This document discusses appropriate services for sexual minority youth. It begins by defining terms used to describe various sexual orientations and gender identities. It then estimates that between 2-5% of youth identify as a sexual minority. The document discusses factors that make this group less visible and reluctant to self-identify in more conservative communities. It outlines several risks faced by sexual minority youth, such as homelessness, bullying, substance abuse, and elevated suicide rates. The document stresses the importance of providing non-discriminatory, welcoming, and person-first services to sexual minority youth.

1. Appropriate Services for
Sexual Minority Youth
Our Children Succeed Initiative
Timothy Denney, MS, CRC
Funded in part by a cooperative agreement between the NW Minnesota
Council of Collaboratives and SAMHSA

2. What is meant by “Sexual Minority?”
Current SAMHSA designation: LGBTQI2-S
 Lesbian
 Gay
 Bi-sexual
 Transgender (pre/post-operative)
 Questioning
 Inter-sexed
 Two-spirit
Appropriate Services for Sexual Minority Youth 2

3. Defining terms
Lesbian: Females who are emotionally and sexually attracted to,
and may partner with, females only.
Gay: Males who are emotionally and sexually attracted to, and
may partner with, males only. “Gay” is also an overarching
term used to refer to a broad array of sexual orientation
identities other than heterosexual.
Bi-sexual: Individuals who are emotionally and sexually
attracted to, and may partner with, both
males and females.
Appropriate Services for Sexual Minority Youth 3

4. Defining terms
Transgender (pre/post-operative): Individuals who express a
gender identity different from their birth-assigned gender.
Questioning: Individuals who are uncertain about their sexual
orientation and/or gender identity.
Inter-sexed: Individuals with medically defined biological
attributes that are not exclusively male or female; frequently
“assigned” a gender at birth, which may differ from their
gender identity later in life.
Appropriate Services for Sexual Minority Youth 4

5. Defining terms
Two-spirit: A culture-specific general identity for Native
Americans (American Indians and Alaska Natives) with
homosexual or transgendered identities. Traditionally a role-
based definition, two-spirit individuals are perceived to
bridge different sectors of society (e.g., the male-female
dichotomy, and the Spirit and natural worlds).
Other Terms: Youth also may use other terms to describe their
sexual orientation and gender identity, such as homosexual,
queer, gender queer, non-gendered, and asexual. Some youth
may not identify a word that describes their sexual
orientation, and others may view their gender as fluid and
even changing over time. Some youth may avoid gender
specific pronouns.
Appropriate Services for Sexual Minority Youth 5

6. How many are in your service area?
Real numbers are hard to come by due in part to reluctance to
self-identify by youth, and to wide variation in survey design.
National statistics most often encountered:
 Reported most often: 2-10%
 “Activist statistics:” 5-20% (“1 in 10” programs based
upon these stats)
 Actual statistics: 2-5% Most likely 3 - 5 % (GLBTQI2-S)
 These numbers can be used for service planning in your area.
Appropriate Services for Sexual Minority Youth 6

7. How many are in your service area?
National Longitudinal
Study of Adolescent Health
7% Same Sex Attraction,
(13-17 Y.O. 6%)
National Health & Nutrition
Exam Survey III 17-39 Y.O: 2.2 % reported same sex partners
Even with the wide range of statistical reports, you can expect 2
to 5 of every 100 people you have worked with, met, or
taught are in the sexual minority.
Appropriate Services for Sexual Minority Youth 7

8. How many are in your service area?
Massachusetts's YRBS, a comprehensive study
of school-aged youth in that state.
 Male 2% Female 4% Total 3%
 No sexual contact by those reporting
LGBTQI orientation was approximately
1.5% of general population (55% of the
total LGBTQI)
Appropriate Services for Sexual Minority Youth 8

9. Reluctant to self-identify
 This is a difficult region in which to self-identify
 Socially conservative local culture
 Strong religious influences
 Contrary orientation to most local cultural settings
 Issue is not talked about
 Small town gossip
 Other reasons?
Appropriate Services for Sexual Minority Youth 9

10. Reluctant to self-identify
How hard would it be to “come out”
in your community?
Being “out” is in many respects the
process of “coming out” to someone everyday.
This is a process that can be freighted with emotions: fear,
rejection, abuse, avoidance, non-support.
For many it may be perceived as a survival issue.
Appropriate Services for Sexual Minority Youth 10

11. Often Not Visible in Minnesota
Discuss: What factors would make this minority group less
visible in your particular
community?
Discuss: When would a youth or
young adult self-identify in your
community or region?
Appropriate Services for Sexual Minority Youth 11

