Article

Are Sexual Minority Youth Overrepresented in Foster Care, Child Welfare, and Out-of-Home Placement? Findings from Nationally Representative Data

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Abstract

Background: Preliminary evidence suggests that sexual minority (e.g. lesbian, gay, bisexual, and same-sex attracted) youth are overrepresented in child welfare services. Yet, no study to date has been able to test this hypothesis with national data. Objective: Using a two-study design, we test whether sexual minority youth are overrepresented in child welfare, foster care, and out-of-home placement using nationally representative data from the United States. Participants and setting: Study 1 data are from the National Longitudinal Study of Adolescent to Adult Health (n = 14,154; Mean age = 15.4). Study 2 data are from wave three of the National Survey of Child and Adolescent Well-Being II (n = 1309; Mean age = 15.0). Methods: For Study 1, we use adjusted logistic regression models to test differences in lifetime foster care involvement between sexual minority and heterosexual youth. In Study 2, we calculate a Disproportionality Representation Index (DRI) - a ratio of sample prevalence relative to the general population - to estimate whether sexual minority youth were overrepresented in child welfare and out-of-home care. Results: Study 1 results indicate that sexual minority youth are nearly 2.5 times as likely as heterosexual youth to experience foster care placement (aOR = 2.43, 95% CI 1.40, 4.21, p = .002). Results from Study 2 show that sexual minority youth were largely overrepresented in child welfare services (DRI = 1.95-2.48) and out-of-home placement (DRI = 3.69-4.68). Conclusions: Findings are the first to demonstrate sexual minority youth's overrepresentation in child welfare, foster care, and out-of-home placement using nationally representative data and emphasizes the need for focused research on sexual minority youth involved in the child welfare system.

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... The nexuses of child abuse and neglect with poverty, limited education and access to health and mental health services, single-parent status, and environmental stress are burdens disproportionately experienced by families of color (Putnam-Hornstein, Needell, King, & Johnson-Motoyama, 2013). The majority of youth in foster care have been removed from their homes due to abuse or neglect; however, many LGBT youth enter foster care due to pushout and family rejection of their gender identity, and gender expression or sexual orientation (Fish et al., 2019;Wilson & Kastanis, 2015). ...
... While in foster care, LGBT youth are likely to experience multiple placements and report being treated less well by the child welfare system (Elze, 2014;Fish et al., 2019;Wilson & Kastanis, 2015). ...
... They report discrimination, violence, and intimidation from foster care providers, foster siblings, foster care staff, receive fewer services, and are less likely to be reunified or adopted (Fish et al., 2019;Scannapieco et al., 2018). ...
Article
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Aims and objectives: The purpose of this study was to describe the role of public health nurses working with lesbian, gay, bisexual, and transgender (LGBT) children in foster care in the San Francisco Bay Area. Background: LGBT youth are disproportionately represented in foster care and experience poor health and education outcomes. Foster care public health nurses (FCPHN) are in a unique position to address disparities with timely and appropriate referrals and advocate for policy changes. Design: An online survey was developed to describe FCPHN responsibilities in case managing LGBT children. Method: In all, 39 FCPHNs completed the survey. Results: Most FCPHN did not know the number of LGBT youth in their caseload and reported that there was no systematic method of collecting this data. Few FCPHN had received training in LGBT health issues. Conclusion: This study confirms reports from other studies regarding lack of systematic data collection to deliver appropriate services to LGBT youth. It reports FCPHN lack of training as well as their assessment of the most important needs of this population. Relevance to clinical practice: FCPHNs are in a unique position to advocate by promoting gender inclusive forms in child welfare agencies and addressing disparities in access to care.
... After coming out, LGBTQ+ youth may be exposed to unaccepting or abusive caregivers who force them out of their homes, resulting in elevated rates of foster care involvement and homelessness (Durso & Gates, 2012). Research suggests LGBTQ+ youth who enter foster care tend to have a higher number of placements, are more likely to live in a group home, and are less likely to be reunited with families or adopted out (Fish et al., 2019;Wilson & Kastanis, 2015). While in the system, LGBTQ+ youth report more negative experiences compared to their heterosexual or cisgender counterparts, including mistreatment such as verbal aggression or explicit violence from foster parents, foster siblings, or child welfare workers, and receipt of fewer services, such as access to crucial medical care (Fish et al., 2019;Mountz & Capous-Desyllas, 2020). ...
... Research suggests LGBTQ+ youth who enter foster care tend to have a higher number of placements, are more likely to live in a group home, and are less likely to be reunited with families or adopted out (Fish et al., 2019;Wilson & Kastanis, 2015). While in the system, LGBTQ+ youth report more negative experiences compared to their heterosexual or cisgender counterparts, including mistreatment such as verbal aggression or explicit violence from foster parents, foster siblings, or child welfare workers, and receipt of fewer services, such as access to crucial medical care (Fish et al., 2019;Mountz & Capous-Desyllas, 2020). ...
Article
Background: The current study is the first to explore the prevalence of reproductive coercion among adolescent women currently or previously involved in the U.S. foster care system. Reproductive coercion (RC), a form of intimate partner violence (IPV) involving exertion of power over a partner by controlling their reproductive health and decision making, is a significant public health concern. Existing research on RC has primarily been conducted in either healthcare settings or on college campuses. Foster youth are disproportionately impacted by both adolescent pregnancy and interpersonal violence. RC may contribute to this elevated risk. Methods: We conducted a cross-sectional survey in 2015 and 2016 of adolescent women (n=136), ages 16-24 years old, seeking services from youth-serving agencies affiliated with a child welfare system in Pennsylvania, United States. Participants completed measures assessing RC, experiences of physical and sexual violence, sexual behaviors, and pregnancy. We used multivariable logistic regression to assess associations between RC and study outcomes. Results: The sample was predominantly African American (67.4%) and largely identified as something other than heterosexual (46.6%). Nearly one-third of the sample (30.1%) reported a history of RC, with the most common being male partners telling them not to use birth control. High rates of IPV (62.1%), lifetime pregnancy (43.4%), and unwanted pregnancy (30.9%) were also reported. RC was associated with significantly higher odds of IPV (Adjusted Odds Ratio (AOR) = 4.22, 95% Confidence Interval (CI): 1.60, 11.13), multi-perpetrator rape (AOR 3.56, 95% CI: 1.04, 12.24), pregnancy (AOR = 5.39, 95% CI: 2.14, 13.60), and unintended pregnancy (AOR 5.39, 95% CI: 2.04, 14.25). Young women reporting RC also had elevated odds for using alcohol or drugs before sex (AOR = 4.34, 95% CI: 1.72, 10.97) and having sex with a male partner 5 years or more older (AOR = 7.32, 95% CI: 2.84, 18.87). No significant differences emerged between RC and sociodemographic characteristics. Implications: These data suggest women involved in the U.S. foster care system, particularly women of color and/or LGBTQ+ identified who comprised the majority of participants in the current study, may be at an increased risk for experiencing RC and other forms of IPV associated with adolescent pregnancy. In addition to efforts to prevent IPV and sexual violence, assessment for RC, healthy relationships education, and access to sexual and reproductive health care may mitigate these risks and improve outcomes for these young women.
... Several studies indicate that lesbian, gay, bisexual, transgender, and queer (LGBTQ+) youth are overrepresented in the foster care system (Irvine & Canfield, 2016;Martin et al., 2016;Wilson & Kastanis, 2015). Although LGBTQ+ youth account for approximately 6-8% of the US population, studies estimate that up to 19% of children in out-of-home care identify as something other than heterosexual and cisgender (Erney & Weber, 2018;Fish et al., 2019). More than half of those children are youth of color, though it is likely that these data underestimate the actual figures due to stigma and fear of being "outed" (Erney & Weber, 2018). ...
... While most LGBTQ+ youth enter foster care for the same reasons as their cisgender peers, due to experiences of abuse and/or neglect as a result of family substance abuse or domestic violence, they often experience rejection while in foster care or when transitioning out of care, which complicates permanency and can have implications for their adult lives (Mountz, 2020). LGBTQ+ youth receive an unbalanced quality of care and, therefore, child welfare workers place these youth in dangerous situations that do not consider their unique needs (Fish et al., 2019). Erney and Weber (2018) recommend focusing on the specific and lived experiences of LGBTQ+ youth in foster care in order to determine how best to work with them. ...
Article
Full-text available
LGBTQ+ (lesbian, gay, bisexual, transgender, queer/questioning) youth, especially youth of color, are overrepresented in foster care in the USA. While the child welfare system is supposed to protect and support vulnerable youth, instead this institution perpetuates stigmatizing heteronormative beliefs that often lead to more trauma and discrimination. The US child welfare system needs a major upheaval in order to meet the unique needs of marginalized children and their families. Critical theories, including feminist and queer theories and intersectionality, call for a new understanding of large-scale social issues. A human rights lens also allows for an investigation into the underlying causes of injustice and demands that social workers actively participate in the change process. Human rights social work requires broad, transformational goals. The only way to truly transform the harmful practices of child welfare in the USA is to abolish the current system. The child welfare abolition movement urges an end to the harmful and traumatizing removal of children from their families due to racist and systemic policy failures. LGBTQ+ youth of color are especially harmed by these policies that this movement is targeting. Abolition of the child welfare system calls for the active support of children and families and an increase is social safety net programs, rather than the current punitive approach based on assumptions of child maltreatment related to poverty. A reconceptualization of child welfare in the USA is an immediate obligation for social workers, as this crisis only continues to worsen.
... SGMY are overrepresented in the child welfare system at an approximate ratio of 2.5:1 compared to cisgender, heterosexual youth (Fish et al., 2019). The disproportionality may be even greater as SGMY fear harm if they disclose their gender and sexuality to foster carers and child welfare workers (McCormick et al., 2017). ...
... The disproportionality may be even greater as SGMY fear harm if they disclose their gender and sexuality to foster carers and child welfare workers (McCormick et al., 2017). These harms include harassment, physical violence, and sexual abuse (Forge et al., 2018;Woronoff et al., 2006), leading to more frequent placement breakdowns and rehoming, and less likelihood of exiting the child welfare system before reaching adulthood (Fish et al., 2019;Wilson & Kastanis, 2015). SGMY who are removed from abusive home environments by the child welfare system do not experience a decrease in their risk for suicide (Walls et al., 2009). ...
