Introduction: Health Disparities, Resilience, and Interdisciplinary Care for LGBTQ+ Youth and Emerging Adults
G. Nic Rider, PhD, LP; Cristina L. Magalhães, PhD, LMHC; & Richard A. Sprott, PhD
Rationale for this Book
Target Audience
Useful Frameworks
- Minority Stress Theory
- Intersectionality Theory
- Resilience-Based and Strength-Focused Approaches
- Interdisciplinary and Whole-Person Approaches
Overview of the Book
Conclusion
References
SECTION I: THEORETICAL APPROACHES
1 Minority Stress Theory and Resilience-Building Practice
Eunice V. Avilés Faría, PsyD, LMHC, LPC
Author’s Note
Minority Stress Theory
Minority Stress Processes
Minority Stress Processes and Transgender and Gender Nonbinary Individuals
- Distal Stressors
- Proximal Stressors
The Impact of Minority Stress on Mental Health
The Impact of Minority Stress on Physical Health
Resilience
- Individual Resilience
- Community Resilience
Resilience-Building Practice: Interventions That Can Enhance Resilience
- Societal Level Interventions
- Community- and Group-Level Interventions
- Individual-Level Interventions (ILI)
Empirical Support for the Minority Stress Model
Gaps in the Literature and Future Directions for Clinically Relevant Research
References
2 Intersectionality, Culturally Sensitive Care, and LGBTQ+ Youth
Kayden J. Schumacher, BA, MSc, MS Ed, LSC; Leonardo E. Candelario-Pérez, PhD, LP; Eunice V. Avilés Faría, PsyD, LMHC, LPC; & G. Nic Rider, PhD, LP
Practice Considerations
Advocacy Considerations
Conclusion
References
3 Interdisciplinary Healthcare for Transgender Youth: An Application of the Gender Affirmative Lifespan Approach (GALA)
Katherine G. Spencer, PhD, LP, CST & Nova Bradford, LGSW
Introduction to Transgender Health
History of Gender Affirmative Healthcare for Youth
Minority Stress
The Gender Affirmative Lifespan Approach (GALA)
- Philosophical Foundations of GALA
- Core Components of GALA
Interdisciplinary Approach
Connections to Medical Interventions
Case Studies
- Case Study A: Research—Unicorn Youth
- Case Study B: Advocacy & Policy—Health Insurance Advocacy in Minnesota
- Case Study C: Clinical Example—Sexuality and Agency
- Case Study D: Youth Homelessness
Conclusion
- Key Knowledge Points
- Recommendations for Professionals
References
SECTION II: DEVELOPMENTAL CONSIDERATIONS
4 The Youngest Part of the Rainbow: Clinical Care for Gender Diverse Children
Dianne R. Berg, PhD, LP*; Caroline Maykut, PhD*; Rachel Becker-Warner, PsyD, LP; Catherine Schaefer, MS; & Jennifer J. Connor, PhD, LMFT (*Co–First Authors)
Social and Historical Context of Research with Gender Diverse Children
Gender Identity Development
Mental Health in Gender Diverse Children
Clinical Implications of Mental Health Research
Resilience in Gender Diverse Children
- Interpersonal Contexts
- Community Contexts
- Schools
- Healthcare Settings
- Medical Settings
- Mental Health Settings
Case Study
- Andi’s Gender Journey
- Sessions 1–3 Assessment: Age 4.11–5.0
- Sessions 4–5 Feedback and Collaborative Treatment Planning with Parents Only: Age 5.1–5.2
- Sessions 6–11 Early Therapy Process: Age 5.3–6.1
- Sessions 12–16 Ongoing Therapeutic Process: Age 6.2–6.7
- Sessions 17–24 Ongoing Therapeutic Process: Age 6.8–7.5
- Sessions 24–35 Ongoing Therapeutic Process: Age 7.6–9.0
- Sessions 36–44 Present Therapeutic Process: Age 9.3–10.5
- Case Reflection
Future Directions
Key Knowledge Points
Recommendations for Practitioners and Professionals
References
5 Risk and Protective Factors among LGBTQ+ Adolescents
Amy L. Gower, PhD; Marla E. Eisenberg, ScD, MPH; & G. Nic Rider, PhD, LP
Interpersonal Relationships
- Friendships
- Romantic Relationships
- Parent/Family Relationships
The School Context
Community Support
Online/Internet Support
Developmental Considerations
Case Study
Conclusions
References
6 Not a Teen, Not Yet an Adult: Health Risk and Protective Factors among LGBTQ+ Emerging Adults
Caleb Esteban, PhD; Alixida Ramos-Pibernus, PhD; Luis X. Díaz-Medero, MS; & Astrid Irizarry-Rodríguez, MS
LGBTQ+ Emerging Adults
Institutional Challenges
- Family