12. LGBTQI2-S Risk Analysis
Homelessness: LGBTQI2-S youth
more likely to be in placement or
homeless at some point.
One study showed up to half of
LGBT youth in placement surveyed
were homeless at some point in past.
One study showed 65% of 400 homeless LGBTQ youth had been
in child welfare placement.
One study showed that 28% of LGB youth dropped out of school
due to feeling unsafe at school.
Appropriate Services for Sexual Minority Youth 12

13. LGBTQI2-S Risk Analysis
(LGBT vs. general population)
 Being bullied 42 vs 21%
 Threatened/injured with a weapon at school 22 vs 5%
 Skipping school because felt unsafe 15 vs 4%
 Using alcohol at higher levels 60 vs 45%
 Being diagnosed with HIV or STD 16 vs 7%
 Being twice as likely to
abuse alcohol
 Being eight times more
likely to abuse cocaine
Appropriate Services for Sexual Minority Youth 13

14. LGBTQI2-S Risk Analysis
National Longitudinal Study of Adolescent Health (Add Study)
revealed that adolescents with same-sex attractions…
 Males were 33% more likely to be victimized
 Females were 18% more likely to be victimized
 Those attracted to the same sex were 86% more likely to be
violently attacked
 Those attracted to both sexes were 43% more likely to be
violently attacked
Appropriate Services for Sexual Minority Youth 14

15. LGBTQI2-S Risk Analysis
Huebner, Rebchook, & Kegeles (2004) analysis of data revealed
that young men 18 to 27 years (average age 23) with same-
sex attractions experienced in the previous 6 months…
 Anti-gay harassment 37%
 Discrimination due to sexual
orientation 11%
 Violence linked to sexual
orientation 5%
Appropriate Services for Sexual Minority Youth 15

16. LGBTQI2-S Risk Analysis
Substance use and abuse research is mixed for this population.
Some studies indicate an elevated risk for substance use and
abuse for this adolescent and young adult population.
Other studies, such as Russell, Driscoll, & Truong (2002)
indicate little variation in the trajectories of drug use and
abuse between sexual minority and sexual majority youth.
There is some evidence of elevated alcohol use among sexual
minority youth and young adults, and for higher rates of
useage among transgender youth and young adults.
Appropriate Services for Sexual Minority Youth 16

17. LGBTQI2-S Risk Analysis
Running away is a common reaction to the pressures of being in
the Sexual Minority as an adolescent.
 Upon identification, many GLBTQ youth are thrown out of
their home, mistreated, or made the focus of their family's
dysfunction.
 Sexual Minority youth are more likely to run away from
home and to experience academic problems.
 Several studies have found that approximately 40% of
homeless "street" teens self-identify as gay/lesbian. This
often leads to abuse, prostitution, high-risk behaviors,
criminality.
Appropriate Services for Sexual Minority Youth 17

18. Related Mental Health Concerns
 Mood disorders,
 Anxiety disorders, fear
 Reactions to violence or threats
 Common presenting problems
 Depression-related behaviors
 Alcohol and drug use
 Anxiety-related behaviors
 Suicide or self-injury
Appropriate Services for Sexual Minority Youth 18

19. One Youth’s Experience
 From Post Secret Website
Appropriate Services for Sexual Minority Youth 19

20. Suicide: loaded topic, divergent statistics
Nearly all studies confounded:
 Alcohol,
 Homelessness
 MH disabilities
Difficult to know actual statistical
risk for suicide attempts in
LGBTQI2-S youth.
Certainly the risk is significantly elevated, requiring more
care in delivering appropriate services
Appropriate Services for Sexual Minority Youth 20

21. Suicide: loaded topic, divergent statistics
MN Student Survey 3% to 5% students OA had a suicide
attempt in previous year.
MN studies: Sexual Minority youth 2-3 times more likely to
attempt suicide than general population youth.
National LS: Sexual Minority youth roughly 2 times more likely
to attempt
Adult MSNBC: 2 times more likely (non-rigorous study)
Appropriate Services for Sexual Minority Youth 21

22. Suicide: loaded topic, divergent statistics
Russell & Joyner (2001) analysis of the Add Study (NLSAHD)
found that
 15.4% of males and 28.3% of females had suicidal thoughts
in the previous 12 months.
various
 5% of males and 12.2 % of females had a suicide attempt in
the previous 12 months
Paul, Cantania, et. al analysis of the National Health and
Nutrition Exam Survey III found that for LGBT populations
 21% had developed a suicide plan
 12% had attempted suicide and 6% had multiple attempts
Appropriate Services for Sexual Minority Youth 22

