Research suggests that young people who are lesbian, gay, bisexual, transgender, or questioning their sexuality (LGBTQ) face a disproportionate risk of homelessness. Available data on youth homelessness are limited and not nationally representative, but studies of homeless youth served by individual providers or in local areas have found that 6 to 35 percent identify themselves as LGBTQ (Substance Abuse and Mental Health Administration 2011).1 In comparison, analyses of data from the National Longitudinal Study of Adolescent Health found that 7.4 percent of boys and 5.3 percent of girls in grades 7–12 reported same-sex romantic attraction, and results of a recent nationally representative survey of U.S. adults indicate that approximately 3.4 percent identify as LGBT (Russell et al. 2001; Gates and Newport 2012). According to a study of a representative sample of high school students in one state, lesbian, gay, and bisexual youth and heterosexual youth who have same-sex sexual partners are 4 to 13 times more likely than exclusively heterosexual youth to be homeless (Corliss et al. 2011). Providers serving homeless youth also report that LGBTQ youth are overrepresented among the youth they serve. Respondents to a national nonrepresentative survey of providers estimated that LGBTQ youth comprise 40 percent of their clientele, on average (Durso and Gates 2012).
Homeless LGBTQ youth also might be more likely than their heterosexual counterparts to experience victimization, engage in high-risk sexual behaviors, and have poor mental health. Several studies have found that lesbian, gay, and bisexual youth are more likely than heterosexual youth to (1) have been physically or sexually victimized, (2) engage in survival sex or sex work, (3) have attempted suicide, (4) use illicit substances, and (5) have greater mental health concerns (Cochran et al. 2002; Van Leeuwen et al. 2006; Ray 2006; Toro et al. 2007; Tyler 2008). Although these studies are not representative of the entire homeless youth population, considered together, they suggest that LGBTQ homeless youth are at high risk of poor outcomes.
In response to these indications of higher prevalence of homelessness among LGBTQ youth and potentially greater risks for those experiencing homelessness, government and private organizations have suggested approaches for enhancing services for LGBTQ youth in out-of-home care (see, for example, National Alliance to End Homelessness et al. 2009; Wilber et al. 2006; Ray 2006; SAMHSA n.d.). Common suggestions include the following:
- Establishing nondiscrimination, antiharassment, and confidentiality policies that address sexual orientation and gender identity, and creating safe and inclusive agency environments
- Enhancing LGBTQ cultural competency among staff through training and other supports
- Providing flexible and tailored programming for LGBTQ youth, including interventions that focus on family acceptance and reunification
- Addressing the unique health and shelter needs of transgender clients
- Establishing connections with other community organizations serving LGBTQ youth
- Collecting data on LGBTQ youth receiving services and using these data to educate decision makers and assess patterns in service provision and outcomes
Some agencies serving homeless youth have already accomplished one or more of these suggested steps. Agencies that serve primarily LGBTQ homeless youth operate in several large cities and tailor many services to this population.2 The Williams Institute’s Homeless Youth Provider Survey (HYPS) gathered information from 354 organizations nationwide on their experiences providing services to homeless LGBTQ youth. Approximately 24 percent of services and activities offered by agencies responding to the survey targeted LGBTQ clients (Durso and Gates 2012).3 In addition, 85 percent of survey respondents agreed with the statement, “I am very knowledgeable about LGBT homeless youth,” indicating they believe themselves competent to work with this population (Durso and Gates 2012).
Yet much remains to be learned about whether and how agencies serving runaway and homeless youth (RHY) implement practices to address the specific needs or circumstances of LGBTQ youth. To better understand provider experiences serving LGBTQ 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 the Administration for Children and Families (ACF), HHS, sponsored case studies of 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 study addressed four sets of questions:
- What are providers’ approaches to collecting and using data on the sexual orientation and gender identity of the youth they serve? What information do providers collect, and when? Do providers use data on sexual orientation or gender identity to tailor services to individual clients or assess program performance? What challenges do providers experience in collecting data on LGBTQ RHY?
- What do providers perceive to be the key needs and capacities of LGBTQ RHY? How do programs assess these needs and capacities? Do program staff perceive differences in needs and capacities of LGBTQ and non-LGBTQ youth?
