency noted that they would consider tailoring more services or offering LGBTQ-specific services if LGBTQ youth comprised a larger share of the agency’s clientele.
Although tailoring of services was common among the agencies, some staff members raised concerns about offering separate services targeting LGBTQ RHY. These concerns might reflect an emphasis on meeting the needs of all RHY and not favoring a specific group. A few staff members also worried that allocating funding to LGBTQ-specific services might reduce the resources available for serving the RHY population as a whole. Yet even staff who expressed the opinion that LGBTQ youths’ needs and risk factors are generally the same as the broader population of RHY offered examples of ways their agencies adjust some services to address the specific circumstances LGBTQ RHY. This suggests that staff generally accept that LGBTQ RHY may benefit from distinct service approaches.