Article
Full-text available
Purpose: Sexual and gender minority youth (SGMY) experience unique challenges related to identity and disclosure, and cope in vibrant ways. Qualitative research has not yet fulsomely explored the risk, resilience, and identity intersections that impact vulnerable SGMY wellbeing. Methods: This digital photo-elicitation study (QueerView) recruited thirty SGMY (aged 14-29) from priority populations that had one or more of the following experiences: trans and gender diverse, homelessness, child welfare, and immigration. From submission of fifteen photos representing resilience and a semi-structured interview via web conferencing, constructivist grounded theory was utilized for multimodal analysis of photos, interview video, and interview transcript. Triangulation, an audit trail, and member checking were employed to support trustworthiness. Results: A visual model emerged showing how participants work towards an integrative self, with themes of reflecting and knowing, discrimination and intersectional challenges, connecting, performing, curating, coping, (re)defining and (re)creating, growing and being. Sub-themes of the impact of family dynamic and values, mental health and trauma, and the cathartic benefit from advocacy and leadership offered insight. Participant images were captured in a digital gallery. Conclusions: QueerView animates the complex lives of multiply marginalized SGMY and their intersectional strengths and challenges while demonstrating the utility of a digital multimodal approach.
... In addition, even though exact numbers of LGBTQIA+ youth in the child welfare system are unknown, the available data suggests that, at least in the USA, they are overrepresented in the system Irvine & Canfield, 2016;Mallon, 2019;McCormick et al., 2017;Wilson et al., 2014). The study by Fish et al. (2019) suggests that LGBTQ+ youth may be overrepresented in public child welfare systems at nearly 2.5 times the rate of their non-LGBTQ+ peers. ...
Book
Written through a constant exchange between LGBTQIA+ young people, researchers, professionals and foster families, this book offers a valuable tool to improve the practice with LGBTQIA+ youth at a personal, organizational, and policy levels. This book shows the powerful influence of relationships and networks for the LGBTQIA+ young person growing up in child protection and welfare systems. LGBTQIA+ youth need meaningful connections with individuals within their communities in order to be able to heal, learn, and be authentically themselves. Child welfare professionals have a crucial role in creating these connections and cultivating supportive environments, free of additional trauma, where LGBTQIA+ young people can feel valued and loved.
... Quantitative studies reveal that SMY are more likely to experience psychological and physical abuse and polyvictimization in their childhood than their heterosexual peers (Baams, 2018;Paul & Monahan, 2019) and are more likely to run away or be asked to leave their home (Pearson et al., 2017). A study using two nationally representative data sets found that SMY are overrepresented in the child welfare and foster care systems (Fish et al., 2019). Parental rejection of their child's sexual orientation may be a significant factor in these alarming findings. ...
Article
Adolescent sexual development is informed by individual, relational, generational, institutional, and cultural perspectives. Families matter: they are the social institution at the intersection of adolescent development and broader social systems, charged with the responsibility for rearing children and adolescents to adulthood. This narrative review maps insights from family theory and research onto adolescent sexual development research. Our purpose is to inform sexuality researchers from diverse fields about how family perspectives can enrich understanding of adolescent sexual development. We present the critical, intersectional theoretical framework guiding this review as consisting of three meta-themes for understanding families through an examination of family structure, process, and context. Then, we apply those meta-themes to current research on adolescent sexual development by selectively organizing our review around the contexts of family structural diversity and family relational complexity, demonstrating that both the structure and the process components are embedded within the intersectional and cultural contexts that shape and are shaped by families. Our review demonstrates that diverse, intersectional family structures and transitions may affect adolescent sexual development by influencing family processes, particularly around sexual communication. We conclude with implications of using family perspectives for future inquiry related to adolescent sexual development.
... TGNC pre-adolescent children are becoming more visible in the public eye (Aramburu Alegria, 2016;Minter, 2012;Moller et al., 2009). These youth are also increasingly visible in school systems (de Jong, 2015), increasingly referred to mental health facilities for clinical care (Zucker, 2004), and are over-represented in the child welfare system (Fish et al., 2019;McCormick, Schmidt, & Terrazas, 2017). Thus, the likelihood that social workers will work with TGNC youth and their families at some point is high (Austin, 2018). ...
Article
Full-text available
Parents are core decision-makers and advocates for their pre-adolescent transgender and gender non-conforming (TGNC) children, yet there is a dearth of research on their experiences, particularly their relationships with extended family members. This study explored how parents make decisions of whether or not to disclose their children’s TGNC identity to extended family members. In Phase 1, 34 parents of TGNC youth under the age of 13 described in interviews their experiences pertaining to disclosure of their child’s TGNC status to extended family members. Phase 2 replicated and expanded these findings with 11 additional parents. Across both phases, two disclosure processes were identified: casual unfolding disclosure, where parents allowed extended family members to witness their child’s TGNC identity development, or explicit direct disclosure, in which parents wrote mailed or emailed letters to help organize their thoughts and direct the course of the conversation. Parents avoided disclosure to select family members, based on five factors: geographical or emotional distance, age, and how conservative or religious family members were. While some relationships were strengthened with disclosure, many parents described tense or unsupportive relationships with extended family members, and some relationships dissolved. The findings suggest extended family members are both potential supporters and stressors, and parents engage in a variety of strategies to bolster their supportive networks while anticipating rejection and mitigating stress. These findings have implications for social work research, practice, and policy.
... Sexual orientation was assessed with the items "I could fall in love with a girl" and "I could fall in love with a boy" (1 ¼ completely agree; 5 ¼ completely disagree), in line with prior research [25,26]. We created a dummy variable representing a heterosexual orientation (0 ¼ exclusively other-sex attracted; completely agree/agree with the statement about falling in love with another sex; and completely disagree/disagree with the statement about falling in love with the same sex) and SM orientation (1 ¼ both-sex or same-sex attracted; completely agree/agree with the statement about falling in love with the same sex). ...
Article
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Purpose Sexual and gender minority (SGM) adolescents are more likely to become victims of bullying and harassment than heterosexual, cisgender adolescents, but little is known about the contextual details of these victimization experiences. This study aims to examine by whom and where adolescents are bullied or harassed, to whom adolescents report such victimization, and whether these experiences differ between SGM and heterosexual, cisgender adolescents. Methods Participants in this nationally representative study were 29,879 students (mean age = 14.1) from 136 Dutch middle/high schools across grades 7–12 (14.5% sexual minority, 2.7% gender minority) who completed a survey about their school-based experiences. Results Perpetrators of victimization of SGM students were more often teachers and school staff compared with heterosexual, cisgender adolescents. Furthermore, SGM students experienced victimization in private locations (in the rest- or changing rooms/parking lots, at home), more often than heterosexual, cisgender students. Finally, SGM students felt less safe than their heterosexual, cisgender peers to report these experiences to teachers or parents, and were more likely to report their experiences to the police or the school janitor. SGM students who reported victimization experiences were less likely to receive support: the problems were less often acted on and persisted more often than those of heterosexual, cisgender students. Conclusions SGM adolescents are not only victimized more often, but also by different perpetrators (teachers, other school staff) and in more private places. Their victimization is also less likely to be recognized or acted on by those responsible for adolescent’s safety: teachers or parents.
... Family acceptance has been associated with increased self-esteem, social support, and general health among sexual minority adolescents and is protective against depression, substance abuse, and suicidal ideation and behaviors among sexual minority young adults (Ryan et al., 2010). Familial rejection contributes to an overrepresentation of sexual minority youth in foster care (Fish et al., 2019). Culture and religion can play roles in familial acceptance and rejection. ...
Article
Full-text available
This article provides an executive summary of the American Psychological Association (APA)-approved 2021 Guidelines for Psychological Practice with Sexual Minority Persons. These Guidelines were produced at the request of the APA Society for the Psychology of Sexual Orientation and Gender Diversity (Division 44) and the APA Committee on Sexual Orientation and Gender Diversity (CSOGD) who, in 2018, jointly established a new task force to revise the 2010 Guidelines for Psychological Practice with Lesbian, Gay, and Bisexual Clients. This article provides an overview of the conceptual foundations that influenced these Guidelines, as well as an overview of the complete Guidelines. We highlight major changes in structure and new content areas.
... Most of the research on SGM youth is focused on contextual factors in the school and family environment, meaning that other systems that SGM youth navigate require focused attention. For example, representative studies of California (Baams, Wilson, & Russell, 2019;Wilson & Kastanis, 2015) and the United States (Fish, Baams, Wojciak, & Russell, 2019) indicate that SGM youth are more likely to experience foster care, out-of-home placement, homelessness, and transitional housing. Although we currently know little about the pathways through which SGM youth enter foster care or out-of-home placements, available research shows that SGM youth are more likely to experience abuse and neglect by their parents (Baams, 2018;Friedman et al., 2011) and report being "pushed out" of their home into homelessness (Pearson, Thrane, & Wilkinson, 2017). ...
Chapter
Sexual and gender minority (SGM) young people are coming of age at a time of dynamic social and political changes with regard to LGBTQ rights and visibility around the world. And yet, contemporary cohorts of SGM youth continue to evidence the same degree of compromised mental health demonstrated by SGM youth of past decades. The authors review the current research on SGM youth mental health, with careful attention to the developmental and contextual characteristics that complicate, support, and thwart mental health for SGM young people. Given a large and rapidly growing body of science in this area, the authors strategically review research that reflects the prevalence of these issues in countries around the world but also concentrate on how mental health concerns among SGM children and youth are shaped by experiences with schools, families, and communities. Promising mental health treatment strategies for this population are reviewed. The chapter ends with a focus on understudied areas in the SGM youth mental health literature, which may offer promising solutions to combat SGM population health disparities and promote mental health among SGM young people during adolescence and as they age across the life course.
... Considering that both girls in foster care and sexual minority girls demonstrate greater risk for poor sexual health outcomes, it is likely that girls in foster care who are also sexual minorities experience unique vulnerabilities for sexual health risks. Local (Los Angeles Foster Youth Survey), state (California Healthy Kids Survey), and national (National Longitudinal Study of Adolescent to Adult Health and NSCAW) survey studies demonstrate that sexual minority youth are overrepresented in the foster care system at approximately 2.5 to 3.5 times the general population rate (Baams, Wilson, & Russell, 2019;Fish, Baams, Wojciak, & Russell, 2019;Wilson & Kastanis, 2015), illustrating the importance of studies detailing the unique sexual health challenges and vulnerabilities of sexual minority youth in foster care. Yet, few studies of sexual health exist with this population (i.e., sexual minority youth specifically in foster care). ...
