Trauma and Health Issues Among LGBTQ Youth
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Trauma and Health Issues Among LGBTQ Youth

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This presentation describes the impacts of trauma and minority stress on LGBTQ youth and discusses resultant health outcomes. Targeted resources for providers are highlighted.

This presentation describes the impacts of trauma and minority stress on LGBTQ youth and discusses resultant health outcomes. Targeted resources for providers are highlighted.

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  • 1. Trauma and Health Issues Among LGBTQ Youth Jean-Michel Brevelle Sexual Minorities Program Manager Maryland Department of Health & Mental Hygiene Prevention and Health Promotion Administration Infectious Disease Bureau
  • 2. Mission and Vision 2 Mission  The mission of the Prevention and Health Promotion Administration is to protect, promote and improve the health and well-being of all Marylanders and their families through provision of public health leadership and through community-based public health efforts in partnership with local health departments, providers, community based organizations, and public and private sector agencies, giving special attention to at-risk and vulnerable populations. Vision  The Prevention and Health Promotion Administration envisions a future in which all Marylanders and their families enjoy optimal health and well-being. Prevention and Health Promotion Administration December 19, 2013
  • 3. Objectives 3 By the end of this presentation, you will be able to:  Recognize key terms and culturally appropriate usage of language with LGBTQ communities  Identify impacts of negative messaging in the lives of sexual and gender minorities  Discuss trauma in relation to health disparities among LGBTQ youth  Locate culturally and linguistically appropriate resources for supporting wellness of LGBTQ adolescents and young adults Prevention and Health Promotion Administration December 19, 2013
  • 4. Words and Definitions 4 “I know you think you understand what you thought I said but I'm not sure you realize that what you heard is not what I meant.” Alan Greenspan Prevention and Health Promotion Administration December 19, 2013
  • 5. Definitions: Sex 5  Sex - Physical identity – specific body design that constitutes our understanding of sex. (e.g, penis and testes for males, vagina and ovaries for females.)   May also be referred to as ―birth sex‖, ―natal sex‖, or ―assigned sex at birth‖. Current social preferences do not tolerate a mixing of physical sexual characteristics (e.g. intersex individuals born with mixed or ambiguous characteristics). Prevention and Health Promotion Administration December 19, 2013
  • 6. Definitions: Gender 6  Gender - Psychosocial identity – your sense of maleness, femaleness, or otherness as it relates to social and cultural expectations of male and female gender roles.   Refers to the socially constructed roles, behaviors, activities, and attributes that a given society considers appropriate for men and women. In many, but not all cultures, gender is expected to align with a person’s sex. There are 3 important components to gender: Gender Identity  Gender Expression  Gender Attribution  Prevention and Health Promotion Administration December 19, 2013
  • 7. Definitions: More Definitions 7  Gender Identity    An individual’s perception of self as being a man/boy or woman/girl, or another gender entirely. Gender identity is formed very early in human development and, in its most fundamental sense, is not related to the way in which a child is raised. An internal sense of gender is a deeply engrained and enduring trait that presents challenges when not aligned with the physical sexual attributes of the body. Prevention and Health Promotion Administration December 19, 2013
  • 8. Definitions: Sexual Orientation 8  Sexual Orientation  Refers to the sex of those to whom one is sexually and romantically attracted. Categories of sexual orientation typically have included attraction to members of one’s own sex (gay men or lesbians), attraction to members of the other sex (heterosexuals), and attraction to members of both sexes (bisexuals). While these categories (LGB) continue to be widely used, research has suggested that sexual orientation does not always appear in such definable categories and instead occurs on a continuum. Prevention and Health Promotion Administration December 19, 2013