- What strategies do providers implement in working with LGBTQ RHY? How, if at all, do organizations tailor their services to LGBTQ RHY? What successes and challenges have providers experienced providing services to these youth?
- What research gaps affect providers’ ability to understand and meet the human service needs of LGBTQ RHY? What data or information are needed to provide services more effectively to this population?
The study aimed to document agency experiences and staff perspectives among a select group of RHY Program grantees, rather than to identify best practices in serving LGBTQ RHY.
Two government initiatives related to services for LGBTQ youth inform the study questions. The first is the United States Interagency Council on Homelessness (USICH) Framework to End Youth Homelessness, which prioritizes improving (1) data collection and quality; and (2) providers’ capacity to serve especially vulnerable groups, including LGBTQ youth (USICH 2013). (We describe the USICH Framework in more detail later in this chapter.) The second initiative is an OPRE project to develop a research agenda on the human service needs of LGBT populations.4 The case studies provided an opportunity to gather input from providers on research priorities related to LGBT populations, especially homeless youth.
Key Terms: Sexual Orientation, Gender Identity, Gender Expression, and Transgender
According to the American Psychological Association (2011):
- Sexual orientation refers to “the sex of those to whom an individual is sexually and romantically attracted” and generally includes the categories lesbian, gay, bisexual, and heterosexual.
- Gender identity refers to “one’s sense of oneself as male, female, or transgender.”
- Gender expression is “the way a person communicates gender identity to others through behavior, clothing, hairstyles, voice, or body characteristics.”
- Transgender is a broad term describing people whose self-identified gender or gender expression does not correspond to their biological sex or sex assigned at birth.
Next, we describe the RHY Program and other key federal efforts related to youth homelessness, site selection criteria and characteristics of the four case study sites, data collection methods, and the organization of the rest of the report.
1 The ages of young people in these studies vary. For this study, we adopt the definition of youth that the U.S. Interagency Council on Homelessness (USICH) uses: people up to 24 years old. The Runaway and Homeless Youth Program of the Administration for Children and Families, U.S. Department of Health and Human Services serves youth up to 22 years old.
2 Examples include the Ali Forney Center and Green Chimneys in New York City; the Ruth Ellis Center in Detroit, Michigan; and the Gay and Lesbian Community Center in Los Angeles, California.
3 A total of 381 people, representing 354 agencies, responded to the survey.
A. The RHY Program and Other Federal Responses to Youth Homelessness
Because homeless youth can be involved in many public systems (such as child welfare, juvenile justice, and homeless assistance), many policies and programs can affect them. With respect to shelter, housing, and outreach services for RHY, key elements of the federal policy and program context include the RHY Program structure, U.S. Department of Housing and Urban Development (HUD) funding for homeless services, and the USICH Framework to End Youth Homelessness. We describe each of these next.
RHY Program. The federal RHY Program, administered by the Family and Youth Services Bureau (FYSB) in ACF (part of the U.S. Department of Health and Human Services), funds community-based organizations and shelters serving young people. The program makes annual grants totaling more than $100 million to support four types of direct services:
- Basic center. Basic center grantees provide up to 21 days of emergency shelter to youth under age 18, along with counseling to support the return of youth to their families, if appropriate.
- Transitional living and maternity group homes. These grants support longer-term housing (up to 21 months), such as supervised apartments and host home programs, in which youth live in the homes of screened and trained adult volunteers. Transitional living programs offer supportive services to youth ages 16 to 22 to promote self-sufficiency and social and emotional well-being. Some transitional living grants fund housing for pregnant and parenting youth. As with other transitional living programs, maternity group homes offer services to make it easier to transition to self-sufficiency, but they also offer parenting skills training.
- Street outreach. Street outreach grantees contact youth living on the streets to build relationships, provide basic living supplies, and offer information on shelters and other services. The primary goal of such programs is to protect youth and prevent sexual exploitation or other harm.
