1 BRIEF - SAMHSA

1 Purpose of This BriefThis Practice BRIEF is for policymakers,administrators, and providers seeking to learnmore about (1) youth who are lesbian, gay,bisexual, transgender , questioning, intersex, ortwo-spirit (LGBTQI2-S) and (2) how to developculturally and linguistically competent programsand services to meet their needs and of Youth Who Are LGBTQI2-SAn estimated million adolescents who arelesbian, gay, or bisexual live in the United youth identify themselves as transgender ,intersex, two-spirit, or questioning, or use otherterms (see Box 1).1 These youth frequentlyencounter numerous challenges and may feelisolated, alienated, depressed, and fearful as theyattempt to navigate their emerging awareness oftheir sexual and/or gender indicate that youth who are LGBTQI2-Sare at risk for a number of negative experiencesand outcomes associated with how others react totheir sexual orientation and/or gender ,3 Compared with other youth.

2 Youth who areLGBTQI2-S are two to three times more likely to attempt are more likely thantheir peers to suffer from depression and use orabuse who are LGBTQI2-S may also be morelikely to experience harassment from other youthand significant adults in their lives, and to be subjected to verbal, sexual, and physical abuse and other forms of trauma. Further, they are more likely to drop out of school and become , bullying and rejection by peers andfamily members due to a youth s LGBTQI2-Sidentity may exacerbate mental health the needs of youth who areLGBTQI2-S presents many challenges to child-serving agencies. Challenges stem, in part, fromlimited knowledge and/or stereotypes about theseyouth.

3 Providers can benefit from acquiring abetter understanding about the experiences of1 Harris, K. M., Florey, F., Tabor, J., Bearman, P. S., Jones, J., & Udry, J. R. (2003). The National Longitudinal Study of AdolescentHealth [Online]. Available at: Gibson, P. (1989). Gay male and lesbian youth suicide. In M. R. Feinleib (Ed.), Report of the Secretary s Task Forceon Youth Suicide: Vol. 3. Preventions and interventions in youth suicide(pp. 110-142). Washington, DC: of Health and Human Ragg, D. M., Patrick, D., & Ziefert, M. (2006). Slamming the closet door: Working with gayand lesbian youth in care . In R. Woronoff and G.

4 P. Mallon (Eds.), LGBTQ youthin child welfare [Special issue]. Child Welfare, 85(2), Services and Supports for Youth who are Lesbian, Gay, Bisexual, transgender , Questioning, Intersex or Two-Spirit1 PRACTICEBRIEFBOX 1youth who are LGBTQI2-S, including discriminationand stigma. The limited availability of programs andservices that are tailored for these youth and theirfamilies also presents a challenge. These youth mayfear disclosing their identities and, as a result, may beinhibited from seeking the supports and therapeuticresources they need. Youth who are afraid to be openabout their identity, or come out, may be less likelyto report their experiences and needs to providers andothers in a service who are LGBTQI2-S are part of a distinctivecultural group.

5 They may share a larger culturalidentity, which includes a defined set of norms, socialevents, styles, and use of language. These youth alsocome from diverse racial and ethnic backgrounds. Given these factors, youth who are LGBTQI2-S can be doubly stigmatized because of their sexual orientationand/or gender identity and their cultural, racial, orethnic identity. The potential for dual discrimination can further deter these youth from accessing , it is important to provide services in a culturallyand linguistically competent manner (see Box 2).System-Level Approaches for Helping Youth Who Are LGBTQI2-Sand Their FamiliesServices for youth who are LGBTQI2-S can beimproved by implementing service- and agency-levelinterventions that include families and comprehensive approach to addressing the needs ofthese youth includes: integrating services and supports across child- and youth-serving systems, including health care providers; ensuring appropriate services and supports are available; facilitating access to services; delivering culturally and linguistically competentservices and supports; delivering quality care without bias or prejudice.

6 And monitoring and assessing BRIEF :PROVIDING SERVICES AND SUPPORTS FOR YOUTH WHO ARE LGBTQI2-S SPRING 2008 Females who are emotionally and sexuallyattracted to, and may partner with, females who are emotionally and sexuallyattracted to, and may partner with, malesonly. Gay is also an overarching term usedto refer to a broad array of sexual orientationidentities other than who are emotionally and sexuallyattracted to, and may partner with, bothmales and who express a gender identitydifferent from their birth-assigned who are uncertain about theirsexual orientation and/or gender with medically defined biologicalattributes that are not exclusively male orfemale.

7 Frequently assigned a gender atbirth, which may differ from their genderidentity later in culture-specific general identity for NativeAmericans (American Indians and AlaskaNatives) with homosexual or transgenderedidentities. Traditionally a role-based definition,two-spirit individuals are perceived to bridgedifferent sectors of society ( , the male-female dichotomy, and the Spirit and natural worlds).The term sexual minority is inclusive,comprehensive, and sometimes used todescribe youth who are LGBTQ2-S. However,it may have a negative connotation becauseminority suggests inferiority to also may use other terms to describetheir sexual orientation and gender identity,such as homosexual, queer, gender queer,non-gendered, and asexual.

8 Some youth may not identify a word that describes their sexual orientation, and others may view their gender as fluid and even changingover time. Some youth may avoid gender-specific OF SEXUAL ORIENTATION AND GENDER IDENTITYL esbianGayBisexualTransgenderQuestioningI ntersex(2-S)Two-SpiritSexualMinorityOthe r TermsPRACTICE BRIEF :PROVIDING SERVICES AND SUPPORTS FOR YOUTH WHO ARE LGBTQI2-S SPRING 2008 The application of the principles of cultural andlinguistic competence by administrators and providersis especially important because this population ofyouth is frequently misunderstood and and linguistic competency for thispopulation of youth and their families requiresinclusion of appropriate values, principles, policies,structures, behaviors, and attitudes throughout theentire service delivery system at all & StrategiesCreating a Welcoming Environment Assess your community or agency at all levels toidentify needs, barriers, challenges.

9 Strengths, andreadiness to develop a welcoming environmentand appropriate services for youth who areLGBTQI2-S and their mission and vision statements indicatingyour community s or agency s commitment toaddress the needs of youth who are LGBTQI2-Sand their a plan to create a resourcedinfrastructure that includes policies, structures,practices, and services that meet the needs andpreferences of youth who are that staff and volunteers possess thenecessary knowledge and appropriate attitudesand behaviors to provide services and high level of awareness of LGBTQI2-S issueswill improve the ability to provide neededservices to these youth and their opportunities for youth who areLGBTQI2-S to discuss experiences and exchangeideas in a confidential, nurturing, safe andsupportive services and resources to youth who are LGBTQI2-S and their families that are linguisticallycompetent ( , welcoming and nonjudgmental.)

10 Respectful of preferred terms for sexual orientation and/or gender identity, and offered in signlanguage and in languages other than English).3 BOX 2 WHAT IS CULTURAL AND LINGUISTIC COMPETENCE?To be culturally competent, systems and organizations are required to:4 have a defined set of values and principles, and demonstrate behaviors, attitudes, policies, and structures that enable them to workeffectively with people of diverse backgrounds; and have the capacity to (1) value diversity, (2) conduct self-assessment, (3) manage the dynamics of difference, (4) acquire andinstitutionalize cultural knowledge, and (5) adapt to the diversity and cultural contexts of the communities they be linguistically competent, systems and organizations must:5 have the capacity to communicate effectively and convey information in a manner that is easily understood by diverse audiences, including persons of limited English proficiency, those with low literacy skills, and individuals with other communication challenges.