  • 9. Definitions: LGB 9  Lesbian – a woman with romantic, emotional, and sexual attraction to other women.  Gay – a man with romantic, emotional, and sexual attraction to other men. (Can also mean same-sex attraction in general.)  Bisexual – someone with romantic, emotional, and sexual attraction to both men and women. These words refer to one’s attraction to others. Prevention and Health Promotion Administration December 19, 2013
  • 10. Definitions: The T in LGBTQ 10  Transgender  A person who experiences and expresses their gender differently from the sex they were assigned at birth (e.g., a person assigned male at birth whose internal sense of sex and/or gender aligns with expectations for females, and vice versa.) This can also be an umbrella term inclusive of many people with diverse gender experiences, such as people who identify as transexual, genderqueer, bigender, agender, twospirit, and others. This word refers to self-concept and is different from words describing romantic, emotional, or sexual attraction. Prevention and Health Promotion Administration December 19, 2013
  • 11. Definitions: The Q in LGBTQ 11  Q can have two meanings:   Questioning – someone who is questioning their emerging sexual or gender identity (or both). This may be related to a developmental phase, a recent and new experience, or something that cannot be readily identified. Queer – Sometimes used as an umbrella term which embraces a matrix of sexual and gender expressions, orientations, and identities of the notexclusively-heterosexual-and-monogamous majority.  Sometimes used as a sexual orientation label instead of ―bisexual‖ as a way of acknowledging that there are more than two sexes or genders to be attracted to, or as a way of stating a non-heterosexual orientation without having to state a specific, limiting orientation.  Queer is also a reclaimed word that was formerly used solely as a slur but that has been semantically overturned by members of the maligned group, who use it as a term of defiant pride.  Prevention and Health Promotion Administration December 19, 2013
  • 12. Definitions: More Definitions 12  Cisgender  A person whose gender identity and expression aligns (agrees) with the social and cultural expectations of their sex assigned at birth. (Literally, ―same‖ (cis-) gender. )  Gender Non-Conforming  A person whose mannerisms, appearance (clothing, hair, use of cosmetics, etc.), social roles, and other gender-labeled traits differ from societal expectation (e.g., ―feminine‖ behavior or appearance in a male, ―masculine‖ behavior or appearance in a woman). Sometimes also referred to as gender variance, gender-variant. Gay, lesbian, and bisexual people are sometimes labeled by others as gender non-conforming. Prevention and Health Promotion Administration December 19, 2013
  • 13. Definitions: Last One, I Promise 13  Heteronormative  A term describing any of a set of societal norms that hold that people fall into distinct and complementary genders (man and woman) with natural roles in life. It also holds that heterosexuality is the normal sexual orientation, and states that sexual and marital relations are most (or only) fitting between a man and a woman. Consequently, a heteronormative view is one that involves alignment of biological sex, sexuality, gender identity, and gender roles. Prevention and Health Promotion Administration December 19, 2013
  • 14. Binary Gender Model Biological Sex: hormones, genitalia, secondary sex characteristics Gender Identity: ―I am…‖ Male Man Gender Expression: mannerisms, role, social context Masculine Sexual Orientation: erotic, emotional attraction to others Prevention and Health Promotion Administration Women *GENDER LINE * DO NOT CROSS! 14 Female Woman Feminine Men December 19, 2013
  • 15. Impact of Gender Binary View 15  Assumes, reinforces, and privileges   Cisgender identity Heterosexual ―norm‖  Assigns and distributes gender-exclusive roles, mannerisms, clothing, relationships, and other social capital  Invalidates   Identities and expressions that do not conform to societal sex/gender expectations Equality of LGBT individuals  Makes difference and nonconformity unsafe. Gives license to stigmatize or discriminate against ―the other‖ Prevention and Health Promotion Administration December 19, 2013