Article
Girls in foster care are at heightened risk for poor sexual health outcomes compared to their general population counterparts. Sexual minority girls are also at greater risk for poor sexual health compared to their heterosexual counterparts. Yet, little is known about the sexual health of sexual minority girls in foster care. This study aims to provide a preliminary understanding of how sexual minority girls in foster care experience the phenomenon of sexual health. Using a single-case interpretative phenomenological analysis (IPA) design, we interviewed five sexual minority girls in foster care using a single in-depth focus group discussion and analyzed the data using a series of IPA steps. Analysis revealed three major themes about the lived experiences of sexual health among sexual minority girls in foster care: fear of being victimized and distrust within sexual relationships, self-protection from sexual relationship harm, and sexual health communication. Further research is warranted to investigate the sexual health experiences and needs of sexual minority girls in foster care, with particular sensitivity to the potential impact of past sexual victimization and abuse on their sexual health and wellbeing.
... While estimates vary, studies suggest that 15-30% of youth in foster care identify as LGBTQ+ compared to approximately 3-11% of those in the general population (Baams, Wilson, & Russell, 2019;Detlaff, Washburn, Carr, & Vogel, 2018;Gates, 2011;Kann et al., 2016;Scannapieco, Painter, & Blau, 2018;Wilson & Kastanis, 2015). Using data from National Longitudinal Study of Adolescent to Adult Health, Fish, Baams, Wojciak, and Russell (2019) found that youth who reported experiencing any attraction to a member of the same sex were 2.43 times more likely than heterosexual youth to report foster care involvement. Though LGBTQ+ youth enter the foster care system for a variety of reasons, a considerable proportion of these youth enter the system as a result of conflict with parents over their sexual orientation or gender identity (Mallon, 2011). ...
Article
Full-text available
LGBTQ+ youth are over-represented in the foster care system. Child welfare systems across the country have been struggling with how to make their systems work better for the LGBTQ+ youth they serve. One strategy is developing foster caregiver trainings that bolster caregivers’ knowledge and support of LGBTQ+ youth in their care. This study has three aims: (1) to provide an overview of a module designed to support relationship building between LGBTQ+ youth in foster care and their caregivers, (2) to describe the theater testing procedure used to assess usability of the developed module with foster caregivers and adults, and (3) to share the results of the theater test. Overall, participants provided positive usability feedback about the module activities, as well as a wide variety of recommendations for strengthening the content for widespread use. Participants felt the module should be directed specifically toward caregiver skill development rather than toward both caregiver and youth support. This module represents one example of how materials focused on building foster caregivers’ knowledge and support have the potential to help LGBTQ+ teens who are over-represented in the foster care system.
... kriminalitet) og utfall (f.eks. psykisk helse, rusmiddelbruk) Dettlaff et al., 2018;Fish et al., 2019;Wilson og Kastanis, 2015). I tillegg var det en studie som beskrev lhbti-ungdommers fungering når de ikke lenger er involvert i barnevernsystemet (Shpiegel og Simmel, 2016). ...
Book
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Denne rapporten oppsummerer funnene fra prosjektet «Barnevern i et lhbti-perspektiv» som NTNU Samfunnsforskning og SINTEF har gjennomført på oppdrag fra Bufdir i perioden 2018-2020. Hovedmålet med prosjektet har vært å fremskaffe kunnskap som kan belyse hvordan lhbti-perspektivet ivaretas i barnevernet, med mål om likeverdige tjenester til barn og unge som bryter med normer for kjønn og seksualitet. Dette er et felt hvor det finnes lite kunnskap, både i forskningen og i praksisfeltet. Dette har nødvendiggjort en bred og eksplorativ tilnærming til problemstillingene i prosjektet og vi har benyttet ulike metoder for å sikre et bredt kunnskapsgrunnlag. Vi har laget en kunnskapsstatus på feltet, med fokus på forskning både internasjonalt og i Norge. Vi har også gjennomført kvalitative intervjuer med ungdommer i målgruppen, ansatte i kommunale barneverntjenester og institusjoner, nøkkelpersoner i relevante organisasjoner, samt likekjønnede fosterforeldre. I tillegg har vi gjort en kartlegging av omfang av skeive fosterforeldre i de ulike Bufetat-regionene og vi har gjennomført en breddeundersøkelse til landets barnevernledere og et utvalg ansatte.
... Studies including younger children found 15.5 % lesbian-, gay-or bisexual in children involved in child care (Dettlaff et al., 2018). Yet another study, Fish, Baams, Wojciak, and Russell (2019) have found support in U.S. national registry data for overrepresentation of sexual minority youth in child welfare studies. Based on these studies, there is support for a higher representation of sexual minority youth in OHC, as well as signs of an age gradient where overrepresentation for sexual minority orientation for children in care are less marked in younger adolescence and more marked among late adolescence, plausibly following the sexuality development pathway during adolescence. ...
Thesis
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In this thesis, the conclusions from the four individual papers in my Ph.D. studies are presented. They all concern the health and school conditions for children and youth in out-of-home care.
... | LGBTQ youth in contact with CWSAs presented inTable 3, most of the included studies (22 of 42) concerned LGBTQ youth. In Appendix S1, the studies concerning this topic are presented.3.3.1 | Prevalence, characteristics and outcomesThere were four quantitative studies investigating the prevalence/ proportion of LGBTQ Youth in CWS and various risks (e.g., criminality and victimization) and outcomes (e.g., mental health and substance use)Dettlaff et al., 2018;Fish et al., 2019; ...
Article
Full-text available
Sexual and gender minorities, for example, lesbian, gay, bisexual, transgender and questioning (LGBTQ) youth, are overrepresented in the child welfare system and an increasing number of LGBTQ people are becoming foster parents. The objective of this scoping review is to provide an overview of the existing empirical research on the practices of child welfare services towards LGBTQ individuals (i.e., youth, carers and foster parents). The review followed the methodology framework outlined by the Joanna Briggs Institute (JBI). The electronic databases MEDLINE, Embase,PsycINFO, Web of Science, PubMed and Idunn were searched to identify studies appropriate for inclusion. There were 45 studies that met the inclusion criteria;24 concerned LGBTQ youth, 10 encompassed foster parents, while nine had the ser-vice perspective as the primary focus. The studies originated from the USA (k=34), the UK (k=6), Australia (k=2) and the Netherlands (k=1). Of the included studies,28 were qualitative, 14 were quantitative, and three studies used mixed method approach. The findings indicate that LGBTQ youth are overrepresented in the child welfare system and that LGBTQ youth and foster parents often face stigma and discrimination. The results reveal a gap in the current knowledge about social workers' attitudes, knowledge and experiences regarding working with LGBTQ individuals.
... These findings highlight the potential of trans adults to serve as foster and adoptive parents for children who are both overrepresented and often considered less adoptable in the U.S. child welfare system (Dave Thomas Foundation for Adoption, 2017). For instance, nationally representative data reveal that sexual minority youth are overrepresented in foster care, child welfare services, and out-of-home placements as compared to their heterosexual counterparts (Fish, Baams, Wojciak, & Russell, 2019). In the Los Angeles foster care system alone, 19% of youth identified as LGBT (Wilson & Kastanis, 2015). ...
... Multiple empirical studies have demonstrated the prevalence of LGBTQ youth within the foster care system, where they are represented at 1.5 to twice the rate they exist within the general population (Dettlaff, Washburn, Carr, & Vogel, 2018;Fish, Baams, Wojciak, & Russell, 2019;Wilson & Kastanis, 2015). Within some geographic contexts, the majority of youth in foster care who identify as LGBTQ are also youth of color (Wilson & Kastanis, 2015;Dettlaff, Washburn, Vogel, & Carr, 2017). ...
Article
Lesbian, gay, bisexual, trans, or queer (LGBTQ) identified youth are overrepresented in the foster care system. Many experience discrimination, violence, and oppression related to their sexual orientation or gender identity/expression before, during, and after foster care. There is limited research regarding LGBTQ-identified youth who have aged out of the foster care system. Theoretically informed by intersectionality, queer, and feminist theories, the purpose of this community based qualitative research study was to gain a nuanced understanding of the experiences of 25 diverse LGBTQ former foster youth before, during, and after being in foster care. In-depth qualitative interviews with LGBTQ former foster youth between the ages of 18 and 26 provided participants with the opportunity to narrate their histories and pathways into and out of the foster care system. Consensual Qualitative Research (CQR) was used to analyze interview findings. This article presents one cluster of interview findings pertaining to: (1) LGBTQ former foster youth’s reasons for first entering foster care; (2) the effects of intergenerational mental health and substance abuse; (3) family and caregiver rejection as a barrier to permanency; and (4) experiences of transitioning from foster care.
... Finally, SGM people who are incarcerated or institutionalized are at elevated risk for poor mental health. Compared to their heterosexual peers, SM youth are more likely to be placed in and remain in foster care and are vulnerable to discrimination from foster families [27]. Similarly, transgender people who are incarcerated face unique vulnerabilities exacerbated by the prison environment. ...
Article
Full-text available
Purpose Sexual and gender minority individuals (SGM; e.g., people who identify as gay, lesbian, bisexual, or transgender) have known disparities in mental health outcomes compared to cisgender (i.e., non-transgender) and heterosexual people including higher rates of depression, anxiety, substance use, and suicidal thoughts and behaviors. These disparities can be attributed to greater social and economic obstacles to health, generally known as social determinants of health and often operationalized for SGM individuals as minority stressors. This review aims to describe recent reviews and key studies on social determinants of health and the known associations with mental health outcomes among SGM individuals. We categorize social determinants according to the framework proposed by Healthy People 2030: neighborhood and built environment, health and health care, social and community context, education, and economic stability. Recent findings Much of the recent literature has examined how the social and community context contributes to mental health outcomes for SGM people, especially the effects of discrimination and other minority stress. Summary Social determinants of health such as the neighborhood and built environment, health and health care, education, and economic stability require additional research. However, the categories of social determinants of health are overlapping and interrelated, with discrimination and other minority stressors strongly influencing the experiences of SGM individuals within neighborhood, health care, educational, and economic settings. Implications for the integration of social care and medical care are discussed.
... In British Columbia, 61% of all children and youth in care are Indigenous (Trocmé et al., in press). Estimates from the US showcase that LGBTQ2+ children and youth are 2.5 times more likely to be placed in foster care than non-LGBTQ2+ children and youth (Fish et al., 2019). ...