23. Suicide: loaded topic, divergent statistics
Meyer, Dietrich, & Schwartz (2008) study of LGBT young adults
ages 18-29 found that
 47% had lifetime prevalence of any anxiety disorder
 66-77% had lifetime prevalence of any disorder
various
 35-51% had lifetime prevalence of substance abuse disorder
 30% had lifetime prevalence any mood disorder
 8-18% had lifetime prevalence of drug dependency
 8-10% had lifetime prevalence of serious suicide attempt
Appropriate Services for Sexual Minority Youth 23

24. Suicide: loaded topic, divergent statistics
Actual risk 2-3 times more than general population, meaning
there is likely a 6-15% suicide risk factor for Sexual
Minority youth/young adults.
 Although the real percentages are hard to establish, Estimates
range from 12-20% of age-group suicide attempts are Sexual
Minority population.
Common statistic quoted: 30% to 33% of suicides are Sexual
Minority youth/young adults.
 Not much evidence to support these higher percentages.
 Statistical sources discredited: Kinsey report (sexuality),
Gibson report (suicide)
Appropriate Services for Sexual Minority Youth 24

25. Sexual activity risks
(LGBT vs. general population)
 Reported lifetime
sexual activity 73% vs 43%
 Reported sex before age 13 13% vs 5%
 Reported four or more partners 36% vs 11%
 Reported being tested for STD/HIV 42% vs 24%
Appropriate Services for Sexual Minority Youth 25

26. Understanding our own cultural limitations
Sexual minority orientations are considered “outside the
mainstream” by many (or most) in our communities. This
grants “privilege” to the “mainstream.”
(1) A special right, advantage, or immunity for a particular person
(2) the right to say or write something without risk of
punishment
Information on this slide from Elaine Slaton, FFCMH
Appropriate Services for Sexual Minority Youth 26

27. Understanding our own cultural limitations
Infers protection against the disadvantages others have…
 This privileged, protected status in relation to others without
this status – infers power.
 The privileged have power over unprivileged.
 Heterosexual people have privileged status (over Sexual
Minorities)
Information on this slide from Elaine Slaton, FFCMH
Appropriate Services for Sexual Minority Youth 27

28. Understanding our own cultural limitations
Mainstream Privilege as viewed
from GLBTQI2-S perspectives:
 Very visible
 Felt as the experience of “quiet” discrimination and
occasionally active discrimination
 Part of a complex system that determines access to resources,
education/economic opportunities, and services
 A challenge that one may need to confront on a daily basis in
personal life
Information on this slide from Elaine Slaton, FFCMH
Appropriate Services for Sexual Minority Youth 28

29. Sexual Minority Youth Have Rights
Non-discrimination in health care, mental health care, social
services, and justice services.
 How are Sexual Minority youth discriminated against in
human services?
 Lack of regard for sexual
orientation, a “non-topic.”
 Lack of trained professionals.
 Few safe places to self-disclose.
 Others reasons?
Appropriate Services for Sexual Minority Youth 29

30. Sexual Minority Youth Have Rights
Our responsibility is to provide appropriate services and to
respect civil rights. Period.
Professional responsibility requires us to offer appropriate
services using best practices in a manner appropriate to each
individual consumer.
Practice Brief 1:
Appropriate Services for Sexual Minority Youth 30

31. Sexual Minority Service Barriers
 Discrimination and perceived service barriers lead to…
 Low rate of self-identification due
to fear (from prior experiences)
 Some possible MH causal factors
are effectively “off the table.”
 Self-identification may lead to
discrimination or “outing.”
 Result: real issues not addressed
or therapeutic relationship is
discontinued.
Appropriate Services for Sexual Minority Youth 31

32. Sexual Minority Service Barriers
Service barriers often extend from our cultural insensitivity.
 Monolithic “mainstream”
culture issues
 Our personal orientation
or religious background
 Other personal lenses or past experiences
 Disclosure of orientation may lead to discomfort and poor
responses from the professional.
Appropriate Services for Sexual Minority Youth 32

33. Personal safety LGBTQI2-S youth
Sexual Minority youth may fear rejection and discrimination due
to their sexual orientation. In a representative sample of 1,067
teens, only one youth self-identified as gay although five
percent had engaged in same-sex sexual behavior.
What are the threats to personal safety a Sexual Minority student
may face?
“Outing” Rejection
Abuse Service barriers
Homelessness Loss of support network
Blaming and shaming Victimization
Appropriate Services for Sexual Minority Youth 33