  • 16. Quick Stats 16 What we Know about LGBT Populations and Health Disparities Prevention and Health Promotion Administration December 19, 2013
  • 17. Key Health Issues for LGBT People 17  Cancer  Depression  Heart Disease  Anxiety  Obesity  Self-injury  Injury/Violence  Suicide  Tobacco Use  Substance Abuse  Sexually Transmitted Infections (HIV, syphilis, HPV, etc.)  Viral hepatitis (A,B,& C) Prevention and Health Promotion Administration December 19, 2013
  • 18. Discrimination and Barriers to Health Care 18 LGBT people and people living with HIV experience enormous challenges accessing quality, non-discriminatory health care services. N=4,916 When Health Care Isn’t Caring: Lambda Legal’s Survey of Discrimination Against LGBT People and People with HIV (New York: Lambda Legal, 2010). Available at www.lambdalegal.org/health-care-report Prevention and Health Promotion Administration December 19, 2013
  • 19. Anti-LGBTQ Violence 19 Prevention and Health Promotion Administration December 19, 2013
  • 20. LGBT People & Mental Health Issues 20  LGBT people are at higher risk for depression, anxiety, and substance abuse disorders. 1  LGB people are about 2 ½ times more likely than their heterosexual peers to have had a mood, anxiety, or substance abuse disorder in their lifetime. 1  LGBT people who experience interpersonal trauma and sexual discrimination have an increased likelihood of engaging in suicidal and nonsuicidal self-injury. 2 Prevention and Health Promotion Administration December 19, 2013
  • 21. LGB & PTSD 21  In a 2010 study, lesbians and gay men, bisexuals, and heterosexuals who reported any same-sex sexual partners over their lifetime had greater risk of childhood maltreatment, interpersonal violence, trauma to a close friend or relative, and unexpected death of someone close than did heterosexuals with no samesex attractions or partners. 3  LGB people were twice as likely to suffer from post traumatic stress disorder as the heterosexual people in the study. 3 Prevention and Health Promotion Administration December 19, 2013
  • 22. LGBT Youth & Suicide 22  LGB youth are 4 times more likely, and questioning youth are 3 times more likely, to attempt suicide as their heterosexual peers.4  Suicide attempts by LGB and questioning youth are 4 to 6 times more likely to result in injury, poisoning, or overdose that requires medical treatment, compared to their heterosexual peers. 4  LGBT youth who come from highly rejecting families are up to 8 times as likely to have attempted suicide as LGBT peers who reported no or low levels of family rejection. 5 Prevention and Health Promotion Administration December 19, 2013
  • 23. LGBT Youth & Suicide 23  A recent study of LGBT youth reported that elevated levels of depression and suicidal ideation among males can be explained by their high rates of LGBT school victimization. 6  Nearly half of young transgender people have seriously thought about taking their lives, and 25% report having made a suicide attempt. 7  37.4% of LGBT youth in one study reported suicidal ideation. 8   Neither gender nor gender non-conformity was predictive of suicidal ideation. LGBT victimization and lower social support were associated with greater suicidal ideation. Prevention and Health Promotion Administration December 19, 2013
  • 24. Tony 24 A Health Care Story Prevention and Health December 19, 2013
  • 25. Tony’s Story 25 Credit to the Movement Advancement Project Prevention and Health Promotion Administration http://www.lgbtmap.org December 19, 2013
  • 26. Growing Up LGBT 26 Risk Factors Minority Stress Negative Messaging Prevention and Health Promotion Administration December 19, 2013
  • 27. Stress Factors Influencing LGBT Adolescent Development 27  LGBT adolescents have the same basic needs as other youth:    development of self-esteem, identity, and intimacy social and emotional well-being physical health  LGBT adolescents may be especially vulnerable to not having their basic needs met.  They may feel different from their peers, and unsure how their friends and family will react to their sexual orientation or gender identity. They often lack other outlets for exploring their sexual identity, such as talking to mentors or same-sex dating.  LGBT adolescents are subject to high rates of physical and verbal abuse, being forced out of their homes, and sexual assault (D'Augelli, AR 1995). Although most LGBT youth show remarkable resilience, these factors combined with stigma may be related to higher rates found in LGBT adolescents of dropping out of school, using tobacco, alcohol or drugs, suicide attempts, depression, and HIV disease (Frankowski 2004). Prevention and Health Promotion Administration December 19, 2013