Article
Objective: Provincial and territorial legislation across Canada mandates child welfare agencies to release youth from their care at the age of majority. Consequently, youth exiting care tend to have limited support networks, mostly comprised of formal and short-term connections. There is a gap in research examining long-term supportive relationships from the perspectives of youth who have 'aged out' of care. Methods: This PAR photovoice project involved 8 former youth in care ages 19 to 29 in Vancouver, B.C. over the course of 12 weeks, and entailed collaborative thematic analysis of the photographs. The lead researcher executed additional analysis following the data collection phase. Results: Relationships to culture, spirituality and the land were identified as important by racialized and Indigenous youth. Animal companions also emerged as an important non-human connection. Key barriers included a lack of culturally matched foster placements and social workers, gentrification, housing restrictions and a narrow definition of family relationships. Key strengthening factors included supportive community organizations and culturally responsive workers. Conclusion and Implications: Findings highlight the importance of including the relationships that matter to youth in care within child welfare decision-making and planning processes, and a need for systemic investment in long-term nurturing of those relationships. Connections that are outside of the traditional social capital framework for young people in care, such as non-human relationships, also need to be valued. By doing so, youth exiting care have a better chance at accumulating social capital and building a support network they can rely on during their transition to adulthood.
Article
Black youth have been overrepresented in the U.S. foster care system for decades. This, coupled with disparities in treatment and outcomes, has forced all child welfare agencies to take note and influenced policy change, at the federal level. Recently, literature has begun to bring to light the existence of a substantial LGBTQ (lesbian, gay, bisexual, transgender, and queer) foster youth population which is overrepresented and underserved. This article offers a comprehensive look at the LGBTQ foster youth population, its vulnerabilities, and its distinct needs. It further contributes to the existing body of literature by exploring the intersectionality of foster youth who identify as Black and LGBTQ.
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This paper explored whether SGM (sexual and gender minority) young adults in Michigan thought religion played a role in the bullying they had witnessed or experienced. Twenty-four self-identified SGM young adults ages 20–29 participated in this study. Semi-structured in-depth interviews were conducted with participants following protocols approved by an institutional review board. The majority of participants (23/24) stated that religion had played a role in the bullying they witnessed or experienced. Additionally, several participants noted that the worst bullying they experienced based upon religion came from their families.
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Introduction In previous studies, it is estimated that sexual minorities (eg, lesbian, gay, bisexual, transgender and questioning (LGBTQ) individuals) are overrepresented in the child welfare system. However, the numbers are unclear, and there are limited studies in this field. No systematic review of LGBTQ issues across a broader context (ie, youth, foster parents and service providers) of child welfare services exists. The overall objective of this scoping review is to systematically scope the existing research on LGBTQ issues in the context of child welfare services, including policy, practice, service providers and users’ perspectives. Methods and analysis The scoping review framework outlined by the Joanna Briggs Institute (JBI) based on previous work by Arksey and O’Malley and Levac and colleagues will guide this review. In addition, the PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation will be used throughout the process. We will search electronic databases (PubMed, EMBASE, PsycINFO, Web of Science and Idunn) and grey literature sources to identify studies that are appropriate for inclusion in this review. Using inclusion and exclusion criteria based on the ‘Population–Concept–Context’ framework, two researchers will independently screen titles, abstracts and full-text articles considered for inclusion. Any qualitative, quantitative and mixed-method study of LGBTQ issues in the child welfare context will be described and synthesised using a thematic synthesis approach. Ethics and dissemination A scoping review is a secondary analysis of published literature and does not require ethics approval. This scoping review is meant to provide an overview of the existing literature, aiming to expand policy-makers’ and practitioners’ knowledge of LGBTQ issues in a child welfare context and identify research gaps that can be used as a basis for further research. The results will be disseminated through a peer-reviewed publication, a conference presentation and a presentation to the key stakeholders. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
Article
Purpose: The purpose of this study was to assess the future family building desires of assigned female at birth (AFAB) transgender and gender diverse (TGD) adolescents initiating hormone therapy, and to characterize the individuals interested in adoption. Methods: This was a retrospective chart review of AFAB TGD adolescents ages 15-17 years old initiating testosterone gender-affirming hormone therapy between 2010 and 2019, analyzing interest in adoption, demographics, and gender-affirming care. Results: Of 195 AFAB TGD adolescents asked about family planning goals, 58% (n = 113) indicated desire for adoption in their future, and 13.3% (n = 26) had no desire for children. There was no difference between those who did and did not want to adopt in terms of age at time of first visit (p = 0.22), or race distribution (p = 0.45); however, straight-identified patients were more likely to desire adoption (p = 0.02) than people with other sexual orientations. Fifty-nine percent (n = 110) of those who did not have a history of adoption and/or experience with the child welfare system desired adoption, compared with 22% (n = 2) of those with a history (odds ratio, 5.14; 95% confidence interval, 1.04-25.39; p = 0.05). Conclusion: Some AFAB TGD adolescents endorse adoption as their desired pathway to parenthood. Clinicians should be sensitive to the complexities of parenthood desires of AFAB TGD patients and have resources to direct patients to more information. Further research is needed to better understand why many AFAB TGD adolescents desire adoption, how this changes with age, and the barriers they face in achieving their goals.
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Transgender women report high rates of interpersonal victimization, including child abuse and maltreatment, intimate partner violence and sexual assault, and community and bias-related violence. Transgender individuals experience distinct barriers to help-seeking, including fear of discrimination, harassment, or violence by police, being outed as transgender by partners, and discrimination by social services for survivors of violence. The present study explores experiences of cumulative victimization across the life course and barriers to help-seeking behaviors among a sample of 21 transgender women in Chicago. Study findings can be used to inform interventions that are inclusive of transgender women survivors.
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Sexual and gender minority youth (SGMY) are overrepresented in the foster care system and experience greater foster-care-related stressors than their non-SGM peers. These factors may further elevate their risk of anxiety/depressive, post-traumatic stress disorder, self-harm, and suicidality. The system currently produces unequal and disproportionate adverse mental health outcomes for SGMY and needs points of intervention to disrupt this status quo. This article provides an empirically grounded conceptual–theoretical model of disproportionate representation and burden of psychological comorbidities experienced by SGMY in the foster care system. We apply findings from an integrated literature review of empirical research on factors related to overrepresentation and mental health burden among SGMY to minority stress theory to explicate how and why the foster care system exacerbates mental health comorbidities for SGMY. Searches were conducted in June 2020 in PubMed using MeSH terms and title/abstract terms for foster care, sexual or gender minorities, and psychological comorbidities. Inclusion criteria are studies conducted in the United States, published in English, focused on mental illness, and published between June 2010 and 2020. Developmental/intellectual and eating disorders were excluded. The initial search returned 490 results. After applying inclusion criteria, 229 results remained and are utilized to build our conceptual–theoretical model. We assert that the phenomenon of disproportionate psychological comorbidities for SGMY in foster care is best represented as a complex and dynamic system with multiple feedback loops. Extant empirical and theoretical literature identifies three critical areas for intervention: family acceptance, community belonging and queer chosen/constructed family, and affirming and nondiscriminatory child welfare policy.
Article
There is a need to increase health equity in sexual and gender diverse (SGD) populations, a medically underserved group with widening health disparities. To better understand and address SGD health disparities, we have developed a multi-level conceptual framework for nurse scientists that incorporates the concepts of stigma, intersectionality, identify affirmation, and life course trajectory. Social determinants of health formed the background of our conceptual framework. Using this framework, we proposed recommendations to promote SGD health equity through nursing research, health care practice, health care education, and public health care policy. These recommendations align with the National Institute of Nursing Research's goals of dismantling structures that perpetuate racism and impede health inequity and the need to implement interventions that address social determinants of health. As a result, nurse scientists are poised to influence health care policy by translating effective interventions to reduce health disparities for the SGD population into practice.
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Youth in foster care are a vulnerable group of adolescents that experience worse sexual health outcomes, including higher rates of STIs, HIV, and early and repeat pregnancy, compared to youth not in foster care. Caregivers of youth in foster care may play a critical role in improving the sexual health of youth in their care. However, many caregivers of youth in foster care do not talk to youth about sexual health, and few studies have directly asked caregivers about the trainings they may need to provide better sex education to youth. This exploratory study examined the training needs of caregivers of youth in foster care. Participants were a state-wide sample of 347 caregivers of youth in foster care in North Carolina, United States, who completed an online survey that asked about training needs. Almost half (49.0%) of participants state that they do not feel fully prepared to parent youth in foster care. Seventy-two percent of participants indicated they would like to receive more training on at least one of the three topics relevant to adolescent relationships and sexual health. By topic, the percentage of participants who desired more information included: peer pressure and friendships (48.1%); sexuality and sexual risk reduction (e.g. healthy relationships, pregnancy, STIs) (43.8%); and puberty and physical development (40.3%). Another area that most participants expressed a desire for more training was adolescent technology use (56.2%) – which is relevant to adolescent relationships and sexuality given a rise in the use of technology-based platforms to meet relationship partners, look at pornography, and share sexual messages and photos. Many caregivers desire additional training on how to engage with youth about sexuality and sexual risk reduction. Training caregivers of youth in foster care may be an effective strategy for improving the sexual health outcomes of this vulnerable population of youth.
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In diesem Kapitel werden wir uns zunächst damit befassen, wie sich zwischen Kindern und wichtigen Bezugspersonen eine Bindung entwickelt. Anschließend werden wir untersuchen, auf welche Weise die Entwicklung von Bindungen die emotionale Basis für die kurz- und langfristige Entwicklung des Kindes legt. Wir werden sehen, dass der Bindungsprozess eine biologische Grundlage zu haben scheint, sich aber in Abhängigkeit vom familiären und kulturellen Kontext auf unterschiedliche Weise entfaltet. Im Anschluss daran werden wir ein verwandtes Thema untersuchen – die Entwicklung des kindlichen Bewusstseins des Selbst, also ihr Selbstverständnis, ihre Selbstidentität und ihr Selbstwertgefühl. Auch wenn viele Faktoren diese Entwicklungsbereiche beeinflussen, bildet die Qualität der frühen Bindungen doch die Grundlage dafür, wie sich Kinder in Bezug auf sich selbst fühlen, einschließlich ihres Erlebens von Sicherheit und Wohlbefinden.