In addition to direct services, the RHY Program supports the National Runaway Safeline, which connects youth in crisis to available services, and a training and technical assistance network for RHY grantees.5
FYSB requires grantees of the RHY Basic Center and Transitional Living programs to report semiannually the number and demographics of youth they serve, the types of services provided, and the status of youth when they exit RHY programs. Grantees record and submit these data to the federal government through the Runaway Homeless Youth Management Information System (RHYMIS), a database created for this purpose. Agencies create entry and exit records for each youth served, including youth who reenter services. Entry records document the young person’s (1) demographic characteristics, (2) living situation at entry, (3) referral source, (4) school status, and (5) involvement in the child welfare or juvenile justice system. Exit records document (1) youths’ “critical issues” or needs identified by program staff, including issues related to sexual orientation or gender identity; (2) services provided to youth, (3) plans for providing transitional support or referrals after program exit, and (4) youths’ living situation at exit.
RHYMIS records include fields for reporting the sexual orientation and gender identity of clients served, among other demographic characteristics. This feature distinguishes RHYMIS from the administrative databases of other ACF programs, which do not collect information on participants’ sexual orientation or gender identity. According to the RHY Program’s 2010-2011 Report to Congress, among youth whose sexual orientation was reported in RHYMIS, lesbian, gay, and bisexual youth accounted for 6 or 7 percent served in the Basic Center Program and 9 or 10 percent served in the Transitional Living Program during fiscal years 2010 and 2011 (HHS 2013). Transgender youth accounted for less than 1 percent of youth served in each program during these years (HHS 2013). However, the Report to Congress notes that RHYMIS data may underreport the percentage of youth served who are LGBT, since youth are not always asked these questions or do not always provide responses to them. (We discuss additional challenges related to data collection on sexual orientation and gender identity in Chapter II.)
HUD homeless assistance programs. Many programs serving homeless youth receive funding from multiple government and private sources, including HUD. HUD homeless assistance programs support emergency shelter, supportive services, transitional housing, homelessness prevention, and other services through Continuum of Care (CoC) awards to coalitions of nonprofit organizations, State agencies, and/or local government agencies operating in a specific geographic area. HUD awarded $1.67 billion in CoC grants in fiscal year 2012. Lead agencies receiving CoC awards may subaward funds to individual service providers. This approach to funding is intended to promote collaborative planning and service delivery among agencies that address the various needs of homeless people in a local area. HUD requires most agencies receiving CoC awards or subawards to implement a Homeless Management Information System (HMIS) to collect and report on client characteristics and services provided in their local areas. Some agencies also use HMIS as an internal case management system. HUD does not require that HMISs report clients’ sexual orientation and gender identity, but agencies may choose to collect such data through their locally developed HMIS.
USICH Framework to End Youth Homelessness. The USICH is an independent agency within the federal executive branch whose mission is to coordinate the federal response to homelessness and to create partnerships to reduce and end homelessness in the nation. The USICH’s 2010 strategic plan to prevent and end homelessness established a goal of ending homelessness among children, families, and youth by 2020 (USICH 2010). In February 2013, USICH released a framework proposing two strategies for addressing youth homelessness: (1) improving data collection; and (2) improving the capacity of federal, state, and local systems that serve youth experiencing homelessness or at risk of becoming homeless (USICH 2013). Both strategies have implications for providers serving LGBTQ youth.
The first strategy focuses on creating systems to gather and communicate accurate information on the number and circumstances of homeless youth. It emphasizes such steps as including youth in point-in-time counts of the homeless population, integrating or coordinating federal information systems that record data on homeless youth receiving services, and undertaking national studies to address information gaps regarding the number and characteristics of homeless youth. As one step in this strategy, USICH and several other federal agencies have launched Youth Count!, an effort to identify promising methods for counting unaccompanied homeless youth in local areas. Improved data on homeless youth will incorporate information on key subpopulations, including LGBTQ youth.
The framework’s second strategy is to create and disseminate an intervention model for serving homeless youth and helping them achieve desired outcomes: stable housing, enhanced connections with sources of social support, increased participation in education or employment, and improved health and well-being. The preliminary model posits screening and assessment, followed by provision of services (housing or shelter, mental or physical health care, and social supports) matched to youth circumstances and risk levels (USICH 2013). A key principle of the model that USICH proposes is that services should be culturally appropriate and tailored to youth characteristics, including sexual orientation and gender identity.