  • 28. Impact of Societal Pressure and Stigma 28  LGBT identities and lives are stigmatized and devalued by our society, which promotes heterocentric norms and ideals as the only ―right‖ or ―acceptable‖ way to be.  LGBTQ youth are exposed to a tremendous amount of negative messaging about their desires, identity, and expression from virtually all quarters of society. Prevention and Health Promotion Administration Culture Religion Media Family Community School Peers December 19, 2013
  • 29. Minority Stress 29 Prejudice directed toward minorities is stressful and may lead to adverse mental health outcomes. Minority Stress is:  Socially based –stems from social structures beyond the individual’s control  Chronic–constantly present in social and cultural structures  Unique–additive to general stressors Minority Stress Model, Ilan H. Meyer, Ph.D. Prevention and Health Promotion Administration December 19, 2013
  • 30. Negative Messaging Math Problem 30 Scenario: Greg is a 15 year old gay-identified male who hears negative messages about being gay from many sources – his family, friends, teachers, pastor, at school, on the TV and the internet, at the mall, etc. Greg hears negative messages about being gay at least 15 times each day. Greg has been taking in these messages since he was about 2 years old. By age 15, how many ―doses‖ of anti-gay messages has Greg received? Prevention and Health Promotion Administration December 19, 2013
  • 31. Negative Messages Dosage Math 31 Prevention and Health Promotion Administration December 19, 2013
  • 32. Negative Messages Dosage Math – Part 2 32  Learned Helplessness (Internalization)  Dog experiment (Seligman and Maier, cir. 1967)  Assisted ―unlearning‖ – 280 attempts before success Prevention and Health Promotion Administration December 19, 2013
  • 33. Negative Messages Dosage Math – Part 3 33  What will it take for Greg to overcome the effects of these messages? Prevention and Health Promotion Administration December 19, 2013
  • 34. Growing Up LGBT in America. Human Rights Campaign, December 19, 2013 Prevention and Health Promotion Administration http://www.hrc.org/youth#.UrITefRDvng
  • 35. Health Risk Multipliers 35  Family rejection  Childhood sexual abuse  Bullying in school  Unemployment or reliance on street economy  Homelessness  Sexual exploitation  including but not limited to sex work  Sexual assault  Moderate to severe body dysphoria Prevention and Health Promotion Administration December 19, 2013
  • 36. Trauma 36 “Childhood trauma does not come in one single package.” ― Dr. Asa Don Brown Prevention and Health Promotion Administration December 19, 2013
  • 37. What is Trauma? 37  The key to understanding traumatic events is that it refers to extreme stress that overwhelms the person’s ability to cope.  It is the individual’s subjective experience that determines whether an event is or is not traumatic, not the actual event.  Psychological trauma is the unique individual experience of an event or enduring conditions, in which   the individual's ability to integrate his/her emotional experience is overwhelmed, or the individual experiences (subjectively) a threat to life, bodily integrity, or sanity. (Pearlman & Saakvitne, 1995, p. 60) Prevention and Health Promotion Administration December 19, 2013
  • 38. Impacts of Trauma 38  Trauma, especially when left untreated, can have severe negative impacts on a person’s physical and emotional well-being, such as:           Hallucinations Delusions Depression Suicidal ideation/attempt Chronic anxiety Hostility Interpersonal sensitivity (―poor social skills‖) Somatization (chronic fatigue syndrome, etc.) Eating disorders Dissociation Prevention and Health Promotion Administration December 19, 2013
