Research suggests that barriers to service access for LGBTQ youth result from societal, provider, and youth factors (Acevedo-Polakovich et al. 2011). Social stigma and prejudice may negatively influence providers’ attitudes toward LGBTQ youth. Providers’ lack of knowledge about LGBTQ youth or difficulty identifying them might reduce their ability to deliver appropriate services to these populations. In addition, youth might be reluctant to access services because of their own fears of rejection or concerns about personal safety if their LGBTQ status is disclosed.
Agencies serving RHY have taken steps to reduce access barriers for LGBTQ youth and ensure their programs address risks LGBTQ youth are likely to face. These steps may include organizational changes to improve the safety and friendliness of the overall service environment for LGBTQ youth, increase staff skills in serving these populations, and enhance access to relevant local resources. Agencies also tailor individual services in an effort to increase their accessibility and effectiveness for LGBTQ youth. As a whole, such strategies may support a key element of the USICH intervention model for homeless youth: matching interventions (including treatment, housing, and skill-building programs) to the characteristics of subgroups of youth and individual youth.
We explored the types of strategies case study agencies had implemented and the challenges and successes they encountered in doing so. Our discussions with staff distinguished between (1) strategies that focus on the organization as a whole and (2) adjustments to the delivery of specific services. We found the following:
- All agencies we 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.
- Agencies tailor a variety of services to make them more accessible or relevant to the needs and circumstances of LGBTQ youth. Adjustments to emergency shelter and physical and mental health services are common.
- Challenges that affect efforts to improve services for LGBTQ RHY include (1) lack of local resources that focus on LGBTQ youth; (2) 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 continuing to help all youth who need an agency’s services.
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A. Organizational Strategies
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We explored agencies’ implementation of six main organizational strategies for serving LGBTQ RHY, focusing on recommendations frequently made in publications addressing service provision to these populations: (1) adopting policies prohibiting discrimination and harassment, (2) protecting the confidentiality of information about youth, (3) establishing a safe and affirming service environment, (4) developing staff cultural competency, (5) hiring staff with relevant expertise, and (6) partnering with other organizations serving LGBTQ youth (National Alliance to End Homelessness et al. 2009; Wilber et al. 2006; Ray 2006). Table IV.1 presents key examples of the implementation of each of these strategies in the case study sites.
Table IV.1. Organizational Strategies for Serving LGBTQ Runaway and Homeless Youth
Strategy Examples from Study Sites Number of Sites Reportinga Adopting Policies Prohibiting Discrimination and Harassment Maintaining a written nondiscrimination and nonharassment policy inclusive of sexual orientation and gender identity 4 Communicating policies to youth in a formal client rights statement 1 Communicating that incidents of discrimination or harassment by youth can be a reason for restricting access to drop-in center services 1 Protecting Confidentiality of Information on Youth Adopting policies and procedures to ensure information in client files is treated as confidential 4 Not disclosing information (including sexual orientation or gender identity) outside the agency without client permission, unless required by law 4 Requiring staff to sign confidentiality agreements 1 Offering a procedure for client complaints about information protection 1 Establishing a Safe and Affirming Service Environment Offering safe sleeping and bathroom arrangements consistent with individual gender identity expression (including providing private rooms) 4 Displaying posters, symbols, and other materials (such as “Safe Zone” signs) to communicate that facilities are welcoming for LGBTQ youth 2 Promoting an inclusive organizational culture by communicating to staff and clients that the agency values diversity of all kinds 2 Identifying peer and staff role models for LGBTQ youth 2 Intervening to address instances of harassment or mediate conflicts 2 Establishing written policies on appropriate emergency shelter accommodations for transgender youth 1 Making reading materials on LGBTQ subjects available 1 Developing LGBTQ Cultural Competency Among Staff Providing regular (usually annual) staff trainings on LGBTQ cultural competency topics 2 Organizing ad hoc staff discussions in response to specific concerns or issues that arise related to serving LGBTQ youth 2 Occasionally participating in LGBTQ-related trainings offered at local universities or conferences 1 Involving Staff and Volunteers with Expertise Serving LGBTQ Youth Involving staff who openly identify as LGBTQ 4 Including people who openly identify as LGBTQ on boards of directors 2 Communicating during interviews with job candidates that the agency is supportive of LGBTQ youth and employs LGBTQ-identified staff 1 Prioritizing LGBTQ cultural competency in hiring for some positions 1 Partnering with Other Organizations Serving LGBTQ Youth Making referrals to non-LGBTQ organizations offering support or social groups for LGBTQ people 4 Connecting with LGBTQ organizations operating community centers and/or support groups 3 Partnering with providers of mental health services that target LGBTQ youth 1 Connecting youth to LGBTQ-affirming religious groups 1 Source: Discussions with agency staff during site visits conducted April–June 2013.
aNumber is based on staff responses to open-ended questions and may not include all agencies implementing each practice.
Adoption of nondiscrimination and nonharassment policies inclusive of sexual orientation and gender identity. A clear and widely communicated statement that an agency does not discriminate or tolerate harassment based on sexual orientation or gender identity is believed to establish an institutional framework for inclusion (National Alliance to End Homelessness et al. 2009). All case study agencies maintained written nondiscrimination and nonharassment policies that mentioned sexual orientation and gender identity. Agencies communicated these policies to staff through employee handbooks and other agency documents. Some agencies took additional steps to communicate and implement these policies. For example, one reported that the statement of client rights youth receive includes a pledge of services free of discrimination. Staff at another agency noted that they might restrict access to their drop-in center for youth who violate policies by harassing others based on sexual orientation or gender identity.