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Are empirical data and results of research by social scientists relevant to court decisions in foster care cases, and if so, how? How should they be brought to the court's attention? These questions arose in the context of Fulton v. City of Philadelphia (2021), a recent U.S. Supreme Court case that posed the question of whether a religiously based foster care agency could refuse to provide service to LGBTQ+ prospective foster parents on the grounds of religious beliefs, and still accept public funds. Empirical evidence is relevant to the evaluation of at least three propositions related to foster care that were raised in Fulton: (1) There is a need for qualified prospective foster parents; (2) LGBTQ+ adults are at least as likely as others to be interested in becoming foster parents and they are likely to become competent foster parents; and (3) If sufficient numbers of qualified prospective foster parents cannot be found, children are likely to suffer. Consideration of the evidence reveals that each of these three propositions is supported by factual evidence. In the United States today, there is a definite need for competent foster parents, and competence as a foster or adoptive parent is not associated with parental sexual orientation. Moreover, LGBTQ+ adults may be more likely to show interest in becoming foster parents, on average, than their heterosexual peers. If LGBTQ+ adults are not permitted to become foster parents, some children are very likely to remain without homes, and in this way, will suffer. If the best interests of children are to prevail, then child welfare agencies should search out, welcome, and support LGBTQ+ prospective foster parents, rather than turning them away. Ways of bringing the findings from research to the attention of the court are also discussed.
Article
LGTBQ+ youth in foster care need unique support and acceptance; however, few case workers and caregivers receive specialized training. To address this, the Connecting: Sexual Orientation and Gender Identity Expression (SOGIE) eLearning was developed. This evaluation assesses whether attitudes and behavioral intentions regarding LGBTQ+ youth improved as a result of this training. Caregivers and child welfare professionals showed growth in many areas, including how important they felt it was to learn strategies and skills to support LGBTQ+ youth, as well as their confidence to care for LGBTQ+ youth. The Connecting: SOGIE eLearning is a promising tool for child welfare systems.
Article
This research seeks adds to the emergent literature on intersectionality and public administration through examining how transgender women of color (trans WOC) are interacting with U.S. social welfare offices. It is our contention that trans WOC, facing a compounded set of negative stereotypes derived from racial and gender identities, will be more likely than other transgender identifying persons to: 1) avoid seeking out public welfare benefits, and 2) be more likely to report experiencing discriminatory treatment in social welfare offices. Using data from the 2015 U.S. Transgender Survey we uncover evidence that trans WOC are more likely to avoid social welfare offices and face discrimination in social welfare offices. Scholars and administrators of social welfare programs, including Social Security related benefits, should be aware of the potential for public benefit avoidance and administrative discrimination directed toward historically marginalized groups, and prioritize social equity considerations among clients facing compounded intersectional barriers.
Article
Background Research on the experiences of LGBTQIA+ youth in out-of-home care has mainly focused on these youth's adversities and the resulting negative impact on their wellbeing. Little is known about the ways through which LGBTQIA+ youth in out-of-home care are resilient to these adversities. To date, a review study on resilience in this population is lacking. Objective To map and synthesize the existing research on resilience among LGBTQIA+ children and youth in out-of-home care. Specific goals were to summarize and analyze 1) the general characteristics of the existing studies, and 2) the resilience resources found at the individual, relational, sociocultural, and ecological levels. Methods We carried out a scoping review examining empirical published academic literature. Results The 14 studies included in this scoping review indicated that resilience studies among LGBTQIA+ youth in out-of-home care are mainly qualitative, cross-sectional, US-based, and were centered on gay youth. Studies suggested that resilience resources were mostly focused at the socio/relational level (e.g., foster family acceptance) with fewer studies at the individual (e.g., LGBTQ positive identity), and community levels (e.g., LGBTQ centers). Importantly, no studies explored the interaction of resilience resources across these different domains. Conclusions Resilience among LGBTQIA+ youth in out-of-home care remains understudied and the results of this scoping review point to specific research gaps. Recommendations are provided for research, practice, and policy.
Article
Background Among the more than 400,000 children in foster care, there is a small group who will run away from care and face increased risks of negative outcomes. Previous studies on the predictors of running away from care use limited samples or outdated data. Objective The present study replicates and extends prior research by presenting an updated analysis of predictors of running away from foster care as well as 10-year trends in the prevalence and predictors of running from care. Participants and setting This study uses the Adoption and Foster Care Analysis and Reporting System (AFCARS) data to assess the runaway status of 597,911 children who were involved in foster care in 2019. Longitudinal trend analyses utilize AFCARS data from 2010 to 2019. Method Using chi-square/t-tests and binary logistic regression analyses, this study investigates individual- and case-level predictors of running away from foster care programs. Results Findings show that girls (OR = 1.29, p < .001), African American children (OR = 1.89, p < .001), and older children (OR = 1.61, p < .001) are at increased risk of running away from foster care. Removal reasons such as child substance abuse (OR = 1.65, p < .001), abandonment (OR = 1.38, p < .001), and child behavioral problems (OR = 1.31, p < .001) are also associated with an increased risk. Analysis of 10-year trends shows a steady decline in running from care: 1.40% in 2010 to 0.98% in 2019. The profile of risk factors is stable overall, with a few notable exceptions. Conclusions The percent of children running from foster care is at a 10-year low. Prevention and intervention efforts regarding running from care must focus on the needs of African American and Hispanic children, especially girls, as well as children with substance use or behavior problems. Given that programs rarely have prospective information regarding why children leave care and the negative consequences of labeling children as “runaways,” shifting language to “missing from care” should be considered.
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Research on the lives of lesbian, gay, bisexual, transgender, queer, intersex, asexual and other forms of sexual identities and orientations (LGBTQIA+) youth in care has mainly examined their experiences from a risk-based approach, while few studies have explored their resilience experiences. Using in-depth interviews, the present study aims to illuminate the resilience experiences of 13 LGBTQIA+ young people in out-of-home care in the Netherlands. Four themes emerged from their narratives: relationships that support and empower; construction of a positive identity around their sexual orientation and gender identity and expression (SOGIE); community involvement and self-relying strategies. Our findings support the view of resilience as a complex process that shows at an individual, interpersonal and social level.
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The National Longitudinal Study of Adolescent to Adult Health (Add Health) has been instrumental in identifying sexual minority youth health disparities. Recent commentary suggested that some Wave 1 youth responders, especially males, intentionally mismarked same-sex attraction and, as a result, published reports of health disparities from these data may be suspect. We use two recently developed approaches to identify "jokesters" and mischievous responding and apply them to the Add Health data. First, we show that Wave 1 same-sex attracted youth, including those who later reported completely heterosexual identities in adulthood, were no more likely than different-sex attracted youth and consistently heterosexual participants to be "jokesters." Second, after accounting for mischievous responses, we replicated six previously established disparities: depressive symptoms, suicidal ideation and behaviors, alcohol use, cocaine use, parental satisfaction, and school connectedness. Accounting for mischievousness resulted in the elimination of one observed disparity between heterosexual and sexual minority youth: suicidal ideation for males who reported romantic attraction to both sexes. Results also showed that accounting for mischievous responding may underestimate disparities for sexual minority youth, particularly females. Overall, results presented here support previous studies that identified health disparities among sexual minority youth using these data.
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The Decision Making Ecology provided a framework for empirically testing the impact of Case, Caseworker and Organizational factors on the decision to place children in out-of-home care. The structural equation model we developed fit the data extremely well, indicating a complex relationship between the variables. The main findings indicate that Case factors, even as aggregated to the worker level, were of most importance: Percent Removed was increased in part by greater average Risk being assessed and more families on a worker's caseload being Low Income. Furthermore, removal rates were increased by lower proportions of Hispanic families on the caseload, as well as lower organizational support, and a perception of manageable workload and sufficient resources. Individual factors, i.e., variables characterizing the caseworkers themselves, were not found to directly influence the placement decision, including workers' own race/ethnicity, though various orders of mediated effects were indicated, and these are detailed. Interrelationships between variables that affect case, caseworker and organizational factors are discussed along with implications for practice. Copyright © 2015 Elsevier Ltd. All rights reserved.
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Youth who age out of foster care are at risk of poor outcomes and risky behaviors in young adulthood. Yet, little is known about what child welfare workers can do to decrease these risks. The effect of foster care placement instability on substance use and risky sexual behaviors is examined using data from 114 young adults who aged out of care. When controlling for variables commonly associated with these behaviors, a history of foster care placement instability increased the young adults’ likelihood to use substances. Child welfare practitioners could potentially reduce the vulnerability of this population by providing them greater stability during adolescence.
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This article is based on the findings from a subset of gender identity and sexual orientation questions from The Casey Field Office Mental Health Study (CFOMH). It aims to contribute the experiences of youth in the care of Casey Family Programs to the increasing body of research on lesbian, gay, bisexual, transgender, or questioning (LGBTQ) youth in foster care, as well as inform future studies in this area. The CFOMH study interviewed 188 adolescents ages 14 to 17 who were receiving foster care services from Casey Family Programs in 2006. The experiences in care of youth who identified as LGBQ (n = 10) are presented in narrative form, along with data from all youth in care (N = 188) regarding their perceptions of the foster care environment for LGBTQ youth. These findings are intended to underscore the need to conduct a larger, more in-depth study of the experiences of LGBTQ youth in foster care and the environment that foster care provides for them.
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This study examined factors associated with gay, lesbian, and bisexual (GLB) youths’ parents’ knowledge of their children's sexual orientation. Over a 2-year period, we studied 196 youths whose parents were aware or unaware of their children's sexual orientation, and youths whose sexual orientation became known to their parents. Differences between youths in their sexual orientation development, psychosocial adjustment, support, victimization by parents, and involvement in GLB social activities were considered. Youths whose parents were aware of their sexual orientation indicated that they were more same-sex oriented and reported less internalized homophobia than youths in the other two groups. Youths whose sexual orientation became known had poorer parental relationships and also feared parental harassment and rejection.
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Several decades of research have shown that lesbian, gay and bisexual (LGB) adults are at high risk for substance use and substance use disorders (SUDs). These problems may often start prior to young adulthood; however, relatively little is known about risk for substance use in LGB adolescents. The primary aims of this paper were to conduct a meta-analysis of the relationship between sexual orientation and adolescent substance use and a systematic review and critique of the methodological characteristics of this literature. Medical and social science journals were searched using Medline and PsychInfo. Studies were included if they tested the relationship between sexual orientation and adolescent substance use. Eighteen published studies were identified. Data analysis procedures followed expert guidelines, and used National Institutes of Health (NIH)-sponsored meta-analysis software. LGB adolescents reported higher rates of substance use compared to heterosexual youth (overall odds ratio = 2.89, Cohen's d = 0.59). Effect sizes varied by gender, bisexuality status, sexual orientation definition and recruitment source. None of the studies tested mediation and only one tested moderation. One employed a matched comparison group design, one used a longitudinal design, and very few controlled for possible confounding variables. The odds of substance use for LGB youth were, on average, 190% higher than for heterosexual youth and substantially higher within some subpopulations of LGB youth (340% higher for bisexual youth, 400% higher for females). Causal mechanisms, protective factors and alternative explanations for this effect, as well as long-term substance use outcomes in LGB youth, remain largely unknown.