  • 39. Trauma is Common and Pervasive 39  Between 55% and 90% of us have experienced at least 1 traumatic event. Average is 5. (Fallot & Harris, 2009)  Disproportionately affects the most vulnerable   People who are homeless, impoverished, diagnosed with severe mental illness, struggle with addiction, or who are developmentally disabled are at increased risk of trauma. Research suggests that LGBT people may experience trauma at much higher rates than the general population.  Impact is broad, often deep and long-lasting  Affects the way people approach helping relationships  Has often occurred within the service context itself Prevention and Health Promotion Administration December 19, 2013
  • 40. The Science of Trauma 40  Trauma produces neurobiological impacts on the brain, causing dysfunction in the hippocampus, amygdala, medial prefrontal cortex, and other limbic structures.  When confronted with danger, the brain moves from a normal ―information-processing‖ state to a survivaloriented, reactive ―alarm state.‖  Trauma causes the body’s nervous system to experience: an extreme adrenaline rush; intense fear; information processing problems; and a severe reduction or shutdown of cognitive capacities, leading to confusion and a sense of defeat. Prevention and Health Promotion Administration December 19, 2013
  • 41. The Science of Trauma 41  If there are insufficient biological or social resources to assist in coping, the ―alarm state‖ may persist even when the immediate danger has passed, and this can lead to PTSD.  Excessive and repeated stress causes the release of chemicals that disrupt brain architecture by impairing cell growth and interfering with the formation of healthy neural circuits.  When trauma occurs repeatedly, permanent changes in the brain can occur, compromising core mental, emotional, and social functioning – and resulting in a brain that is focused on surviving trauma. Prevention and Health Promotion Administration December 19, 2013
  • 42. Adverse Childhood Experiences 42  ACE Study (1998 & 2009)  Kaiser Permanente, San Diego – 17,000 (1995-1997)  5 States via Behavioral Risk Factor Surveillance Survey 26,229 (2009) (AR, LA, NM, TN, WA)  ACEs have been linked to a range of adverse health outcomes in adulthood, including substance abuse, depression, cardiovascular disease, diabetes, cancer, and premature mortality. Centers for Disease Control and Prevention. MMWR, December 17, 2010 / 59(49);1609-1613 Prevention and Health Promotion Administration December 19, 2013
  • 43. ACE Scoring 43 While you were growing up, during your first 18 years of life: 1. Did a parent or other adult in the household often or very often… Swear at you, insult you, put you down, or humiliate you? or Act in a way that made you afraid that you might be physically hurt? Yes No If yes enter 1 ________ 2. Did a parent or other adult in the household often or very often… Push, grab, slap, or throw something at you? or Ever hit you so hard that you had marks or were injured? Yes No If yes enter 1 ________ Excerpted from Finding Your ACE Score, assessment tool. 092406RA4CR Prevention and Health Promotion Administration December 19, 2013
  • 44. ACE Scoring 44 While you were growing up, during your first 18 years of life: 3. Did an adult or person at least 5 years older than you ever… Touch or fondle you or have you touch their body in a sexual way? or Attempt or actually have oral, anal, or vaginal intercourse with you? Yes No If yes enter 1 ________ 4. Did you often or very often feel that… No one in your family loved you or thought you were important or special? or Your family didn’t look out for each other, feel close to each other, or support each other? Yes No If yes enter 1 ________ Excerpted from Finding Your ACE Score, assessment tool. 092406RA4CR Prevention and Health Promotion Administration December 19, 2013
  • 45. ACE Comprehensive Chart 45 Column 1 Column 2 Column 3 Adverse Childhood Experiences Neurobiological Impacts and Health Risks Long-Term Health and Social Problems the greater the neurobiological impacts and health risks… the more serious the lifelong consequences to health and well-being. Substance Use Violence/Bullying Suicide Attempts 50+ Sex partners Asthma Liver Disease Homelessness HIV The more types of adverse childhood experiences… Abuse Neglect Trauma in the Household Prevention and Health Promotion Administration December 19, 2013
  • 46. ACE Pyramid 46 http://www.theannainstitute.org/ Prevention and Health Promotion Administration December 19, 2013
