How can child welfare agencies effectively support LGBTQ+ youth in care?

Youth who identify as lesbian, gay, bisexual, transgender, and/or questioning (LGBTQ+) are 3.8 times more likely to experience childhood sexual abuse, 1.2 times more likely to be physically abused by a caregiver, and nearly 2.5 times more likely to enter foster care than their heterosexual peers.1,2 They also are overrepresented in the child welfare system. Recent studies suggest that 15% to 30%3 of youth in care identify as LGBTQ+, compared to only 3% to 11% of youth in the general population.4,5 While all system-involved youth face challenges, LGBTQ+ youth experience disparate outcomes due to bias and rejection based on their sexual orientation and/or gender identity. Compared to their heterosexual peers, LGBTQ+ youth involved in the child welfare system are more likely to have adverse outcomes and yet, until recently, limited attention has been given to their specific needs, concerns, and experiences. More specifically, LGBTQ+ youth are:6,7,8,9

Less likely to:

  • Be placed in a family-based setting.
  • Achieve permanency through reunification or adoption.
  • Have strong ties to their birth family and communities.

More likely to:

  • Be placed in congregate care or group home settings.
  • Have multiple placements.
  • Experience harassment and violence.
  • Face isolation from other youth.
  • Deal with physical health and mental health issues, including depression.   
  • Experience homelessness.
  • Engage in illegal drug use.
  • Contract HIV and STDs.
  • Attempt suicide.

Defining the Terminology

“+” is added to LGBTQ (Lesbian, Gay, Bisexual, Transgender, and/or Questioning) to be encompassing of all sexual orientations and gender identities, including (but not limited to) queer, intersex, asexual, demisexual, non-binary, gender fluid, pansexual, and polyamorous.

LGBTQ+ youth and the child welfare system

LGBTQ+ youth enter foster care for many different reasons, but a significant number become involved in the child welfare system as a result of conflict with caregivers over their sexual orientation and/or gender identity.10 Before entering care, many youth experience severe trauma and rejection by their family, peers, and/or community members. LGBTQ+ youth of color, compared to their white peers, are even more likely to experience rejection and violence, and studies show that they have elevated levels of stress and unique challenges related to their gender and sexual identities. Once in care, some LGBTQ+ youth are then faced with additional challenges and hardships, including discrimination, harassment, and/or violence from caseworkers, foster parents, program staff, and/or peers. Even for accepting and well-intentioned caseworkers and foster parents, a lack of knowledge and training on LGBTQ+ issues and limited access to LGBTQ+-affirming and -focused health and social services makes it challenging to meet the needs of LGBTQ+ youth.11

Additionally, despite the fact that placing children and youth in foster care in family-based settings reduces trauma and placement instability, LGBTQ+ youth are frequently placed in restrictive environments such as group homes because of a lack of accepting foster home placement options.12,13 They also are likely to experience multiple placements during their time in foster care.14 With each new placement, LGBTQ+ youth risk losing whatever social support they were able to identify and cultivate, and they are again forced to determine if — and to whom — they should disclose their sexual orientation and/or gender identity. The emotional distress of repeated disclosures can have long lasting effects on youth. Moreover, in addition to heightened and sustained stress, placement instability also is associated with negative social and academic outcomes.15,16

LGBTQ+ youth also are less likely to achieve permanency than their peers and more likely to experience harassment and secondary abuse while in care, which in some cases leads youth to run away from their placements. These youth then often experience housing instability and homelessness, among other negative outcomes.17

Jurisdictional efforts

To better support LGBTQ+ youth in care, a number of jurisdictions have developed LGBTQ+-focused guidance, policies, trainings, services, and programs.

The Los Angeles LGBT Center’s RISE Initiative

The Los Angeles LGBT Center’s Children, Youth and Family Services Department operates Recognize Intervene Support Empower (RISE) Youth, an initiative designed to help LGBTQ+ children and youth in the child welfare system find durable family connections, achieve emotional permanency, and obtain legal permanency in homes where they feel safe, nurtured, and loved. The RISE model integrates wraparound supports, family finding, and engagement services, and LGBTQ+-specific education to support youth, caregivers, and families.

In addition to the delivery of these direct services, RISE provides organizational-level training, coaching, and technical assistance to agencies seeking to implement best practices for system-involved LGBTQ+ youth. Technical assistance support includes capacity building in agency assessment, policy development and implementation, creating affirming environments, and the development of youth, family, and caregiver supports.

Highlight: RISE

Findings from RISE’s youth qualitative interviews show that youth involved in RISE activities:

  • Felt comfortable and open with RISE staff and felt like staff really cared about them.
  • Liked talking to someone who also identified as LGBTQ+ and could relate to their experiences.
  • Learned how to communicate better with their families.
  • Improved their ability to define and express their LGBTQ+ identity.
  • Experienced an increase in their overall self-esteem, confidence, and coping skills.