5 For additional information on the Runaway and Homeless Youth Program, please see the program’s most recent Report to Congress (http://www.acf.hhs.gov/system/files/fysb/rhy_congress_2010_11.pdf).
B. Site Selection and Characteristics
In selecting study sites, we aimed to identify federally funded RHY programs that provide a range of services, operate in different regions of the country, and have experience serving LGBTQ youth. We used three main criteria to identify potential case study sites:
- Receipt of RHY funding. Because the study focuses on HHS-funded service providers, we included only agencies that had received RHY basic center, transitional living, or street outreach grants in 2012.
- Participation in the HYPS.6 We limited candidates to agencies that responded to the HYPS. This narrowed the number of potential sites and increased access to data about each site. In addition, participation in the survey signaled that at least one person at each agency was interested in issues facing LGBT-identified homeless youth.
- Experience serving LGBTQ youth. To ensure we could address questions regarding approaches to serving LGBTQ-identified youth, we aimed to identify sites with relevant experience. We established two indicators of this experience: (1) the agency offers services expressly for LGBTQ-identified youth and/or (2) the agency reported in the HYPS that it serves LGBTQ youth.
In addition to the screening criteria, we specified agency characteristics that would help us assess whether sites varied in ways that might influence an agency’s service approaches and the challenges it faces in serving LGBTQ youth. These characteristics included the agency’s size in terms of staff and budget, types of services provided, and geographic location. Drawing on a variety of information sources, including the HYPS and agency websites, we developed a list of 10 potential sites.
After consultations with ASPE and OPRE, as well as discussions with representatives of the RHY Program and advocacy organizations that focus on homeless youth, we selected four sites for inclusion in the study. The selection of the four sites prioritized (1) diversity among the agencies in size, reported proportion of youth served who are LGBTQ, and urban or rural service area; (2) inclusion of some agencies that had not participated in previous studies of RHY providers; and (3) inclusion of all three types of RHY Program grantees.
Table I.1 summarizes characteristics of the study sites. (Appendix A includes a brief profile of each site.) The group includes agencies with urban and rural service areas in four states: Colorado, Minnesota, Ohio, and Texas. The agencies employ from 19 to 65 staff members and serve from 157 to as many as 2,550 youth annually. 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 widely, from 5 to 28 percent. (These figures, based on staff estimates or agency reports, were not always consistent with the data provided in response to the HYPS or reported to RHYMIS; we present percentages reported by program staff or in program documents.) Two of the agencies offer services designed specifically for LGBTQ homeless youth: a host home program and a designated LGBTQ case manager.
Table I.1. Characteristics of Study Sites
Sources: Agency documents and site visits conducted April to June 2013.
cReported in agency’s annual or evaluation report.
FY = fiscal year; LGBTQ = lesbian, gay, bisexual, transgender, or questioning.
6 The Homeless Youth Provider Survey (HYPS), conducted by the Williams Institute, gathered information from 354 organizations nationwide on their experiences working with homeless LGBTQ youth.
C. Data Collection Methods
During spring 2013, the research team completed calls and visits to the four selected sites. Two team members spent a day and a half at each agency, conducting semistructured individual and group interviews with five types of respondents: (1) executive directors; (2) program supervisors; (3) direct service staff, such as case managers; (4) evaluation specialists or database administrators (in programs with such staff members); and (5) representatives of partner organizations working with the selected agencies to serve LGBTQ youth.7 In addition, we asked contacts at each site for information on the number of RHY served annually and client demographics, including the proportion of youth identifying as LGBTQ. Finally, we requested copies of intake and assessment forms and documents describing agency services (such as annual or evaluation reports).
Our review of case study data included preparation of site visit summaries and team discussions to develop findings. After each site visit, researchers prepared two documents: (1) an initial memo identifying broad findings and (2) a detailed summary of information gathered on each research topic and subtopic. As researchers prepared these documents, they compared responses of individual agency staff members to confirm information or identify divergent views. The entire research team reviewed the memos and detailed summaries and, during structured discussions focusing on the research topics, identified key findings and practices within and across the four sites.
7 We did not gather information from youth receiving services, due to limitations on the number of interviews conducted for this study.