34. Working with LGBTQI2-S Youth
Acknowledge their presence in
your setting
Examine your own beliefs and
attitudes
Commit to equal respect, dignity,
service and expectations for all
consumers
Be aware of your language everywhere
Avoid stereotyping
Appropriate Services for Sexual Minority Youth 34

35. Working with LGBTQI2-S Youth
Create a positive and
welcoming environment
Respond appropriately
to self-disclosure
Become the person anyone can go to, regardless of the issue.
Those in need will find you when they need to do so.
Inclusion is needed to counter the exclusion that is universally
experienced
Appropriate Services for Sexual Minority Youth 35

36. Person-first disability services.
Person-first is more than a choice of words. It is choosing to
look at persons before we look at other factors: culture, race,
ethnicity, orientation, disability, disease.
Affirm each person as a person
first. We can easily be distracted
by the other factors.
Person-first thinking is key to both
consumer-driven and strength-
based services.
Appropriate Services for Sexual Minority Youth 36

37. Consumer-driven disability services.
Plan ahead for consumer-driven service to be appropriately
provided to a Sexual Minority individual.
Youth privacy vs. caregiver responsibility issues
“Outing” issues: confidentiality in the staff lunch room.
Appropriate Services for Sexual Minority Youth 37

38. Strengths-based disability services
Work to identify the strengths a youth
brings to the situation.
Find the protective factors that will
work against emotional difficulties
and self-injurious behaviors.
Many pathologies related to the GLBTQI youth experience are
not orientation-based, but are related to fear, exposure,
rejection, and abuse.
Appropriate Services for Sexual Minority Youth 38

39. Casework with LGBTQI2-S Youth
Work to avoid placements
Seek out safe placements: foster
care, congregant care, and
juvenile justice placements
Be prepared: do your homework
Become familiar with local options
Advocate appropriately
Assume nothing: let them inform decisions
Appropriate Services for Sexual Minority Youth 39

40. Working with Transgender Youth
Know the terms and use them appropriately
Understand GID: identification of symptoms
Refer for services related to GID
Allow for expressions of identity
Ensure appropriate care in referrals
Assume nothing: let them inform decisions
Appropriate Services for Sexual Minority Youth 40

41. Juvenile Justice with LGBTQI2-S Youth
Acknowledge their presence
Know that there are a
disproportionate number of
LGBT youth in JJ settings
Safe placements require staff
training and standards.
All youth have the right to be safe in placement.
Appropriate Services for Sexual Minority Youth 41

42. Juvenile Justice with LGBTQI2-S Youth
Identification and stigmatization are inappropriate treatment
Provide appropriate services
and referrals
Assume nothing: let them
inform your decisions. Do
not assume they are sex offenders.
Appropriate Services for Sexual Minority Youth 42

43. Families of LGBTQI2-S Youth
Families may or may not be
supportive of the youth’s
stated orientation
Encourage communication
within the family
Refer for services if there is significant need or conflict
Appropriate Services for Sexual Minority Youth 43

44. Guardians ad Litem working with
LGBTQI2-S Youth
Be aware of the presence of LGBTQI2-S youth in the child
welfare system in disproportionate numbers
Be aware of potential mistreatment and discrimination
Protect consumer privacy
Deal with anti-LGBTQI2-S
discrimination
Know the legal protections
available to consumers
Appropriate Services for Sexual Minority Youth 44

45. Appropriate professional service
Neither a common nor comfortable
professional situation for many.
Lack of training and discussion on this topic
in our region is a problem.
Presumption of indifference or non-
judgment may distract from actual
competency in service: the “color-blind”
myth.
Appropriate service provision will require
education, reflection, planning and
practice
Appropriate Services for Sexual Minority Youth 45

46. Appropriate professional service
 Professional obligation 1: get educated, know the facts.
 About the population
 About appropriate services
 Professional obligation 2: reflect on yourself, address
personal opinions and attitudes.
 Professional obligation 3: plan ahead to become competent in
appropriate skills.
 Professional obligation 4: practice appropriate skills, and
advocate for knowledge and skills growth in your agency.
Appropriate Services for Sexual Minority Youth 46

47. Appropriate professional service
Make this a professional development goal for yourself.
 Look for resources and study them. Web research.
 Find conferences and seminars.
 Become the “go to” person for youth and young adults
 Become the “go to” person for colleagues seeking
information and better practices. Again, advocate for
appropriate services.
Appropriate Services for Sexual Minority Youth 47

48. Open discussion and questions
Appropriate Services for Sexual Minority Youth 48