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Appropriate services for sexual minority youth
Appropriate services for sexual minority youth
Appropriate services for sexual minority youth
Appropriate services for sexual minority youth
Appropriate services for sexual minority youth
Appropriate services for sexual minority youth
Appropriate services for sexual minority youth
Appropriate services for sexual minority youth
Appropriate services for sexual minority youth
Appropriate services for sexual minority youth
Appropriate services for sexual minority youth
Appropriate services for sexual minority youth
Appropriate services for sexual minority youth
Appropriate services for sexual minority youth
Appropriate services for sexual minority youth
Appropriate services for sexual minority youth
Appropriate services for sexual minority youth
Appropriate services for sexual minority youth
Appropriate services for sexual minority youth
Appropriate services for sexual minority youth
Appropriate services for sexual minority youth
Appropriate services for sexual minority youth
Appropriate services for sexual minority youth
Appropriate services for sexual minority youth
Appropriate services for sexual minority youth
Appropriate services for sexual minority youth
Appropriate services for sexual minority youth
Appropriate services for sexual minority youth
Appropriate services for sexual minority youth
Appropriate services for sexual minority youth
Appropriate services for sexual minority youth
Appropriate services for sexual minority youth
Appropriate services for sexual minority youth
Appropriate services for sexual minority youth
Appropriate services for sexual minority youth
Appropriate services for sexual minority youth
Appropriate services for sexual minority youth
Appropriate services for sexual minority youth
Appropriate services for sexual minority youth
Appropriate services for sexual minority youth
Appropriate services for sexual minority youth
Appropriate services for sexual minority youth
Appropriate services for sexual minority youth
Appropriate services for sexual minority youth
Appropriate services for sexual minority youth
Appropriate services for sexual minority youth
Appropriate services for sexual minority youth
Appropriate services for sexual minority youth
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Appropriate services for sexual minority youth

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Learn how important it is to provide services to sexual minorities.

Learn how important it is to provide services to sexual minorities.

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  • Where to look? We will discover some answers to this questions as we go
  • Where to look: Homeless, Drop-outs, placements. Why?
  • Where to look: Victims, truants, substance abusers. Why? All of the kids in these groups? Certainly not.
  • Where to look: MH populations
  • Where to look: Suicide and self-injury. Elevated chance of being in the group
  • Where to look: Sexually active kids, though not all, of course.
  • Transcript

    • 1. Appropriate Services forSexual Minority YouthOur Children Succeed InitiativeTimothy Denney, MS, CRCFunded in part by a cooperative agreement between the NW MinnesotaCouncil 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 termsLesbian: 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 termsTransgender (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 termsTwo-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 LongitudinalStudy of Adolescent Health7% Same Sex Attraction,(13-17 Y.O. 6%)National Health & NutritionExam Survey III 17-39 Y.O: 2.2 % reported same sex partnersEven 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?Massachusettss YRBS, a comprehensive studyof 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-identifyHow 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 MinnesotaDiscuss: 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 AnalysisHomelessness: LGBTQI2-S youthmore likely to be in placement orhomeless at some point.One study showed up to half ofLGBT youth in placement surveyedwere 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 AnalysisNational 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 AnalysisHuebner, 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 AnalysisSubstance 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 AnalysisRunning 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 familys 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 statisticsNearly all studies confounded: Alcohol, Homelessness MH disabilitiesDifficult to know actual statisticalrisk for suicide attempts inLGBTQI2-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 statisticsMN 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 attemptAdult MSNBC: 2 times more likely (non-rigorous study) Appropriate Services for Sexual Minority Youth 21
    • 22. Suicide: loaded topic, divergent statisticsRussell & 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 monthsPaul, 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 statisticsMeyer, 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 statisticsActual 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 limitationsInfers 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 RightsNon-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 BarriersService 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 youthSexual 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 studentmay 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 consumersBe aware of your language everywhereAvoid stereotyping Appropriate Services for Sexual Minority Youth 34
    • 35. Working with LGBTQI2-S Youth Create a positive and welcoming environment Respond appropriately to self-disclosureBecome 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 servicesWork to identify the strengths a youthbrings to the situation.Find the protective factors that willwork against emotional difficultiesand 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 YouthWork to avoid placementsSeek out safe placements: foster care, congregant care, and juvenile justice placementsBe prepared: do your homeworkBecome familiar with local optionsAdvocate appropriatelyAssume nothing: let them inform decisions Appropriate Services for Sexual Minority Youth 39
    • 40. Working with Transgender YouthKnow the terms and use them appropriatelyUnderstand GID: identification of symptomsRefer for services related to GIDAllow for expressions of identityEnsure appropriate care in referralsAssume 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 YouthIdentification and stigmatization are inappropriate treatmentProvide appropriate servicesand referralsAssume nothing: let theminform your decisions. Donot 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 familyRefer for services if there is significant need or conflict Appropriate Services for Sexual Minority Youth 43
    • 44. Guardians ad Litem working withLGBTQI2-S YouthBe aware of the presence of LGBTQI2-S youth in the child welfare system in disproportionate numbersBe aware of potential mistreatment and discriminationProtect consumer privacyDeal with anti-LGBTQI2-SdiscriminationKnow the legal protectionsavailable 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

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