Promoting LGBT Adolescents’ Health and Well-Being

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Health care providers and other professionals have many opportunities to support and encourage the healthy development of LGBT youth, who may be at greater risk for bullying and victimization, according to a new position paper. Although most LGBT youth are healthy and well-adjusted, lack of acceptance by others can cause them added stress and lead to risky behavior or mental health issues, according to a new statement by the Society for Adolescent Health and Medicine issued this month in the Journal of Adolescent Health.

The report calls on professionals in medicine, social work, law, nursing, public health and other fields, to better understand the needs of LGBT youth and how to care for them in different settings. The position paper further calls on professionals to advocate for policy changes to support youth at school, at home and in child welfare and juvenile justice settings.

LGBT young people may be bullied or victimized more often than other adolescents, according to the position paper, which can lead to greater risk of depression or suicide. In one survey of LGBT students cited in the paper, 85 percent said they had been verbally harassed, 40 percent reported physical harassment and two thirds said they felt unsafe at school. Another study discussed in the report links LGBT victimization to nightmares, post-traumatic stress disorder, substance abuse and suicide attempts. Health care providers must be able to counsel patients on these issues and provide appropriate screening and treatment, according to the recommendations. The SAHM paper calls for providers to advocate for anti-bullying laws and policies and to educate their communities about preventing victimization of LGBT adolescents. Additional research into LGBT health needs is also needed, according to the paper.

The position paper takes a strong stance against “reparative therapy” intended to alter individuals’ sexual orientation. The science has firmly established that gender identity and sexual orientation are not choices, and there is a lot of data indicating reparative therapy is harmful, says Dr. David Reitman, the document’s lead author.

The position paper also suggests providers “be cautious in assigning labels to an adolescent’s sexual orientation, because this may evolve over time.” Youth may be feeling a same sex attraction but not feel comfortable labeling themselves as gay or lesbian, Reitman explained. Providers can echo the youth’s language about his or her feelings or identity and should avoid putting value judgments on gay or straight status, he said.

Family acceptance—or rejection—of LGBT adolescents can make a significant difference in their health and well-being outcomes. Research cited in the report from the Family Acceptance Project shows that providing families education and support can create better relationships, which leads to better mental health and less risky behavior for youth.

These findings are particularly important for child welfare professionals. “Fifteen years ago when kids came out and families weren’t accepting, the focus was [on placing youth] in more accepting settings,” Reitman said. “Dr. Caitlin Ryan’s work [through the Family Acceptance Project] shows that the best long term outcome for these kids is reunification and working with the families to increase their acceptance of their kids.” SAHM also calls for agencies to have anti-discrimination policies to protect youth in out of home care.

Juvenile justice agencies should also develop policies to safeguard the physical and emotional well-being of detained youth, according to the position paper. Agencies should partner with public health practitioners to access expertise on health issues facing LGBT youth, the report says.

LGBT youth being isolated or ignored in detention facilities is a concern, as are gender-based housing decisions and continuity of hormone treatment for transgender youth. SAHM recommends that juvenile justice facilities access guidelines published by other groups for serving youth in group facilities.

For juvenile justice facilities in particular, Reitman said, “the data shows that there’s a sense that it’s acceptable for staff to use [derogatory] language or allow kids to do so.”  Providing ongoing education to staff is even more important in these settings. So is requiring staff and young people to behave respectfully toward one another. Ignoring the issue is harmful, he said, because when staff fail to “call kids out on it … it’s an unspoken endorsement.”

To support LGBT youth, Reitman said professionals running programs for youth need to set up rules ahead of time to ensure that bullying isn’t tolerated. Young people need to know they are expected to treat each other with respect, and workers need to hold youth accountable, he said. If a staff member hears unacceptable language being used, they should talk to youth about how it makes others feel. If any young person seems particularly anxious, depressed or withdrawn, possibly due to bullying, Reitman recommends connecting them to appropriate mental health services.

These are happy, healthy kids dealing with the normal things adolescents deal with, Reitman said, but they are also a group that, because of pressures from society, face a number of challenges and risks other teens don’t. Providers working with LGBT adolescents must learn to recognize these challenges, the report says, and support youth to help them achieve self-acceptance and healthy development.

Lisa Pilnik, JD, MS, is a freelance writer, consultant, and co-founder of Child & Family Policy Associates, a Maryland-based consulting firm.