Mental Health Practice with LGBTQ+ Children, Adolescents, and Emerging Adults in Multiple Systems of Care

ContributorsRoberto L. Abreu, Eunice V. Avilés Faría, Matthew J. Beck, Rachel Becker-Warner, Dianne Berg, Nova J. Bradford, Leonardo Candelario-Pérez, Zari K. Carpenter, Kevin Carrión, Taymy J. Caso, Jennifer J. Connor, Luis Díaz-Medero, Marla E. Eisenberg, Caleb Esteban, Jan E. Estrellado, Catherine Forbes, Amy Gower, Kellen R. Grayson, Gary Howell, Astrid Irizarry-Rodríguez, Saeromi Kim, Mira Krishnan, Cristina L. Magalhães, Caroline Maykut, Carrie Mounier, Arlene Noriega, Alixida Ramos-Pibernus, G. Nic Rider, Hiram Rivera-Mercado, Tangela Roberts, Catherine Schaefer, Kat Schuette, Kayden J. Schumacher, Katherine G. Spencer, Richard A. Sprott, Molly M. Strear, Kaitlin Venema, Jessica Ward, Julie Williams, Macy WilsonAbout the EditorsCristina L. Magalhães, PhD, LMHC (she/her), is professor of clinical psychology, director of the Clinical PsyD Program, and coordinator of the Rockway Certificate in LGBTQ Mental Health and Human Services at the California School of Professional Psychology (CSPP) at Alliant International University, Los Angeles. Dr. Magalhães has served on various committees and task forces charged with addressing the needs of LGBTQ+ people and communities. She is founding editor of PERSPECTIVES (2014–2021)—the newsletter of APA Division 35 Section IV on gender and sexual minority concerns—and currently serves as president-elect of the same professional organization. Dr. Magalhães began her training as a psychologist in Brazil in the late 1980s, became licensed as a mental health counselor in Florida in 2002, and obtained her license as a psychologist in California in 2010. She has experience working with LGBTQ+ couples, families, and individuals across the life span in community mental health centers, residential settings, social service agencies, and private practice.Richard A. Sprott, PhD, received his doctoral degree in developmental psychology from University of California Berkeley in 1994. His early work was on social and language development in early childhood. He is president of the Society for the Psychology of Sexual Orientation and Gender Diversity for 2021–2022 (APA Division 44). For more than 12 years, he co-chaired the Children, Youth and Families Committee of Society for the Psychology of Sexual Orientation and Gender Diversity. He is coeditor on a newly released book from APA Books entitled Supporting Gender Identity and Sexual Orientation Diversity in K–12 Schools. He is also the co-author of Sexual Outsiders: Understanding BDSM Sexualities and Communities (Rowman & Littlefield, 2013). Along with Dr. Elisabeth Sheff, he is also co-editor of a new book series, Diverse Sexualities, Genders, and Relationships, from Rowman & Littlefield. He is currently directing research projects focused on identity development and health/well-being in people who express alternative sexualities and nontraditional relationships, with a special emphasis on kink/BDSM sexuality and polyamory or consensual non-monogamy. Richard currently teaches courses in the Department of Human Development and Women’s Studies at California State University, East Bay.G. Nic Rider, PhD, LP, is an assistant professor at the Institute for Sexual and Gender Health at the University of Minnesota Medical School and director at the National Center for Gender Spectrum Health. Dr. Rider’s scholarly work often focuses on social and structural factors affecting the lived experiences of historically marginalized communities and resilience/strengths identified by these communities. Their professional interests are in the areas of intersectionality, improving various health disparities, decolonizing healing justice, systems change, and social justice advocacy. They currently serve as co-chair for the Asian American Psychological Association’s Division on LGBTQQ and participate on committees advocating for sexual and gender diverse individuals globally.

Within the current legislative climate of attacks on LGBTQ+ people in the US, this book provides a positive, affirming view of mental health practices for mental health professionals working with LGBTQ+ children, adolescents, and emerging adults. As edited by Magalha~es, Sprott, and Rider, two factors that make the book stand out are its focus on all groups of younger people and the frameworks utilized. Grounded in minority stress theory and incorporating an intersectional, resilience- and strength-focus approach along with other interdisciplinary and whole-person approaches, the book provides an in-depth overview of given theoretical approaches and of LGBTQ+ issues at various developmental stages: children, adolescents, and emerging adults. This overview is offered along with a look, in part 3, at particular systems of care, e.g., pre-K–12 schools, college campuses, foster care, homelessness, and the (in)justice system. Acknowledging existing research gaps, chapters summarize pertinent gaps and recommend future research and health practice considerations. Although the target audience is mental health professionals who want to implement a more holistic approach in their work with LGBTQ+ youth, the book is also a must read for clinicians in training and educators teaching about LGBTQ+ issues. Highly recommended. Graduate students, faculty, and professionals.