  • 47. Highlights from the Family Acceptance Project 47  In families where parents or caregivers highly pressured their children to conform to [heteronormative] gender expectations, children were:     More than 8 times as likely to have attempted suicide; Nearly 6 times as likely to report high levels of depression; More than 3 times as likely to use illegal drugs; and More than 3 times as likely to be at high risk for HIV and STDs. Dr. Caitlin Ryan, Family Acceptance Project Prevention and Health Promotion Administration http://familyproject.sfsu.edu/ December 19, 2013
  • 48. Highlights from the Family Acceptance Project 48 When gay and transgender youth were accepted by their families, they were much more likely to believe they would have a good life and would be a happy, productive adult. Prevention and Health Promotion Administration December 19, 2013
  • 49. Child Sexual Abuse 49  LGBTQ youth are more likely to have experienced sexual abuse than heterosexual youth. However, sexual abuse does not ―cause‖ heterosexual youth to become LGBTQ. 10, 11, 12  LGBT kids may be disproportionately targeted by abusers. Sexual predators look for children who are vulnerable.  Research indicates a connection between bullying and child sexual abuse, with bully/victims (those youth who bully their peers and have also been bullied) especially at risk for child sexual abuse. 13 Prevention and Health Promotion Administration December 19, 2013
  • 50. School Victimization & Trauma 50  Gender non-conforming students who experience victimization due to sexual orientation status during childhood are at greater risk for developing posttraumatic stress disorder later in life than those who are not gender non-conforming (D’Augelli et al., 2006)  Higher levels of self-reported adolescent gender nonconformity are associated with more LGBT school victimization. (Toomey, et al., 2010) Prevention and Health Promotion Administration December 19, 2013
  • 51. School Victimization & Trauma 51  Gender non-conformity predicts victimization specific to perceptions of LGBT status, and that victimization—not the characteristic of gender nonconformity—accounts for long-term psychosocial adjustment problems (Toomey, et al., 2010)  This study also demonstrated that school victimization due to gender non-conformity fully accounted for poor life satisfaction in early adulthood among participants. No other mediating factors were needed. Prevention and Health Promotion Administration December 19, 2013
  • 52. Best Practice Tips 52 Prevention and Health Promotion Administration December 19, 2013
  • 53. Best Practices Tips 53  Respect the Client’s  Identity  Pronouns  Names  Goals  Privacy  Right to safety Prevention and Health Promotion Administration December 19, 2013
  • 54. Best Practices Tips 54  Acknowledge  Client’s Isolation  Struggle  Resilience  Health seeking behavior   Your Limits of knowledge / experience  Desire to build trust  Commitment to providing quality, compassionate services  Need for respite and support  Prevention and Health Promotion Administration December 19, 2013
  • 55. Best Practices Tips 55  Advocate for  Trauma-informed care  LGBT-inclusive, affirming policies  Professional development at all levels on LGBT health issues  Your client’s access to culturally and medically responsive referrals  Your client’s right to determine their life priorities  Strive to become the resource that you are looking for Prevention and Health Promotion Administration December 19, 2013
  • 56. Allies and Resources 56 Prevention and Health Promotion Administration December 19, 2013
  • 57. 57 http://militarypartners.org/resources/ Prevention and Health Promotion Administration December 19, 2013
  • 58. 58 Resources Available • • • • • Presentations Publications and Tools Web sites Videos TA Partnership Webinars http://tapartnership.org/COP/CLC/lgbtqi2sWorkgroup.php Prevention and Health Promotion Administration December 19, 2013
  • 59. 59 http://www.findyouthinfo.gov/youth-topics/lgbtq-youth Prevention and Health Promotion Administration December 19, 2013
  • 60. 60 http://familyproject.sfsu.edu/ Prevention and Health Promotion Administration December 19, 2013
  • 61. 61 http://www.actforyouth.net/resources/n/n_healthy_adol_sx_dev/ Prevention and Health Promotion Administration December 19, 2013
  • 62. 62 Common Queeries are generated by HIV/AIDS service providers across the state of Maryland. Do you have a question about LGBTQ needs, rights, or culture? Want to subscribe or unsubscribe? Quibbles, comments or compliments? Email Kate Bishop at kbishop@peds.umaryland.edu Prevention and Health Promotion Administration December 19, 2013
