Lesbian Gay Bisexual Transgender and Questioning (LGBTQ)
National research by the Center for the Study of Social Policy (“Out of the Shadows” report) states 22.8% of children in the foster care system identify as LGBTQ. Given that over 20% of the youth in care identify as LGBTQ, attention and sensitivity to the needs of LGBTQ teens is essential. Like all youth, LGBTQ youth in foster care need accurate, age-appropriate, and culturally sensitive information regarding sexual and reproductive health. LGBTQ youth often face bullying and harassment, familial rejection, homelessness, higher rates of teen dating violence, suicide attempts, and become victims of hate crimes. LGBTQ youth face serious safety threats and may have heightened concerns and fears about discussing their sexual orientation and gender identity. LGBTQ youth are at a higher risk of early sexual encounters and abuse than their non-LGBTQ counterparts according to the Centers for Disease Control and Prevention (CDC). Rates of depression and suicide are significantly higher for LGBTQ youth in foster care, likely due to the increased stress and isolation (

Transgender (“trans”) youth face many of the same challenges as other LGBQ youth, but they also face additional health challenges and social stigma. Transgender youth are making decisions around their gender identity, gender expression and transitioning. This can consist of changing their name, pronouns, dress, hairstyle, voice, and a myriad of other changes that help the youth express their gender. Some youth may want to begin or are currently using hormones to assist in their transition, which may include puberty blockers and/or hormone therapies. Additionally, youth may want to begin other procedures to alter their bodies to be aligned with their gender. A transgender foster youth should speak to their attorney regarding consent for medical care such as puberty blocking medication or hormone therapy. It is critical to assist a foster youth in talking to their attorney and medical providers if they wish to seek hormone therapies. When caregivers and social workers ignore a youth’s request for help, they put the youth at increased risk of seeking hormones from non- medical venues. Taking hormones without proper medical monitoring is dangerous and can even be deadly. It is important that transgender youth talk to a skilled counselor or therapist as well a healthcare provider who understands their unique needs.

ScenarioWhat To Do
The youth discloses
that they are gay,
lesbian or bisexual.
• The caregiver can provide reassurance to the youth and can ask the youth what would help them feel safe and supported.
• The caregiver can assist the youth by thoughtfully directing them to helpful websites, programs, and resources for information and to find answers to the questions they may have.
• The caregiver can assist youth in finding and attending LGBTQ community activities, events, resources, organizations and social programs for LGBTQ youth.
• The caregivers can help the youth get connected to a positive LGBTQ mentor.
• The caregiver shall not disclose information regarding a youth’s sexual orientation or gender identity without the youth’s permission.
The youth discloses they are
or gender non- conforming.
• The caregiver can provide reassurance to the youth and ask the youth what would help them feel safe and supported.
• The caregiver can ask the youth what name and gender pronouns to use, and will refer to the youth using the terms the youth requests.
• The caregiver can offer to support the youth to get clothing and supplies that match their gender.
• The caregiver should ask if the youth would prefer a room change that allows the youth to be placed with the gender they most identify with, rather than their biological sex.
• The caregiver can require staff to respect the trans youth and stop any incidents of bullying, harassment, or discrimination.
• The caregiver can get to know and welcome their partner if they have one.
• The caregiver can help the youth get connected to a positive trans mentor.
• The caregiver can ask if they have any questions concerning transgender issues and if they would like to discuss them with a therapist or healthcare provider. The caregiver shall assist with scheduling a healthcare appointment if requested and shall transport the youth to the appointment.
• The caregiver shall maintain the youth’s rights to privacy and confidentiality and only share information that the youth permits the caregiver to share.
The youth
that they
have gone to a clinic for hormones
and has started to transition.
• The caregiver can provide reassurance to the youth and help them feel safe and supported.
• The caregiver shall not prohibit any youth from accessing medical attention including prescribed hormone therapies.
• The caregivers should get educated about the hormones or medications the youth was prescribed.
• The caregiver should ask the youth what medications they were prescribed, how they are feeling on their medications, and if they are experiencing any adverse side effects.
• Hormone therapy medications shall be centrally stored in the facility and must be logged. The Centrally Stored Medication and Destruction Record (lic 622) is available for this purpose. Identify what information must be recorded for all centrally stored medications.
• Medications shall be locked and inaccessible to unauthorized caregivers, children, and other youth.
• All medications shall be stored in accordance with label instructions (refrigerate, room temperature, out of direct sunlight, etc.).