How can you better support LGBT youth and their families?

Find out in this Q&A with the editors of Improving Emotional and Behavioral Outcomes for LGBT Youth: A Guide for Professionals

About the editors

Sylvia K. Fisher, Ph.D., is the director of the Office of Research and Evaluation in the Health Resources and Services Administration (HRSA). She manages evaluations to assess the effectiveness of federal health programs throughout the nation.

Dr. Fisher has worked extensively throughout her career to improve the health and well-being of children and youth and LGBT populations. She has launched a national workgroup to address the needs of youth in systems of care who are LGBT and their families. She is currently a member of both the Healthy People 2020 Committee on LGBT populations and the National Action Alliance on Suicide Prevention LGBT Task Force.

Dr. Fisher has received the Leadership Award for Outstanding Volunteer Service from the Lesbian Services Program of the Whitman-Walker Clinic in Washington, D.C. She and her spouse of almost 30 years, Susan, have a daughter, Elise.

Jeffrey M. Poirier

Jeffrey M. Poirier, M.A., PMP, Ph.D. candidate, is a senior researcher at the American Institutes for Research (AIR). He leads the LGBTQI2-S Learning Community that is part of the Technical Assistance Partnership for Child and Family Mental Health.

Mr. Poirier is coordinator of the Substance Abuse and Mental Health Services Administration's National Workgroup to Address the Needs of Children and Youth Who Are LGBTQI2-S and Their Families.

Mr. Poirier is motivated by a deep passion for ensuring all children/youth experience safe, supportive communities and for improving the well-being and outcomes of LGBT youth. He openly identified as gay at the age of 15, but personally acknowledged this orientation at the age of 5. He is very grateful for his accepting, loving family, who fostered a positive coming-out experience.

Dr. Gary M. Blau

Gary M. Blau, Ph.D., is a clinical psychologist and the chief of the Child, Adolescent and Family Branch of the Center for Mental Health Services. He provides national leadership for children's mental health and for creating systems of care across the country.

Dr. Blau has received many awards, including the prestigious Pro Humanitate Literary Awards, the Governor's Service Award, the Phoebe Bennet Award for outstanding contribution to children's mental health in Connecticut, the Making a Difference Award by Connecticut's Federation of Families for Children's Mental Health, and the Outstanding Achievement Award by the National Association of Children's Behavioral Health. He was the recipient of the 2009 HHS Secretary's Award for Meritorious Service for national leadership in children's mental health.

In 2011, Dr. Blau was also the first recipient of the Rock Star Award, by Youth M.O.V.E. National for "being a true champion for the youth movement and advocate for youth voice." He has been happily married to Gwenn Blau for 29 years, and they have two children, Jennifer and Andrew.


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Take this self-assessment to see whether your organization is ready to support and promote the well-being of LGBT youth and their families.

Q: Your new book is devoted to helping professionals support lesbian, gay, bisexual, and transgender (LGBT) youth, and those who are questioning, and their families. Typically, have the needs of LGBT youth been addressed in training for professionals?

A: Historically, the needs of LGBT youth have not been included in workforce development efforts, but we are learning about more and more efforts to integrate support for LGBT youth into professional trainings and learning opportunities.

Professional associations are increasingly focusing on LGBT topics as part of their larger priorities. For example, the National Association of School Psychologists includes sexual orientation and gender identity/expression in its professional ethics, noting that school psychologists should work to promote fairness and equity, and ensure schools are safe and welcoming to all.

Numerous resources from various organizations (e.g., GLSEN, Lambda Legal, National Association of Social Workers) are now available to facilitate delivery of professional development on LGBT topics.

Q: We hear stories in the news about bullying, exclusion, harassment, and other struggles of LGBT youth. But we also are seeing greater acceptance of differences. What are some of the particular challenges of LGBT youth?

A: First of all, we think it is important to say that many LGBT youth are happy and healthy and have people who love them and strong support systems. It is true, however, that LGBT youth experience challenges such as bullying, exclusion, and harassment at higher rates compared to their non-LGBT counterparts.