  • 63. Questions? 63 Prevention and Health Promotion Administration December 19, 2013
  • 64. Moving Upstream 64 It’s always easier to fight the current at the river’s source than it is at its end. The most significant experiences that shift the balance of risk for LGBT people take place in childhood and adolescence. This is where our efforts must be targeted. Prevention and Health Promotion Administration December 19, 2013
  • 65. Contact Information 65 Jean-Michel Brevelle Sexual Minorities Program Manager (410) 767-5016 jean-michel.brevelle@maryland.gov Maryland Department of Health & Mental Hygiene Prevention and Health Promotion Administration Infectious Disease Bureau http://phpa.dhmh.maryland.gov/ Prevention and Health Promotion Administration December 19, 2013
  • 66. References & Data Sources (1) 66 1. Mental Health Issues among Gay, Lesbian, Bisexual, and Transgender (GLBT) People. NAMI Multicultural Action Center, June 2007. 2. House, A. S.,Van Horn, E., Coppeans, C., & Stepleman, L. (in press). Interpersonal trauma and discriminatory events as predictors of suicidal and nonsuicidal self-injury in gay, lesbian, bisexual and transgender persons. Journal of Traumatology June 2011 vol. 17 no. 2 75-85. 3. Roberts AL, Austin SB, Corliss HL, Vandermorris AK, Koenen KC. Pervasive Trauma Exposure Among US Sexual Orientation Minority Adults and Risk of Posttraumatic Stress Disorder. Am J Public Health. 2010 Dec;100(12):2433-41. doi: 10.2105/AJPH.2009.168971. Epub 2010 Apr 15. 4. CDC. Sexual Identity, Sex of Sexual Contacts, and Health-Risk Behaviors Among Students in Grades 9-12: Youth Risk Behavior Surveillance, 2011. 5. Ryan, C., Russell, S. T., Huebner, D., Diaz, R. and Sanchez, J. (2010), Family Acceptance in Adolescence and the Health of LGBT Young Adults. Journal of Child and Adolescent Psychiatric Nursing, 23: 205–213. 6. Russell ST, Ryan C, Toomey RB, Diaz RM, Sanchez J. Lesbian, gay, bisexual, and transgender adolescent school victimization: implications for young adult health and adjustment. J Sch Health. 2011 May;81(5):223-30. 7. Grossman AH, D'Augelli AR. Transgender youth and life-threatening behaviors. Suicide Life Threat Behav. 2007, Oct;37(5):527-37. 8. Richard T. Liu, Brian Mustanski. Suicidal Ideation and Self-Harm in Lesbian, Gay, Bisexual, and Transgender Youth. Am J Prev Med. 2012 Mar;42(3):221-8. 9. D’Augelli, A. R., Grossman, A. H., & Starks, M. T. (2006). Childhood gender atypicality, victimization, and PTSD among lesbian, gay, and bisexual youth. Journal of Interpersonal Violence, 21, 1462–1482. Prevention and Health Promotion Administration December 19, 2013
  • 67. References & Data Sources (2) 67 10. Arreola S, Neilands T, Pollack L, et al. Childhood sexual experiences and adult health sequelae among gay and bisexual men: defining childhood sexual abuse. J Sex Research. 2008;45:246-252. 11. Brady S. The impact of sexual abuse on sexual identity formation in gay men. J Child Sexual Abuse. 2008;17:359-376. 12. Friedman MS, Marshal MP, Guadamuz TE, et al. A meta-analysis of disparities in childhood sexual abuse, parental physical abuse, and peer victimization among sexual minority and sexual nonminority individuals. Am J Public Health. 2011;101:1481-1494. 13. Holt M, Finkelhor D, Kaufman Kantor G, et al. Hidden forms of victimization in elementary students involved in bullying. School Psychology Rev. 2007;36:345-360. Prevention and Health Promotion Administration December 19, 2013
  • 68. Trauma Informed Care 68 The five core elements of TIC are:  Safety — is everything being done to ensure physical and emotional safety (welcoming, respectful, sufficient personal space, consistency)  Trustworthiness — are expectations and interactions for everyone clear and consistent (boundaries, respect, non-judgmental)  Choice — is a condition being created so individuals experience a feeling of choice and control (providing options, choices, optional program supports  Collaboration — is the approach one of sharing and collaboration in all interactions (learning from each other, seeking input, listening first)  Empowerment — is there a fostering of the individual's strengths, experiences, and uniqueness for building upon (recovery, hope, skill building) Prevention and Health Promotion Administration December 19, 2013