- College
- Religious Institutions
- Healthcare
- Government
Interpersonal Challenges
- Relationships
- Marriage
- Peers
- Religious Affiliation
Personal Challenges
- HIV/STIs
- Healthcare
- Substance Abuse
- Mental Health
- Depression and Anxiety
- Suicide
Protective Factors for LGBTQ+ Emerging Adults
- Resilience
- Social Support
- Community Engagement and Connectedness
Gaps and Future Direction for Studies
Clinical Implications
Case Study
Case Study Discussion
Key Knowledge Points
Recommendations for Mental Health Clinicians
References
SECTION III: SYSTEMS OF CARE
7 Pre-K–12 Schools
Molly M. Strear, PhD, NCC & Matthew J. Beck, PhD, LCPC, NCC, ACS
SBMHPs Working with LGBTQ+ Youth: Review of Literature
- School Counselors
- School Social Workers
- School Psychologists
- SBMHP Collaboration
Recommendations for SBMHPs
Coordination of Services through MTSS
- Tier 1—Universal Support
- Tier 2—Supplemental Support
- Tier 3—Intensified Support
- Family/Community Engagement
Implications and Future Directions
Conclusion
- Key Knowledge for Students
- Recommendations for Practitioners and Professionals
References
8 Serving LGBTQ+ Students at University and College Campuses
(Jan E. Estrellado, PhD, & Saeromi Kim, PhD)
Challenges Facing LGBTQ+ College Students
- Mental Health Disparities
- Identity Development as a Major Task of Late Adolescence and Emerging Adulthood
- Acceptance and Visibility of LGBTQ+ Students on Campus
- Intersectionality and Marginalized Identities
The Need for Affirming LGBTQ+ College Student Services
- Student Support Services
- Relationships with Faculty
- Relationships with Peers
- Health Services on Campus
Gaps in Research
- First-Generation Students
- Bisexual and Fluid Students
- Transgender, Nonbinary, and Gender Expansive (TNBGE) Students
- STEM Students
- Immigration Status
- International Students
Clinical and Policy Recommendations When Working with LGBTQ+ College Students
- University or College Counseling Centers
- Coming Out
- Language
- Complexity of Identities
- Depathologizing Symptoms
- Advocacy
- Policy Recommendations
- Data Collection
- Institutional Policies
- Feedback Loops
- Inclusivity
- Dialogue Spaces
- Intersectionality
- Community LGBTQ+ Services
- Community Colleges
- Protective Factors
- Health Providers
- Counseling Centers
- Academic and Career Advisors
Conclusion
- Key Knowledge Points
- Recommendations for Practitioners
References
9 Medical Care Centers as Beacons of Hope for LGBTQ+ Youth
Hiram Rivera-Mercado, PsyD; Kevin Carrión, PsyD; & Taymy J. Caso, PhD
Role of Hospitals in Serving LGBTQ+ Youth and Emerging Adults
Some Services Included
- Primary Care
- Pediatric Endocrinologist
- Behavioral Health and Mental Health Services
- Obstetrics and Gynecology
Policies and Their Function
Training of Personnel
Community Partnerships and Resources
Creating a Welcoming Environment
- Physical Environment
- Registration and Documentation Processes
- Language and Communication
Conclusion
References
10 Improving Child Welfare and Foster Care Outcomes for LGBTQ+ Youth
Kellen Grayson, PsyD, LMFT & Mira Krishnan, PhD, ABPP
Family Rejection, Abuse, and Homophobia
LGBTQ+ Youth and Polyvictimization
Poverty and LGBTQ+ Youth Vulnerability
Overrepresentation of LGBTQ+ Youth in Child Welfare Services
The State of Foster Care and Child Welfare Systems
- Policies and Practices in Child Welfare Services
- Training and Oversight of Foster Parents and Child Welfare Workers
Gaps in Care
- Transition-Age Youth
- The Landscape for Change
- Religious Freedom Restoration Acts and Child Welfare
- Considerations for Clinicians
Conclusion
References
11 LGBTQ+ Youth Experiencing Homelessness
(Catherine Forbes, PhD, Carrie Mounier, LCSW, & Kaitlin Venema, PhD)
Literature Review and Gaps in Research: LGBTQ+ Youth Experiencing Homelessness
Figure 11.1. Risk Factors for Homelessness Shared with Cisgender/Heterosexual Youth and Unique for LGBTQ+ Youth
Clinical Considerations and Recommendations for Practice in Mental Health and Substance Abuse Treatment
- Trauma-Informed Care