Protection of confidential information. Practices to ensure the confidentiality of sensitive information can help protect LGBTQ youth from potential harm and address concerns that information they share will be disclosed to others without their permission. All agencies reported that their policies and procedures ensure the privacy of client information within guidelines established by federal, state, and local laws. No staff members indicated that their agencies had established specific policies or practices regarding the recording or disclosure of LGBTQ status information. Rather, information on sexual orientation and gender identity, when available, is generally handled in the same way as other private data, such as health information. Staff in one agency reported that they may disclose a youth’s LGBTQ status to partner organizations if the youth has provided consent.
Establishing a safe and welcoming service environment. Providing a space that is free of bullying and harassment, and that positively supports homeless youths’ LGBTQ identity, can be a key factor in facilitating service access (National Alliance to End Homelessness et al. 2009). To achieve this goal, all agencies we visited take steps to provide youth safe and appropriate accommodations in shelters or transitional living arrangements. These steps include (1) arranging for some youth to sleep in a private area if they do not feel comfortable in a male or female dormitory, (2) offering private rooms to all youth, and (3) establishing a written agency policy specifying that youth are to be assigned to dormitories based on their gender identification or offered the option of a private room if safety is a concern.
Other steps signal that agencies offer a space welcoming to LGBTQ youth. For example, some agencies display posters featuring images of LGBTQ youth or “Safe Zone” signs communicating that staff are open to discussing issues of sexual orientation and gender identity. Staff at one agency created a reading corner featuring books and other materials on LGBTQ-related subjects. Staff who identify as LGBTQ may also promote a welcoming environment by serving as role models and helping to create a sense of community for LGBTQ youth. Finally, staff in two agencies reported that they quickly intervene to address any instances of harassment based on sexual orientation or gender identity observed in their facilities.
Developing LGBTQ cultural competency. Staff members’ LGBTQ cultural competency—their ability to understand the perspectives of LGBTQ people and communicate effectively with them—is likely to influence the quality of their interactions with LGBTQ RHY and youths’ willingness to use agency services (National Alliance to End Homelessness et al. 2009; Substance Abuse and Mental Health Services Administration, n.d.). Agencies reported that they attempt to improve cultural competency through staff trainings on LGBTQ issues. Training methods and frequency varied among sites. Staff in one agency indicated that they occasionally access LGBTQ cultural competency training through local universities or conferences for RHY providers. Two other agencies offer an annual in-house training that addresses topics relevant to serving LGBTQ youth, including nonharassment and antidiscrimination policies, appropriate use of language (such as identifying youth with the name or gender pronouns they prefer), and strategies for creating a safe and inclusive environment for youth. In addition, individual staff members sometimes served as experts on LGBTQ issues within an agency, providing training or informal consultation to their colleagues.
Involving staff with expertise serving LGBTQ youth. Agencies can use hiring processes to identify job candidates with expertise on issues related to sexual orientation and gender identity or screen candidates for their openness to working with LGBTQ youth. Sites do not intentionally recruit LGBTQ employees, but all the sites currently have staff who identify as LGBTQ. One manager reported that her agency communicates its nondiscrimination policy to job candidates, and interviews include questions to assess applicants’ experiences with LGBTQ people. Another indicated that knowledge of LGBTQ issues could be considered an important qualification for some agency positions. According to staff in two agencies, board members familiar with the LGBTQ community can also be an important resource for information and organizational partnerships that will improve service delivery to sexual minority and transgender youth.
Partnering with organizations serving LGBTQ people. Partnerships with other organizations working with LGBTQ people can help RHY providers link youth to appropriate services and sources of social support. All study sites pursue such relationships. Some partnerships enable referrals to professional organizations that target a broad population but are competent in providing such services as health care and employment assistance to LGBTQ youth. (We describe partnerships to help youth access specific types of services later in this chapter.) These links sometimes feature sharing of information about individual clients through case management contacts, which was perceived to strengthen relationships between agencies and support effective service provision. Staff in three sites refer youth to LGBTQ-specific organizations for social or support groups. For example, staff in one agency reported that they work with a local LGBTQ community center to facilitate the participation of LGBTQ RHY in PrideFest events and youth activities.
Some organizational strategies, especially creating a safe and welcoming environment and developing cultural competency among staff, seemed to require relatively more effort for agencies to implement. Staff in two agencies emphasized that offering a hospitable environment for LGBTQ youth depends on establishing an overall agency culture or philosophy promoting respect for diversity and inclusion. Agency managers must embrace this philosophy, and it must be constantly reinforced among employees and youth to foster consistently welcoming and respectful spaces. Staff in another agency noted that opportunities and resources for participating in LGBTQ cultural competency training locally were limited. In addition, one staff member believed that cultural competency skills are difficult to maintain if agency workers have infrequent interactions with LGBTQ-identified youth.
In addition, the limited availability of LGBTQ-specific resources in a community might constrain sites’ ability to connect youth with organizations offering LGBTQ-related services. Staff from two agencies noted a dearth of groups that focus on the LGBTQ community in their service areas. Although both these organizations identified partners able to address the mental health or employment needs of LGBTQ youth, it was more difficult for them to connect youth with supportive, in-person social groups outside the RHY agency. The other two agencies were able to cultivate partnerships to access services offered by multiple LGBTQ organizations in their cities, such as a drop-in center for LGBTQ youth, transgender-specific health care, and resources to prevent sexual exploitation or human trafficking among LGBTQ youth.
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B. Tailoring Services to LGBTQ RHY
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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.
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