Article
Few societal attitudes and opinions have changed as quickly as those regarding sexual minority people and rights. In the context of dramatic social change, there have been multiple policy changes toward social inclusion and rights for lesbian, gay, and bisexual (LGB) people, and perceptions that the sociocultural context for LGB people—perhaps particularly for youth—has improved. Yet recent evidence from the developmental sciences points to paradoxical findings: in many cases there have been growing rather than shrinking health disparities. The authors suggest that there is a developmental collision between normative adolescent developmental processes and sexual minority youth identities and visibility.
Article
Objectives: To identify patterns of childhood adversity in a sample of adolescents and assess disparities in these experiences for lesbian, gay, bisexual, transgender, and questioning adolescents and by level of gender nonconformity. Method: By using the cross-sectional, statewide, anonymous 2016 Minnesota Student Survey, 81 885 students were included in the current study (50.59% male; mean age = 15.51). Participants were enrolled in grades 9 and 11 in a total of 348 schools. Results: Four patterns of childhood adversity were identified with sex-stratified latent class analyses (entropy = 0.833 males; 0.833 females), ranging from relatively low levels of abuse (85.3% males; 80.1% females) to polyvictimization (0.84% males; 1.98% females). A regression analysis showed that compared with heterosexual adolescents, gay, lesbian, bisexual, and questioning adolescents were more likely to be classified into profiles characterized by polyvictimization (odds ratio [OR] 1.81-7.53) and psychological and/or physical abuse (OR 1.29-3.12), than no or low adversity. Similarly, compared with nontransgender adolescents, transgender adolescents were more likely to be classified into profiles characterized by patterns of polyvictimization (OR 1.49-2.91) and psychological and/or physical abuse (OR 1.23-1.96). A higher level of gender nonconformity predicted a higher likelihood of being classified into each adversity profile compared with the no or low adversity profile (OR 1.14-1.45). Conclusions: Sexual minority adolescents and adolescents with high levels of gender nonconformity are vulnerable to experience adversity. The disparities for lesbian, gay, bisexual, transgender, and questioning adolescents and adolescents with high gender nonconformity highlight the variation in patterns of childhood adversity that these youth are at risk of experiencing. The findings reveal the need for further research on the benefits and harm of screening for childhood adversity by physicians and pediatricians.
Article
Background: An established body of research documents that sexual minority (i.e., lesbian, gay, and bisexual) populations are at higher risk for several adverse health behaviors and outcomes compared to their heterosexual counterparts. Smoking is one behavior where the gap is especially large, particularly among youth. Researchers have increasingly drawn attention to contextual determinants of health behaviors affecting sexual minority youth. Purpose: Although these factors have evolved over time, few scholars have examined time as a contextual factor that affects sexual minority health behaviors or the level of inequality with heterosexual populations. We aimed to fill this gap. Procedures: We used eight years of data from the Massachusetts Youth Risk Behavior Survey (MYRBS), pooled into four waves, to determine whether gaps between sexual minority and heterosexual youth have widened or narrowed for three different indicators of smoking: having ever smoked, early onset smoking, and daily cigarette smoking in the past 30 days. Results: We find that, though rates of smoking for all youth in Massachusetts have declined since the late 1990s, significant disparities remain between sexual minority and heterosexual youth. Conclusions: Findings may suggest that targeted tobacco control programs in Massachusetts are needed; perhaps shifts in social attitudes toward smoking have affected smoking behaviors in diverse segments of society.
Article
Background and aims: Although sexual orientation-related alcohol use disparities are well established, researchers have not identified whether disparities are diminishing as societal attitudes towards lesbian/gay and bisexual (LGB) people become more accepting. We examined changes in four alcohol-related disparities between heterosexual and LGB youth from 1998 to 2013 by (1) estimating the prevalence of these behaviors; (2) estimating disparities in alcohol-related outcomes between heterosexual and LGB youth within each wave year; and (3) testing whether the degree of difference in alcohol-related disparities between heterosexual and LGB youth has changed. Design: Logistic regression models and year × sexual orientation interactions with repeated, cross-sectional, provincially representative data. Setting: British Columbia, Canada. Participants: Students (ages 12-19) from the 1998 (n = 22 858), 2003 (n = 29 323), 2008 (n = 25 254) and 2013 (n = 21 938) British Columbia Adolescent Health Survey (total n = 99 373, 48.7% male, mean age = 14.84). Measurements: We modeled age-adjusted differences in life-time alcohol use, age of onset, past 30-day drinking and past 30-day heavy episodic drinking between heterosexual and three subgroups of sexual minority youth (i.e. mostly heterosexual, bisexual and lesbian/gay). Findings: Generally, alcohol use declined for all youth, although less so among LGB youth [average adjusted odds ratio (aOR) = 0.58 and aOR = 0.53 for heterosexual males and females and aOR = 0.71 and aOR = 0.57 for sexual minority males and females, respectively). Within-year comparisons demonstrated elevated rates of alcohol use among LGB compared with heterosexual youth for each of the four survey years, especially among females. Findings indicate few changes over time; however, results show an increase in risky alcohol use from 1998 to 2013 among mostly heterosexual (aOR = 1.58 for life-time alcohol use, aOR = 1.58 for 30-day alcohol use and aOR = 1.34 for 30-day heavy episodic drinking), and bisexual (aOR = 1.95 for life-time alcohol use) females. Conclusion: Despite the general decline in the prevalence of alcohol use among young people in Canada since 1998, lesbian/gay and bisexual youth in Canada continue to show elevated rates of alcohol use compared with heterosexual youth.
Article
Sexual minority youth are more likely to run away from home or experience homelessness, leaving them at increased risk of victimization and negative health outcomes. In this study, the authors use a developmental perspective that considers both vulnerable beginnings in families and the risky trajectories that follow to explore the connections between running away or being thrown out by parents and sexual minority women's and men's health in adulthood. Using four waves of data from the National Longitudinal Study of Adolescent to Adult Health (Add Health), the authors consider multiple dimensions of health and several potential intervening mechanisms. Findings suggest that runaway and thrownaway experiences have persistent negative effects on health into adulthood, in part because of their association with sexual victimization, educational attainment, and relationships with parents. Sexual minority men who have been thrown out by parents report a greater likelihood of suicidal ideation, smoking, and substance use into adulthood. Sexual minority women with runaway experiences have poorer health and increased depressive symptoms, while women with thrownaway experiences engage in more health risk behaviors. Sexual victimization stands out as a key mechanism for sexual minority women's health, as more than half of these young women report experiences of sexual victimization.
Article
Objectives: Despite evidence from numerous studies that document disparities in suicidality for sexual minorities, few have investigated whether or not these trends have improved over time, which is the objective of the current study. Methods: Using school-based population data over a 15-year period (1998 to 2013), multivariate logistic regressions were used to calculate age-adjusted odds ratios separately by gender. Interactions were included to test widening or narrowing disparities within orientation groups, which makes this one of the first studies to test whether gaps in disparities between heterosexual and sexual minorities have widened or narrowed over time. Results: Results show that sexual minority youth are persistently at a greater risk for suicidal behaviour, a trend that has continued particularly for bisexual youth of both sexes. Results also suggest that the gap in suicidal behaviour is widening among some female sexual orientation groups, yet narrowing for other male sexual orientation groups. Conclusions: These findings have important public health implications, especially since we see decreases in suicidal behaviour for heterosexual adolescents, but not in the same way for many sexual minority youth, despite advances in social acceptance of gay, lesbian, and bisexual issues in North America.
Article
In child welfare, there is sometimes a false dichotomy between child safety and family preservation. In an evaluation of Family Group Decision Making in four child welfare jurisdictions, worker surveys were administered to caseworkers, supervisors, program directors, and program coordinators asking about worker perceptions, demographics, organizational culture and climate, and job characteristics. The surveys contained the Dalgleish Scale, an instrument designed to measure the perspectives of workers across the continuum of child safety versus family preservation beliefs. Assessing a number of worker characteristics, an analysis of the Dalgleish Scale revealed that staff who have worked in child welfare longer are more likely to be oriented toward family preservation, whereas staff working in the field for a shorter time period or rating the shared vision among staff higher are more likely to be oriented toward child safety. Evidence has demonstrated that caseworkers’ perspectives influence disposition decision making, and that child and family outcomes, such as maltreatment recurrence or out-of-home placement, are not solely determined by family and case characteristics. The potential utility of developing a better understanding of staff orientation has implications for organizational culture, compliance with policy mandates, workforce development, and most importantly, outcomes for child welfare-involved families.
Article
Problem: Sexual identity and sex of sexual contacts can both be used to identify sexual minority youth. Significant health disparities exist between sexual minority and nonsexual minority youth. However, not enough is known about health-related behaviors that contribute to negative health outcomes among sexual minority youth and how the prevalence of these health-related behaviors compare with the prevalence of health-related behaviors among nonsexual minorities. Reporting period: September 2014-December 2015. Description of the system: The Youth Risk Behavior Surveillance System (YRBSS) monitors six categories of priority health-related behaviors among youth and young adults: 1) behaviors that contribute to unintentional injuries and violence; 2) tobacco use; 3) alcohol and other drug use; 4) sexual behaviors related to unintended pregnancy and sexually transmitted infections, including human immunodeficiency virus infection; 5) unhealthy dietary behaviors; and 6) physical inactivity. In addition, YRBSS monitors the prevalence of obesity and asthma and other priority health-related behaviors. YRBSS includes a national school-based Youth Risk Behavior Survey (YRBS) conducted by CDC and state and large urban school district school-based YRBSs conducted by state and local education and health agencies. For the 2015 YRBSS cycle, a question to ascertain sexual identity and a question to ascertain sex of sexual contacts was added for the first time to the national YRBS questionnaire and to the standard YRBS questionnaire used by the states and large urban school districts as a starting point for their YRBS questionnaires. This report summarizes results for 118 health-related behaviors plus obesity, overweight, and asthma by sexual identity and sex of sexual contacts from the 2015 national survey, 25 state surveys, and 19 large urban school district surveys conducted among students in grades 9-12. Results: Across the 18 violence-related risk behaviors nationwide, the prevalence of 16 was higher among gay, lesbian, and bisexual students than heterosexual students and the prevalence of 15 was higher among students who had sexual contact with only the same sex or with both sexes than students who had sexual contact with only the opposite sex. Across the 13 tobacco use-related risk behaviors, the prevalence of 11 was higher among gay, lesbian, and bisexual students than heterosexual students and the prevalence of 10 was higher among students who had sexual contact with only the same sex or with both sexes than students who had sexual contact with only the opposite sex. Similarly, across the 19 alcohol or other drug use-related risk behaviors, the prevalence of 18 was higher among gay, lesbian, and bisexual students than heterosexual students and the prevalence of 17 was higher among students who had sexual contact with only the same sex or with both sexes than students who had sexual contact with only the opposite sex. This pattern also was evident across the six sexual risk behaviors. The prevalence of five of these behaviors was higher among gay, lesbian, and bisexual students than heterosexual students and the prevalence of four was higher among students who had sexual contact with only the same sex or with both sexes than students who had sexual contact with only the opposite sex. No clear pattern of differences emerged for birth control use, dietary behaviors, and physical activity. Interpretation: The majority of sexual minority students cope with the transition from childhood through adolescence to adulthood successfully and become healthy and productive adults. However, this report documents that sexual minority students have a higher prevalence of many health-risk behaviors compared with nonsexual minority students. Public health action: To reduce the disparities in health-risk behaviors among sexual minority students, it is important to raise awareness of the problem; facilitate access to education, health care, and evidence-based interventions designed to address priority health-risk behaviors among sexual minority youth; and continue to implement YRBSS at the national, state, and large urban school district levels to document and monitor the effect of broad policy and programmatic interventions on the health-related behaviors of sexual minority youth.