- Interdisciplinary Programs for LGBTQ+ YEH
- Evidenced-Based LGBTQ+-Affirming Therapeutic Services
- Group Therapy Approaches
- Alternative Programming for LGBTQ+ YEH
- Medical Interventions
Structural Competency and Service Systems for LGBTQ+ YEH
Impact of Structures on Patient Health
Influence of Structures on the Clinical Encounter
Respond to Structures in the Clinic
Respond to Structures beyond the Clinic
Structural Humility
Practice and Policy Recommendations
Healing-Centered Engagement and Structural Violence
Restorative Justice and Structural Violence
Positive Youth Development and Structural Violence
Harm Reduction and Structural Violence
Gaps and Future Directions
References
12 Gender Expansive and Sexual Minority Youth and the (In)Justice System
Macy Wilson, PsyD; Jessica Ward, MA; & Roberto L. Abreu, PhD
Incidence and Prevalence
Risk Factors
School-to-Prison Pipeline
“No Promo Homo” Laws and a Heterosexual-Cisgender School-Based Curriculum
A Failed Welfare System
The (Il)legal System
- Disproportionate Representation
- Unequal Injustice
- Gender Differences
- Youth of Color
- Microaggressions
- Mediating Factors
Mental Health Behaviors While Incarcerated
- Self-Harming Behaviors
- Aggression toward Others
Toward a Socially Just System: Ensuring Safety for LGBTQ+ Youth
- Incorporating a Holistic Approach to Care
- Constitutional Rights
- Legal Rights of LGBTQ+ Youth in the Justice System
Recommendations
Key Knowledge Points
References
13 Services for Youth and Emerging Adults at LGBTQ+ Centers and Other Community-Based Organizations
Tangela Roberts, PhD; Zari Carpenter, MA; & Kat Schuette, MA
Authors’ Note
LGBTQ+ Youth and Emerging Adults of Color
Transgender and Gender-Nonconforming (TGNC) Youth and Emerging Adults
Challenges for LGBTQ+ Youth and Emerging Adults
- Healthcare Challenges
- Mental Health
- Sexual Health
- Interpersonal Challenges
- Coming Out
- Building Community
- Dating and Relationships
- Intimate Partner Violence
- Vocational Challenges
- Career Development
- Employment Discrimination
- Workplace Identity Management
Method
Sample of LGBTQ+ Community Centers
Table 13.1: Number of LGBTQ+ Community Centers in the United States by State
Results
- Physical Health Services
- Mental Health Services
- Services for Queer Youth and Emerging Adults of Color (QYAOC)
- Services for Transgender and Gender-Nonconforming (TGNC) Youth and Emerging Adults
- Emotional Support
- Social Support
- Services Related to the Provision of Basic Needs
- Housing Stability
- Food Insecurity
- Services Related to Educational and Vocational Assistance
- Auxiliary Services
Discussion
- Areas of Improvement in Serving LGBTQ+ Youth and Emerging Adults
- Availability of Services by Geographical Region
- Access to LGBTQ+ Community Centers
- LGBTQ+ Youth and Emerging Adults of Color
- Considerations for Clinical Practice
- Policy Recommendations
References
14 Independent Practice
Gary Howell, PsyD; Arlene Noriega, PhD; & Julie Williams, MS Ed, MA
Independent Practice
- Solo Practices
- Group Practices
- Integrated Practices
Nuances with LGBTQ+ Affirmative Practices
Consultative Roles
Barriers to Care
- Healthcare Disparities
- Sociopolitical Factors
- Social Determinants of Care
- Eliminating Barriers to Care
Cultural Competence
- Intersectional Approach
- Centering Marginalized Voices
- Advocacy
Integrated Approach
- Impact of the Affordable Care Act
- Impact of COVID
- Successes
- Challenges
Research Gaps and Future Directions
Considerations for Practice
Key Knowledge Points
Recommendations for Practitioners
References
Conclusion: Increasing Health and Well-Being of LGBTQ+ Youth and Emerging Adults: Lessons Learned, Questions Unanswered
Richard A. Sprott, PhD; G. Nic Rider, PhD, LP; & Cristina L. Magalhães, PhD, LMHC
Summary of Findings and Lessons
A Possible Agenda for Research, Clinical Treatment, and Policy
- More Resources and Funding
- Train Mental Health Providers
- Systems-Based Approach Refinement
Summary
References
Appendix: List of Resources
Bibliography
Index
About the Authors