Some government and private organizations are interested in improving services for lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youth who run away from home or experience homelessness. These efforts are prompted, in part, by research suggesting LGBTQ youth may be at greater risk for experiencing homelessness and, if they become homeless, more likely than their heterosexual counterparts to experience victimization, engage in high-risk sexual behaviors, and have poor mental health.
To better understand provider experiences serving LGBTQ runaway and homeless youth (RHY), the Office of the Assistant Secretary for Planning and Evaluation (ASPE) of the U.S. Department of Health and Human Services (HHS), in collaboration with the Office of Planning, Research and Evaluation (OPRE) in HHS’s Administration for Children and Families (ACF), sponsored case studies of four local agencies receiving grants from ACF’s RHY Program. The purpose of the study, conducted by Mathematica and its subcontractor, the Williams Institute, was to learn about programs’ strategies for identifying and serving LGBTQ RHY, the challenges programs face in understanding and addressing the needs of this population, and potential areas for future research.
The four study sites are federally funded RHY programs that provide a range of services, operate in different regions of the country, and have experience serving LGBTQ youth. They include agencies with urban and rural service areas in Colorado, Minnesota, Ohio, and Texas. One agency receives RHY Program funding for basic center services, two for transitional living, and two for street outreach. The share of clients identified as LGBTQ ranges from 5 to 28 percent.
Drawing on site visit interviews as well as reviews of agency documents and forms, this report presents findings on four topics: (1) agencies’ collection and use of data on clients’ sexual orientation and gender identity, (2) providers’ assessment and perceptions of needs and capacities among LGBTQ RHY, (3) providers’ approaches to serving LGBTQ RHY, and (4) providers’ perceptions of research gaps and data needs related to services for LGBTQ RHY. We conclude by suggesting issues for policymakers and practitioners to consider related to collecting data on, and serving, this population.
Collection and Use of Sexual Orientation and Gender Identity Data
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. Two of the four agencies collect information on sexual orientation through questions on intake or assessment forms completed by staff or youth. In three agencies, intake or assessment forms include questions on gender identity that feature response options for transgender status.
Staff at all agencies reported using information on youths’ sexual orientation and gender identity when planning individual services. 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. No agencies reported that they analyze patterns of service use or outcome by sexual orientation and gender identity (or any other demographic characteristic). Agencies do not conduct these analyses because they do not record client-level sexual orientation or gender identity information in the agency’s management information system or other records, or because it is not their general practice to break down service use data by demographic group.
The accuracy of data on the number of LGBTQ youth served at the agency level and reported to the federal government is uncertain and might vary widely among agencies. Factors that appear to affect complete or accurate collection of sexual orientation and gender identity data include youths’ reticence in answering questions, concerns among staff members about protecting youths’ privacy and recording these characteristics in agency records, and the absence in some agencies of standardized protocols for gathering sexual orientation or gender identity information.
Assessment and Perceptions of Needs and Capacities of LGBTQ RHY
Agency staff conduct assessments during initial intake sessions and subsequent meetings with youth to determine immediate needs, detail personal circumstances, and identify risk factors or barriers that may need to be addressed through longer-term services. Assessment tools used by some agencies inquire about sexual orientation and gender identity, but no agencies reported using tools that specifically target LGBTQ youth. Some staff reported that they assess needs or circumstances related to LGBTQ identity based on their own knowledge of these issues and techniques for exploring them with clients.
Many staff felt that homeless youth face similar types of risks, regardless of sexual orientation and gender identity. Nevertheless, some types of risks—emotional distress and poor mental health, substance abuse and sexual risk behavior, and problems with family and personal relationships—were perceived to be particularly salient or frequent among LGBTQ youth. According to staff reports, LGBTQ youth of color and transgender youth are at the highest risk of encountering barriers to accessing appropriate services or resources, especially those related to health and employment. Staff also perceived some distinctive protective factors among LGBTQ youth. In particular, LGBTQ youth may be “survivors” who develop positive self-protection skills after experiencing stigma and rejection.
Approaches to Serving LGBTQ RHY
All agencies visited implement some organizational strategies that focus on LGBTQ youth, including adopting nondiscrimination and nonharassment policies and protecting the confidentiality of information shared by youth. Agencies differ in the extent to which they have implemented other organizational strategies, such as establishing a safe and affirming environment, developing staff skills in serving LGBTQ youth, and creating partnerships with other organizations serving LGBTQ youth. Opportunities to improve cultural competency in serving LGBTQ youth ranged from annual trainings on site in two agencies to occasional attendance at sessions offered at universities or conferences for staff at another agency.
Agencies also tailor a variety of services to make them more accessible or relevant to the needs and circumstances of LGBTQ youth. For example, 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. Two agencies offered services specifically for LGBTQ youth. One agency employs an LGBTQ case manager who develops individual service plans for LGBTQ-identified youth in its housing programs. Another operates a host home program specifically for LGBTQ youth, matching these youth with LGBTQ-supportive adults who offer youth transitional housing in private homes.
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 general mediation strategies in their attempts to work with families.
Two factors that appear to affect 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. Having staff with appropriate expertise and a visible LGBTQ clientele may encourage agencies to take steps to better serve this population. Challenges that can impede efforts to improve or tailor services for LGBTQ RHY include (1) a lack of local resources that focus on LGBTQ youth; (2) the difficulty of overcoming social stigma, especially toward LGBTQ youth of color and transgender or gender-nonconforming youth; and (3) staff concerns about singling out a specific population of RHY while still being able to help all youth who need an agency’s services.