Article
Today's lesbian, gay, bisexual, and transgender (LGBT) youth come out at younger ages, and public support for LGBT issues has dramatically increased, so why do LGBT youth continue to be at high risk for compromised mental health? We provide an overview of the contemporary context for LGBT youth, followed by a review of current science on LGBT youth mental health. Research in the past decade has identified risk and protective factors for mental health, which point to promising directions for prevention, intervention, and treatment. Legal and policy successes have set the stage for advances in programs and practices that may foster LGBT youth mental health. Implications for clinical care are discussed, and important areas for new research and practice are identified. Expected final online publication date for the Annual Review of Clinical Psychology Volume 12 is March 28, 2016. Please see http://www.annualreviews.org/catalog/pubdates.aspx for revised estimates.
Article
Empirical research is needed to support ongoing efforts to improve services for sexual and gender minority youth in foster care. Further, data on the presence of sexual and gender minority youth within the child welfare system are needed to encourage counties that have not yet begun to engage in any efforts to address the unique needs and barriers to permanency for these youth. The current study reports on the findings of the Los Angeles Foster Youth Survey (LAFYS) which was designed to assess the proportion of youth placed in the Los Angeles County public child welfare system who are LGBTQ and to examine their experiences in communities, schools, and foster care. Findings indicate that approximately 19% of Los Angeles foster youth are LGBTQ. This proportion of youth is significantly higher than estimates of adolescent and young adult sexual and gender minority identification rates in the general population. Further, analyses also indicate that sexual and gender minority youth in this study are less satisfied with their child welfare system experience, are more likely to experience homelessness, are moved around to more placements, and are experiencing higher levels of emotional distress compared to their non-LGBTQ counterparts.
Article
Income assistance programs (e.g., Temporary Assistance to Needy Families; TANF) and child welfare service (CWS) programs have implicit intentions to prepare children for an adulthood that is free from serious criminal activity. This cross-sectional study compares the felonious arrests as adults of youth who were involved with TANF (n = 6,596) with those who were involved with CWS (n = 1316). In the CWS population, we compare youth who emancipated from foster care (n = 841), those who reunified (n =278), and those with other exits (n = 197). Outcomes of interest include the severity of the felony an individual was charged with as an adult as well as the hazard of being arrested after age 16 years. Findings show that as adults, TANF-involved youth are less likely than former foster youth to be charged with a felony; moreover, when former TANF youth are charged with felonies as adults, the felonies are less severe than felony charges incurred by former foster youth. Overall, as young adults, males and African American youth are not only more likely to be charged with felonies than other race youth or females but also are more likely to be charged with felonies of higher severity ratings than other race youth or females. Entering foster care as an adolescent and having multiple placements in care are associated with poorer outcomes in adulthood. However, youth who remain in foster care longer are less likely to be charged with a felony. The study confirms earlier work on adverse criminal justice-related outcomes for former foster youth and clarifies the need for specific interventions to reduce subsequent criminal involvement.
Article
There are thousands of lesbian, gay, bisexual, and transgender 3 ("LGBT") young people in the child welfare and juvenile justice systems throughout the country. Unfortunately these systems routinely subject LGBT youth to differential treatment, deny them appropriate services and fail to protect them from violence and harassment. 4 Increasingly, through lawsuits and other system reform efforts, advocates around the country are calling attention to this issue in order to bring about much needed change. For example, in 2003, a young transgender woman won a landmark lawsuit against the New York City Administration for Children's Services ("ACS") for not 1 Rudy Estrada is a staff attorney at Lambda Legal Defense and Education Fund. Lambda Legal is the country's oldest and largest civil rights organization for LGBT people and people with HIV and is known for such landmark cases as the 2003 U.S. Supreme Court decision in Lawrence v. Texas, striking down the Texas same-sex sodomy law, and its groundbreaking work on foster care, including its 2001 publication Youth in the Margins: A Report on the Unmet Needs of Lesbian, Gay, Bisexual, and Transgender Adolescents in Foster Care. 2 Jody Marksamer is a staff attorney at the National Center for Lesbian Rights (NCLR). NCLR is a national legal resource center with a primary commitment to advancing the rights and safety of lesbian, gay, bisexual, and transgender people and their families through litigation, public policy advocacy, and public education. NCLR was founded in 1977 and serves more than 5,000 clients each year, including youth clients, in all fifty states. NCLR has an extensive history of providing legal support to LGBT youth and working for institutional and policy change that protects the rights of LGBT youth, with considerable success particularly in Safe Schools work. In recent years, NCLR has also developed a complementary component of this work that addresses the specific needs of LGBT youth in state care. 3 We use the term "transgender" to describe individuals who have a gender identity or gender expression that differs from that traditionally associated with their sex assigned at birth. The phrase "gender identity" refers to one's internal identification or self-image of their gender. For most people, their gender identity is consistent with their sex assigned at birth; however, for transgender individuals, their gender identity differs from their assigned sex. A "transgender woman" is a transgender individual who identifies as female, and a "transgender man" is a transgender individual who identifies as male. Some transgender individuals experience clinically significant distress or impairment in important areas of functioning in relation to their gender identities. These individuals may be diagnosed with Gender Identity Disorder. According to the American Psychiatric Association's fourth edition and text revision of the Diagnostic and Statistical Manual ("DSM-IV-TR"), Gender Identity Disorder is described as a "strong and persistent cross-gender identification" and "[p]ersistent discomfort with [one's] sex or sense of inappropriateness in the gender role of that sex," which causes "clinically significant distress or impairment in social, occupational, or other important areas of functioning." Id. at 581. 4 The types of harassment that LGBT youth experience include verbal abuse, such as derogatory name calling, demeaning and insulting comments and threats of physical or emotional acts or negative consequences (including religious condemnation); physical abuse, including destroying property, pushing, hitting, and other acts of violence; sexual abuse, including unwanted sex acts, touching, pantomime and threats; and emotional abuse such as shunning or isolation.
Article
Substance use tends to escalate across adolescence and into young adulthood, and can be intensified by experiences with trauma and maltreatment, mental illness, and exposure to parental alcohol and drug use. Despite the disproportionately high levels of these variables among youth placed in the foster care system, relatively few studies have focused on the measurement of substance use in this vulnerable population. The current review summarizes the published literature on alcohol and drug outcomes for current and former foster youth. Specifically, prevalence of use and diagnoses are presented separately, as well as a review of risk and protective factors. Discussion of results addresses limitations and suggestions for improvement in the measurement of these outcome variables.
Article
Child welfare personnel repeatedly move a lesbian youth from one inappropriate placement to another, subjecting her to constant rejection and discrimination and depriving her of a permanent home or family; Detention facility staff place a gay youth in isolation "for his own protection," depriving him of education, recreation, companionship, or other programming and services; Line staff in a group home fail to intervene when residents harass and abuse a transgender youth because they believe he "asked for it" by being open about his gender identity. These disturbingly common practices illustrate the serious problems in the care of lesbian, gay, bisexual, and transgender youth in the child welfare and juvenile justice systems. The lack of professional guidance related to youths' sexual identities has left a vacuum that is often filled by harmful, discriminatory practices based on personal biases rather than informed, evidence-based policies. The best practice guidelines in this book will improve outcomes for youth with accurate, up-to-date information about the best practices for providing competent services to youth who are lesbian, gay, bisexual, or transgender (LGBT). The "Best Practices Guidelines" after opening with an acknowledgments and introduction section offers eight chapters as follows: (1) LGBT Youth in Out-of-Home Care; (2) Creating an Inclusive Organizational Culture; (3) A Family-Centered Approach to Serving LGBT Youth; (4) Promoting Positive Adolescent Development; (5) Collecting and Managing Confidential Information; (6) Ensuring Appropriate Homes for LGBT Youth; (7) LGBT Youth in Institutional Settings; and (8) Providing Appropriate Health, Mental Health, and Education Services to LGBT Youth. The "Guidelines" conclude with appendices (1) Model Standards Project Staff; and (2) Model Standards Project Advisory Committee; a glossary; and a list of references.
Article
The first-ever study of its kind, this report chronicles the experiences of lesbian, gay, bisexual and transgendered (LGBT) youth in the New York juvenile justice system. This report combines existing social science research and personal interviews with juvenile justice professionals and LGBT youth and reveals that the system is plagued by discrimination and bias against LGBT youth. A major goal of this report is to bring attention to an otherwise largely invisible segment of the juvenile justice population. The research identified six major issues that LGBT youth confront once in the system: a lack of awareness about the existence of LGBT youth and their needs; a lack of appropriate sentencing options appropriate; the safety of detained LGBT youth; professionals who lack expertise and training on how to meet the needs of this population; a lack of specific policies relating to LGBT youth; and a lack of services that are sensitive to the needs of LGBT youth. This report concludes with further recommendations on moving forward, including the formulation of task forces by the city and state juvenile justice agencies. It is suggested that advocates in the juvenile justice and LGBT communities use this report to raise their own awareness and attention to LGBT youth in the system as well as lobby for policy changes to improve the system overall. (Contains 56 references.) (GCP)
Article
Victimization and family rejection of sexual orientation are two salient stressors facing gay, lesbian, and bisexual (GLB) young people. While initial research has established a link between these sexuality-related stressors and GLB youths’ mental health outcomes, the factors that underlie this relationship remain unclear. The current study examines the role of negative GLB identity (i.e., negative feelings about one's own sexual orientation) in mediating the relationship between sexuality-related stress (i.e., victimization, family rejection) and youth outcomes (i.e., internalizing problems, substance use, and cigarette smoking). Participants included 81 GLB young people (ages 14 to 25 years) recruited through college groups, youth organizations, study advertisements, and friend referrals. Path analyses revealed that victimization and family rejection experiences were related to youths internalizing problems via negative GLB identity. However, stressors and health risk behaviors were not related through negative GLB identity, although some direct relationships between stressors, substance use, and smoking emerged. Limitations and implications of the present study are discussed.