Allegheny County’s getREAL Initiative

The getREAL (Recognize. Engage. Affirm. Love.) Project in Allegheny County, Pa., is a network of 23 child welfare jurisdictions nationwide working to bring about systemic changes to promote positive sexual and gender identity development for youth involved in the child welfare system. With support from the Center for the Study of Social Policy, the Allegheny County Department of Human Services (DHS) began field testing the Guidelines for Managing Information Related to the Sexual Orientation and Gender Identity and Expression of Children in Child Welfare Systems. The goal of implementing the guidelines is to regularly gather information related to sexual orientation and gender identity, and use the information to improve child welfare practice and outcomes.

As of April 2019, DHS integrated LGBTQ+-affirming practices into a variety of agency systems and processes. Examples of this integration include:

  • Institutionalizing mandatory trainings and case consultations that give workers a common language to discuss sexual orientation and gender identity.
  • Amending the Kids Integrated Data System – which links administrative data across a variety of public agencies to examine how children and families are faring across systems – to include methods for documenting youth’s gender identity, sexual orientation, preferred name, and gender pronouns.
  • Requiring workers to engage with youth about their gender identity and sexual orientation.
  • Releasing LGBTQ+-affirming standards of practice for child and family serving systems.
  • Identifying explicitly the need for agencies to address how they will serve LGBTQ+ youth when responding to RFPs for foster care and psychiatric services.
  • Deliberately including LGBTQ+-identifying teens as a focus population for the county’s plan to recruit, engage, and support resource families for teenagers.
  • Asking questions related to gender and sexuality in youth surveys.

Highlight: getREAL

Allegheny County DHS conducted a service needs assessment and training at the onset of the project. The agency found that there was:

  • Unaddressed LGBTQ+-based bias within the workplace.
  • Inadequate knowledge of current protections, policies, and best practices for working with families with LGBTQ+ youth.
  • Mixed opinion about whether discussing gender identity and sexual orientation with youth is appropriate.
  • A lack of family-based interventions that directly address LGBTQ+-related family conflicts.
  • Limited understanding of how issues of gender identity and sexual orientation intersect with race.

Source: Washburn, M., Good, M., Lucadamo, S., Weber, K., Bettencourt, B., & Dettlaf, A. J. (2018). Yes We Can Allegheny: Implementing SOGIE Inclusive System Improvements in Child Welfare. Child Welfare, 96(2), 99–124.

New York City’s Administration for Children’s Services’ Office of LGBTQ Child and Family Well-Being

The New York City Administration for Children’s Services’ (ACS) Office of LGBTQ Child and Family Well-Being was established to support system-wide implementation of best practices for working with and serving LGBTQ+ youth and families. In addition to ensuring all of ACS’s services are affirming of LGBTQ+ youth and families, the office provides a central place to access resources for youth, families, and practitioners, as well as all of ACS’s LGBTQ+ policies and practices. ACS’s LGBTQ+ policies, practices, and services include:

  • Case consultation from an ACS senior advisor whose responsibility is to assess LGBTQ+ needs within the child welfare system and maintain relationships with community-based LGBTQ+ programs.
  • An overarching LGBTQ+ policy that includes everything from guidance on how to house transgender youth, to protections for LGBTQ+ youth, to when to seek case consultation from ACS’s senior advisor.
  • A juvenile justice and foster care intake process that includes sexual orientation, gender identity, and gender expression demographic questions, as well as well-being questions related to family acceptance and rejection, school bullying, and experience with homelessness.
  • A Provision of Non-Medicaid Reimbursable Treatment or Services for Youth in Foster Care policy that provides guidance to foster care agencies on how to get gender-affirming medical care (including trans-related healthcare) that is categorically excluded from New York State’s Medicaid coverage reviewed, approved, and reimbursed by ACS.
  • The LGBT Foster Care Project, which is a collaboration between ACS and the New York City Lesbian, Gay, Bisexual & Transgender Community Center to recruit and train LGBTQ+ families and LGBTQ+ allies as foster parents in order to increase the number of supportive family-based placements available for LGBTQ+ youth in the child welfare system.

Highlight: Office of LGBTQ Child and Family Well-Being

New York City ACS’ Office of LGBTQ Child and Family Well-Being has compiled an extensive database of LGBTQ+-affirming resources, ranging from housing programs to mental health providers to places of worship. Most are for LGBTQ+ youth, including sexually exploited children, while other resources are for parents. Users can search for resources by topic, target recipient (youth or parent), and location.

Additional resources for child welfare agencies

Several other resources exist to support child welfare leaders in enhancing services and building foster parent capacity to provide nurturing homes for LGBTQ+ youth in their care.

Center for the Study of Social Policy

Advancing Healthy Outcomes describes eight ways the Family First Prevention Services Act can be used to promote the health and well-being of LGBTQ+ youth involved with the child welfare system.

Child Welfare Capacity Building Collaborative’s Center for States

A Toolkit to Support Child Welfare Agencies in Serving LGBTQ Children, Youth, and Families provides electronic links to tip sheets, information briefs, websites, and other online resources.