For example, the Centers for Disease Control and Prevention report that 60% of LGBT youth feel unsafe at school, with 80% being verbally harassed and 40% being physically harassed. They also report that LGBT youth experience depression nearly 6 times the amount of non-LGBT youth, are 3 times more likely to use illegal drugs, and 8 times more likely to have attempted suicide.

It is for these reasons that we wanted to create a volume that would help address these issues, while acknowledging the increasing societal acceptance of LGBT youth and the increased recognition of their strengths among professionals.

Q: One of the most difficult aspects of working with LGBT youth is the question of family acceptance. How important is it to integrate families in the support of LGBT youth?

A: Family acceptance has a tremendous impact on an LGBT youth's health and well-being. In fact, Dr. Caitlin Ryan and the Family Acceptance Project (FAP) have documented that LGBT youth who are accepted by their families are more likely to become happy, productive adults. They have higher self-esteem and a greater ability to adapt and adjust to life's challenges.

LGBT youth who are rejected by their families have significantly more challenges, including poor health, more use of drugs and alcohol, and more mental health disorders. They are also more likely to engage in risky sexual behaviors and contract a sexually transmitted disease. We also know that family rejection contributes to large numbers of suicide attempts, self-harming behavior, or homelessness.

Engaging families effectively is critical to the well-being of LGBT youth. Traditionally, providers have tended not to bring families to the table on the assumption that families will reject, or at least not support, their LGBT family member. The Family Acceptance Project has collected substantial evidence to indicate that families can successfully be integrated into services and supports to improve outcomes for LGBT youth. Providers can help families become more accepting, which can give LGBT youth the support and hope they need.

Q: Like anybody, professionals carry their own prejudices—how can professionals reflect on their own biases to be sure they are providing healthy supports for the youth they work with?

A: It is important for professionals to recognize and understand any bias or prejudice they may have, which includes issues related to race, ethnicity, sexual orientation, behavior that doesn't conform to gender "norms," etc. The ethical codes of conduct for human service providers typically address this and require practitioners to work diligently to avoid such biases or to avoid practicing in areas in which they have identified a potential bias.

Negative attitudes or discomfort towards LGBT issues may create fear among youth to disclose information about gender identity or sexual orientation, which can easily hinder the therapeutic process. It is important for providers to be trained to address bias and to provide inclusive, non-discriminatory care for LGBT youth and families.

Addressing these biases is fundamental not only to "do no harm" when working with LGBT youth, but also to go beyond basic support to provide high-quality, culturally and linguistically competent care. Providers should be competent to address disclosure, integration of sexual orientation and gender identity, risk-reduction strategies, discrimination issues, and family acceptance to appropriately serve LGBT youth.

Q: What is meant by "culturally and linguistically competent" care for LGBT youth?

A: Culturally and linguistically competent care takes into account the needs and identities of individuals from diverse cultures and identities. Cultural and linguistic competence (CLC) requires genuine commitment, knowledge development, and explicit strategies to address disparities in access to and utilization of quality care. Such care is free from stigma and bias, which we know many LGBT individuals experience when accessing behavioral health care and in other settings (e.g., juvenile justice facilities, schools).

Culturally and linguistically competent care requires a safe, welcoming environment for all sexual minorities and gender variant/nonconforming individuals, workforce development efforts focused on LGBT topics and the needs of LGBT youth, and meaningful engagement of the LGBT community as knowledgeable cultural brokers and partners in efforts to enhance care for LGBT youth.

Importantly, an organization's leadership must be involved in CLC-related efforts and CLC should be infused in organizational policies and practices.

Q: Your book emphasizes that one size does not fit all when it comes to LGBT youth. Among LGBT youth, what are some groups whose support needs have gone unrecognized?

A: There are several groups among LGBT youth with needs for services and supports that have been particularly unrecognized and underserved. These youth include

  • transgender and gender non-conforming youth
  • youth with disorders or differences of sex development
  • Native American youth with two-spirit, LGBT and/or related tribal identities
  • LGBT youth who are in out-of-home care settings, including foster homes and congregate care settings such as juvenile detention facilities, group homes, and treatment facilities
  • LGBT youth who are homeless

Other groups whose needs and experiences have not been studied adequately include

  • LGBT youth who are culturally and linguistically diverse
  • children identifying at younger and younger ages,
  • youth who identify as bisexual
  • youth with mental health and substance use challenges, and
  • LGBT children who are bullied

Although we are seeing many tragic stories around the nation of LGBT children who have died by suicide who were reportedly bullied, we still do not see a coordinated national or even regional or local response to these tragedies.