Article
Parents' and siblings' awareness of GLB youths' sexual orientation and their reactions were examined in a sample of 516 GLB youth. Youth expected unaware parents to have negative reactions. Less than one-quarter lived with siblings who did not know about their sexual orientation. Youth with only one sibling were more likely to be known by these siblings than youth with several siblings. Few adjustment indicators were associated with parental or sibling knowledge or reactions. Compared to youth not living with parents, those living with parents experienced significantly less verbal abuse from parents related to their sexual orientation but reported less family support. Youth whose parents and siblings knew about their sexual orientation and who reacted positively became aware of their same-sex attractions, identified as GLB, and first disclosed their sexual orientation at earlier ages. Although such youth reported more past verbal harassment based on their sexual orientation from their families, they worried less about rejection.
Article
We compared the likelihood of childhood sexual abuse (under age 18), parental physical abuse, and peer victimization based on sexual orientation. We conducted a meta-analysis of adolescent school-based studies that compared the likelihood of childhood abuse among sexual minorities vs sexual nonminorities. Sexual minority individuals were on average 3.8, 1.2, 1.7, and 2.4 times more likely to experience sexual abuse, parental physical abuse, or assault at school or to miss school through fear, respectively. Moderation analysis showed that disparities between sexual minority and sexual nonminority individuals were larger for (1) males than females for sexual abuse, (2) females than males for assault at school, and (3) bisexual than gay and lesbian for both parental physical abuse and missing school through fear. Disparities did not change between the 1990s and the 2000s. The higher rates of abuse experienced by sexual minority youths may be one of the driving mechanisms underlying higher rates of mental health problems, substance use, risky sexual behavior, and HIV reported by sexual minority adults.
Article
To examine disparities between sexual minority youth (SMY) and heterosexual youth in rates of suicidality and depression symptoms. Separate meta-analyses were conducted to examine suicidality and depression disparities. Studies were included if the average age of the participants was <18 years, and if suicidality or depression symptoms were compared across SMY and heterosexual youth. SMY reported significantly higher rates of suicidality (odds ratio [OR] = 2.92) and depression symptoms (standardized mean difference, d = .33) as compared with the heterosexual youth. Disparities increased with the increase in the severity of suicidality (ideation [OR = 1.96], intent/plans [OR = 2.20], suicide attempts [OR = 3.18], suicide attempts requiring medical attention [OR = 4.17]). Effects did not vary across gender, recruitment source, and sexual orientation definition. Disparities in suicidality and depression may be influenced by negative experiences including discrimination and victimization. Clinicians should assess sexual orientation, analyze psychosocial histories to identify associated risk factors, and promote prevention and intervention opportunities for SMY and their families.
Article
Sexual minority youths are youths who identify themselves as gay or lesbian, bisexual, or unsure of their sexual identity or youths who have only had sexual contact with persons of the same sex or with both sexes. Population-based data on the health-risk behaviors practiced by sexual minority youths are needed at the state and local levels to most effectively monitor and ensure the effectiveness of public health interventions designed to address the needs of this population. January 2001-June 2009. The Youth Risk Behavior Surveillance System (YRBSS) monitors priority health-risk behaviors (behaviors that contribute to unintentional injuries, behaviors that contribute to violence, behaviors related to attempted suicide, tobacco use, alcohol use, other drug use, sexual behaviors, dietary behaviors, physical activity and sedentary behaviors, and weight management) and the prevalence of obesity and asthma among youths and young adults. YRBSS includes state and local school-based Youth Risk Behavior Surveys (YRBSs) conducted by state and local education and health agencies. This report summarizes results from YRBSs conducted during 2001-2009 in seven states and six large urban school districts that included questions on sexual identity (i.e., heterosexual, gay or lesbian, bisexual, or unsure), sex of sexual contacts (i.e., same sex only, opposite sex only, or both sexes), or both of these variables. The surveys were conducted among large population-based samples of public school students in grades 9-12. Across the nine sites that assessed sexual identity, the prevalence among gay or lesbian students was higher than the prevalence among heterosexual students for a median of 63.8% of all the risk behaviors measured, and the prevalence among bisexual students was higher than the prevalence among heterosexual students for a median of 76.0% of all the risk behaviors measured. In addition, the prevalence among gay or lesbian students was more likely to be higher than (rather than equal to or lower than) the prevalence among heterosexual students for behaviors in seven of the 10 risk behavior categories (behaviors that contribute to violence, behaviors related to attempted suicide, tobacco use, alcohol use, other drug use, sexual behaviors, and weight management). Similarly, the prevalence among bisexual students was more likely to be higher than (rather than equal to or lower than) the prevalence among heterosexual students for behaviors in eight of the 10 risk behavior categories (behaviors that contribute to unintentional injuries, behaviors that contribute to violence, behaviors related to attempted suicide, tobacco use, alcohol use, other drug use, sexual behaviors, and weight management). Across the 12 sites that assessed sex of sexual contacts, the prevalence among students who had sexual contact with both sexes was higher than the prevalence among students who only had sexual contact with the opposite sex for a median of 71.1% of all the risk behaviors measured, and the prevalence among students who only had sexual contact with the same sex was higher than the prevalence among students who only had sexual contact with the opposite sex for a median of 29.7% of all the risk behaviors measured. Furthermore, the prevalence among students who had sexual contact with both sexes was more likely to be higher than (rather than equal to or lower than) the prevalence among students who only had sexual contact with the opposite sex for behaviors in six of the 10 risk behavior categories (behaviors that contribute to violence, behaviors related to attempted suicide, tobacco use, alcohol use, other drug use, and weight management). The prevalence among students who only had sexual contact with the same sex was more likely to be higher than (rather than equal to or lower than) the prevalence among students who only had sexual contact with the opposite sex for behaviors in two risk behavior categories (behaviors related to attempted suicide and weight management). Sexual minority students, particularly gay, lesbian, and bisexual students and students who had sexual contact with both sexes, are more likely to engage in health-risk behaviors than other students. Effective state and local public health and school health policies and practices should be developed to help reduce the prevalence of health-risk behaviors and improve health outcomes among sexual minority youths. In addition, more state and local surveys designed to monitor health-risk behaviors and selected health outcomes among population-based samples of students in grades 9-12 should include questions on sexual identity and sex of sexual contacts.
Article
Relatively little is known about how parents influence the health and well-being of lesbian, gay, and bisexual (LGB) adolescents and young adults. This gap has led to a paucity of parent-based interventions for LGB young people. A systematic literature review on parental influences on the health of LGB youth was conducted to better understand how to develop a focused program of applied public health research. Five specific areas of health among LGB young people aged 10-24 years old were examined: (a) sexual behavior; (b) substance use; (c) violence and victimization; (d) mental health; and (e) suicide. A total of 31 quantitative articles were reviewed, the majority of which were cross-sectional and relied on convenience samples. Results indicated a trend to focus on negative, and not positive, parental influences. Other gaps included a dearth of research on sexual behavior, substance use, and violence/victimization; limited research on ethnic minority youth and on parental influences identified as important in the broader prevention science literature; and no studies reporting parent perspectives. The review highlights the need for future research on how parents can be supported to promote the health of LGB youth. Recommendations for strengthening the research base are provided.
Article
We examined specific family rejecting reactions to sexual orientation and gender expression during adolescence as predictors of current health problems in a sample of lesbian, gay, and bisexual young adults. On the basis of previously collected in-depth interviews, we developed quantitative scales to assess retrospectively in young adults the frequency of parental and caregiver reactions to a lesbian, gay, or bisexual sexual orientation during adolescence. Our survey instrument also included measures of 9 negative health indicators, including mental health, substance abuse, and sexual risk. The survey was administered to a sample of 224 white and Latino self-identified lesbian, gay, and bisexual young adults, aged 21 to 25, recruited through diverse venues and organizations. Participants completed self-report questionnaires by using either computer-assisted or pencil-and-paper surveys. Higher rates of family rejection were significantly associated with poorer health outcomes. On the basis of odds ratios, lesbian, gay, and bisexual young adults who reported higher levels of family rejection during adolescence were 8.4 times more likely to report having attempted suicide, 5.9 times more likely to report high levels of depression, 3.4 times more likely to use illegal drugs, and 3.4 times more likely to report having engaged in unprotected sexual intercourse compared with peers from families that reported no or low levels of family rejection. Latino men reported the highest number of negative family reactions to their sexual orientation in adolescence. This study establishes a clear link between specific parental and caregiver rejecting behaviors and negative health problems in young lesbian, gay, and bisexual adults. Providers who serve this population should assess and help educate families about the impact of rejecting behaviors. Counseling families, providing anticipatory guidance, and referring families for counseling and support can help make a critical difference in helping decrease risk and increasing well-being for lesbian, gay, and bisexual youth.
Article
Lesbian, gay, and bisexual youngsters, aged 14-21 and living at home, were studied for patterns of disclosure of sexual orientation to families. Three-quarters had told at least one parent, more often the mother than the father. Those who had disclosed were generally more open about their sexual orientation than those who had not, and few of the nondisclosed expected parental acceptance. Those who had disclosed reported verbal and physical abuse by family members, and acknowledged more suicidality than those who had not "come out" to their families.
Article
A study was conducted with 45 self-identified gay, lesbian, bisexual, transgendered, and questioning (GLBTQ) youth and agency staff at the two known gay-affirming child welfare agencies in the United States: Green Chimneys GLBTQ Programs in New York City and Gay and Lesbian Social Services in Los Angeles, California. The study examined the question, "What are the challenges presented in ensuring permanency, safety, and well-being for gay and lesbian youth in a gay-affirming child welfare environment?" Guided by the framework outlined in the Child and Family Services Reviews National Standards, which support better outcomes for children and youth, the investigators sought to explore the challenges of ensuring permanency, safety, and well-being for this population, as these challenges were identified by the agency staff and youth who live and work in either of these two gay-affirming programs.
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