National Center for Child Welfare Excellence

Two child welfare training curricula focus on LGBTQ+ youth:

Family Acceptance Project

The Family Acceptance Project provides education and training for providers, families, and religious leaders, family education videos, and a “best practice” guide on suicide prevention that is aimed at families with LGBTQ+ youth.

Child Welfare League of America and Lambda Legal

Recommended Practices to Promote the Safety and Well-Being of Lesbian, Gay, Bisexual, Transgender and Questioning (LGBTQ) Youth and Youth at Risk of or Living with HIV in Child Welfare Settings was developed to mitigate the disproportionate outcomes experienced by LGBTQ+ youth involved in the child welfare system.

The Annie E. Casey Foundation

LGBTQ in Child Welfare: A Systematic Review of the Literature is a comprehensive review that identifies and synthesizes literature on LGBTQ+ youth in the child welfare system. It examines best practices and effective strategies for improving the lives of LGBTQ+ youth involved in the child welfare system.

State-specific practice guides

Connecticut, Minnesota, and Utah have created practice guides for supporting and working with LGBTQ+ youth in foster care.

1 Fish, J. N., Baams, L., Wojciak, A. S., & Russell, S. T. (2019). Are sexual minority youth overrepresented in foster care, child welfare, and out-of-home placement? Findings from nationally representative data. Child Abuse & Neglect, 92, 230.
2 The Office of Planning, Research and Evaluation. (2015). LGBT youth and services to support them: A snapshot of the knowledge base and research needs. Retrieved from https://www.acf.hhs.gov/sites/default/files/opre/chapter_brief_youth_508_nologo.pdf
3 Due to inadequate data collection and the fears and concerns of youth to identify themselves as LGBTQ+, the exact number of LGBTQ+ youth involved in the child welfare system is not known.
4 Baams, L., Wilson, B. D. M., & Russell, S. (2019). LGBTQ youth in unstable housing and foster care. Pediatrics, 143(3), 1–11.
5 Scannapieco, M., Painter, K. R., & Blau, G. (2018). A comparison of LGBTQ youth and heterosexual youth in the child welfare system: Mental health and substance abuse occurrence and outcomes. Children and Youth Services Review, 91, 39–46.
6 Salazar, A. M., Haggerty, K. P., Barkan, S. E., Peterson, R., Furlong, M. E., Kim, E., Cole, J.J., & Colito, J. M. (2019). Supporting LGBTQ foster teens: Development of a relationship-focused, self-guided curriculum for foster families. Sexuality Research and Social Policy.
7 Baams, L., Wilson, B. D. M., & Russell, S. (2019). LGBTQ youth in unstable housing and foster care. Pediatrics, 143(3), 1–11.
8 The Annie E. Casey Foundation. (2016). LGBTQ in child welfare: A systematic review of the literature. Retrieved from https://www.aecf.org/resources/lgbtq-in-child-welfare/
9 Washburn, M., Good, M., Lucadamo, S., Weber, K., Bettencourt, B., & Dettlaf, A. J. (2018). Yes We Can Allegheny: Implementing SOGIE Inclusive System Improvements in Child Welfare. Child Welfare, 96(2), 99–124.
10 Salazar, A. M., Haggerty, K. P., Barkan, S. E., Peterson, R., Furlong, M. E., Kim, E., Cole, J.J., & Colito, J. M. (2019). Supporting LGBTQ foster teens: Development of a relationship-focused, self-guided curriculum for foster families. Sexuality Research and Social Policy.
11 Makadon, H. J., Mayer, K. H., Potter, J., & Goldhammer, H. (2015). The Fenway guide to lesbian, gay, bisexual, and transgender health. Philadelphia: American College of Physicians.
12 Wilson, B. D. M., & Kastanis, A. A. (2015). Sexual and gender minority disproportionality and disparities in child welfare. Children and Youth Services Review, 58, 11–17.
13 Salazar, A. M., Haggerty, K. P., Barkan, S. E., Peterson, R., Furlong, M. E., Kim, E., Cole, J.J., & Colito, J. M. (2019). Supporting LGBTQ foster teens: Development of a relationship-focused, self-guided curriculum for foster families. Sexuality Research and Social Policy.
14 Wilson, B. D. M., & Kastanis, A. A. (2015). Sexual and gender minority disproportionality and disparities in child welfare. Children and Youth Services Review, 58, 11–17.
15 Jones, A. S., Bowen, E., & Ball, A. (2018). “School definitely failed me, the system failed me”: Identifying opportunities to impact educational outcomes for homeless and child welfare-involved youth. Children and Youth Services Review, 91, 66–76.
16 Wilson, B. D. M., & Kastanis, A. A. (2015). Sexual and gender minority disproportionality and disparities in child welfare. Children and Youth Services Review, 58, 11–17.
17 Baams, L., Wilson, B. D. M., & Russell, S. (2019). LGBTQ youth in unstable housing and foster care. Pediatrics, 143(3), 1–11.

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