Q: What are some strategies organizations can follow to promote positive and healthy outcomes for youth who are LBGT?

Immediate steps organizations can take include

  • engaging in an authentic self-assessment process that identifies organizational strengths and needs (see the self-assessment from Chapter 3 above)

  • putting in place and enforcing nondiscriminatory policies that enumerate LGBT youth and staff as a protected category

  • promoting staff knowledge about LGBT youth

  • examining organizational processes to ensure they are culturally and linguistically competent (e.g., using gender-neutral language where feasible), and promoting safe and supportive environments for all youth

Q: What are some initial first steps a professional can take to better support LGBT youth and their families?

A: The book emphasizes a number of guidelines professionals can follow to enhance their delivery of culturally and linguistically competent care to LGBT youth and their families. A significant step is the provision of a welcoming, safe environment, ranging from the overt display of welcoming symbols (e.g., pink triangle, rainbow flag) to the adoption of welcoming approaches from front desk staff and clinical and service providers.

Culturally and linguistically appropriate language on forms that LGBT youth and families are asked to complete when accessing services is an important indicator that their needs and identity will be recognized and respected by the professionals they consult.

Other examples include demonstrating comfort with asking questions regarding sexual orientation, using gender-neutral pronouns, embracing terms and language that youth use to reference themselves, and avoiding heteronormative language (such as asking a male youth if he has a girlfriend rather than whether he is dating someone).

All of these efforts will build a climate conducive to promoting trust and the provision of welcoming care for LGBT youth and their families.

School-based professionals have a critical role in creating supportive, welcoming school environments; they can do this in a number of ways by proactively addressing LGBT stigma and harassment, and by working as part of schoolwide teams to build awareness, knowledge, and skills in discussing and addressing LGBT concerns and topics in their schools.

Q: What have been some of the most exciting changes you have seen with regard to support for LGBT youth and what do you hope to see in the future?

A: It has been encouraging to see that during the past 10 years, there has been increasing recognition by both professionals and the larger society that youth who are LGBT exist and have needs, goals, hopes, and dreams like all other children and youth.

We are seeing significant increases in awareness that children and youth can experience and identify as LGBT at younger ages than was originally assumed. Significantly, we are seeing research and practice efforts acknowledging that LGBT children and youth are remarkably resilient and able to cope with multiple environmental, interpersonal, and intrapersonal stressors.

It is encouraging to see greater acceptance of LGBT youth throughout society. Professionals are key to helping LGBT youth and their families cope effectively with challenges and grow and thrive in safe and supportive environments.

Moreover, due to the important work of organizations such as the Family Acceptance Project, families are no longer automatically viewed by professionals as aversive; rather, we have more and more evidence to indicate that families offer fundamental supports to LGBT youth and can actively promote the well-being of their children.

Improving Emotional and Behavioral Outcomes for LGBT Youth: A Guide for Professionals

Be sure to see these other titles:

The Leadership Equation: Strategies for Individuals Who Are Champions for Children, Youth, and Families

The Leadership Equation: Strategies for Individuals Who Are Champions for Children, Youth, and Families

The System of Care Handbook: Transforming Mental Health Services for Children, Youth, and Families

The System of Care Handbook: Transforming Mental Health Services for Children, Youth, and Families

Recognize and Respond to Emotional and Behavioral Issues in the Classroom: A Teacher's Guide

Recognize and Respond to Emotional and Behavioral Issues in the Classroom: A Teacher's Guide

Positive Strategies for Students with Behavior Problems

Building a Home Within: Meeting the Emotional Needs of Children and Youth in Foster Care

The Grieving Student: A Teacher's Guide

The Grieving Student: A Teacher's Guide

Meeting the Needs of Students and Families from Poverty: A Handbook for School and Mental Health Professionals

Meeting the Needs of Students and Families from Poverty: A Handbook for School and Mental Health Professionals