Case Scenarios

  1. Scenario:
    Ryva, a fifteen year-old male-to-female transitioning youth, wants to receive hormone replacement therapy to more closely align her secondary sexual characteristics with her gender identity. Ryva has asked the case manager if she needs permission or if she is old enough to consent to taking this medication or if her foster parent can sign consent.

    What is the Case Manager required to do?
    The case manager must inform Ryva that neither she nor her foster parent can legally consent to this type of medical service. The case manager must inform the caregiver and Ryva that in order to receive hormone therapy services, Ryva will need consent from either a biological parent, her medical rights holder or through a court order. The case manager should encourage Ryva to reach out to her attorney.

    What are some best practices for the case manager in this scenario?
    The case manager should ask Ryva what other types of support she needs. The case manager can assist Ryva with getting consent approved by a required party. The LGBTQ youth enter the foster care system for the same reasons as non-LGBTQ youth in care, such as abuse, neglect, and parental substance abuse. However, many LGBTQ youth have the added layer of trauma that comes with being rejected or mistreated because of their sexual orientation, gender identity or gender expression. The case manager should assess if Ryva needs referrals or assistance, as many LGBTQ youth are at risk for emotional and mental health issues and may experience homelessness or participate in such at risk behaviors as substance abuse and or risky sexual activity.