• Introduction: Health Disparities, Resilience, and Interdisciplinary Care for LGBTQ+ Youth and Emerging Adults G. Nic Rider, PhD, LP; Cristina L. Magalhães, PhD, LMHC; & Richard A. Sprott, PhDRationale for this Book Target Audience Useful Frameworks Minority Stress Theory Intersectionality Theory Resilience-Based and Strength-Focused Approaches Interdisciplinary and Whole-Person Approaches Overview of the Book Conclusion References SECTION I: THEORETICAL APPROACHES1 Minority Stress Theory and Resilience-Building Practice Eunice V. Avilés Faría, PsyD, LMHC, LPCAuthor’s Note Minority Stress Theory Minority Stress Processes Minority Stress Processes and Transgender and Gender Nonbinary Individuals Distal Stressors Proximal Stressors The Impact of Minority Stress on Mental Health The Impact of Minority Stress on Physical Health Resilience Individual Resilience Community Resilience Resilience-Building Practice: Interventions That Can Enhance Resilience Societal Level Interventions Community- and Group-Level Interventions Individual-Level Interventions (ILI) Empirical Support for the Minority Stress Model Gaps in the Literature and Future Directions for Clinically Relevant Research References 2 Intersectionality, Culturally Sensitive Care, and LGBTQ+ Youth Kayden J. Schumacher, BA, MSc, MS Ed, LSC; Leonardo E. Candelario-Pérez, PhD, LP; Eunice V. Avilés Faría, PsyD, LMHC, LPC; & G. Nic Rider, PhD, LPPractice Considerations Advocacy Considerations Conclusion References 3 Interdisciplinary Healthcare for Transgender Youth: An Application of the Gender Affirmative Lifespan Approach (GALA) Katherine G. Spencer, PhD, LP, CST & Nova Bradford, LGSWIntroduction to Transgender Health History of Gender Affirmative Healthcare for Youth Minority Stress The Gender Affirmative Lifespan Approach (GALA) Philosophical Foundations of GALA Core Components of GALA Interdisciplinary Approach Connections to Medical Interventions Case Studies Case Study A: Research—Unicorn Youth Case Study B: Advocacy & Policy—Health Insurance Advocacy in Minnesota Case Study C: Clinical Example—Sexuality and Agency Case Study D: Youth Homelessness Conclusion Key Knowledge Points Recommendations for Professionals References SECTION II: DEVELOPMENTAL CONSIDERATIONS4 The Youngest Part of the Rainbow: Clinical Care for Gender Diverse Children Dianne R. Berg, PhD, LP*; Caroline Maykut, PhD*; Rachel Becker-Warner, PsyD, LP; Catherine Schaefer, MS; & Jennifer J. Connor, PhD, LMFT (*Co–First Authors)Social and Historical Context of Research with Gender Diverse Children Gender Identity Development Mental Health in Gender Diverse Children Clinical Implications of Mental Health Research Resilience in Gender Diverse Children Interpersonal Contexts Peer Group Family Community Contexts Schools Healthcare Settings Medical Settings Mental Health Settings Case Study Andi’s Gender Journey Sessions 1–3 Assessment: Age 4.11–5.0 Sessions 4–5 Feedback and Collaborative Treatment Planning with Parents Only: Age 5.1–5.2 Sessions 6–11 Early Therapy Process: Age 5.3–6.1 Sessions 12–16 Ongoing Therapeutic Process: Age 6.2–6.7 Sessions 17–24 Ongoing Therapeutic Process: Age 6.8–7.5 Sessions 24–35 Ongoing Therapeutic Process: Age 7.6–9.0 Sessions 36–44 Present Therapeutic Process: Age 9.3–10.5 Case Reflection Future Directions Key Knowledge Points Recommendations for Practitioners and Professionals References 5 Risk and Protective Factors among LGBTQ+ Adolescents Amy L. Gower, PhD; Marla E. Eisenberg, ScD, MPH; & G. Nic Rider, PhD, LPInterpersonal Relationships Friendships Romantic Relationships Parent/Family Relationships The School Context Community Support Online/Internet Support Developmental Considerations Case Study Practice Considerations Conclusions References 6 Not a Teen, Not Yet an Adult: Health Risk and Protective Factors among LGBTQ+ Emerging Adults Caleb Esteban, PhD; Alixida Ramos-Pibernus, PhD; Luis X. Díaz-Medero, MS; & Astrid Irizarry-Rodríguez, MSLGBTQ+ Emerging Adults Institutional Challenges Family College Religious Institutions Healthcare Government Interpersonal Challenges Relationships Marriage Peers Religious Affiliation Personal Challenges Physical Health HIV/STIs Healthcare Substance Abuse Mental Health Depression and Anxiety Suicide Protective Factors for LGBTQ+ Emerging Adults Resilience Social Support Community Engagement and Connectedness Gaps and Future Direction for Studies Clinical Implications Case Study Case Study Discussion Key Knowledge Points Recommendations for Mental Health Clinicians References SECTION III: SYSTEMS OF CARE7 Pre-K–12 Schools Molly M. Strear, PhD, NCC & Matthew J. Beck, PhD, LCPC, NCC, ACSSBMHPs Working with LGBTQ+ Youth: Review of Literature School Counselors School Social Workers School Psychologists SBMHP Collaboration Recommendations for SBMHPs Coordination of Services through MTSS Tier 1—Universal Support Tier 2—Supplemental Support Tier 3—Intensified Support Family/Community Engagement Implications and Future Directions Conclusion Key Knowledge for Students Recommendations for Practitioners and Professionals References 8 Serving LGBTQ+ Students at University and College Campuses (Jan E. Estrellado, PhD, & Saeromi Kim, PhD)Challenges Facing LGBTQ+ College Students Mental Health Disparities Identity Development as a Major Task of Late Adolescence and Emerging Adulthood Acceptance and Visibility of LGBTQ+ Students on Campus Intersectionality and Marginalized Identities The Need for Affirming LGBTQ+ College Student Services Student Support Services Relationships with Faculty Relationships with Peers Health Services on Campus Gaps in Research First-Generation Students Bisexual and Fluid Students Transgender, Nonbinary, and Gender Expansive (TNBGE) Students STEM Students Immigration Status International Students Clinical and Policy Recommendations When Working with LGBTQ+ College Students University or College Counseling Centers Coming Out Language Complexity of Identities Depathologizing Symptoms Advocacy Policy Recommendations Data Collection Institutional Policies Feedback Loops Inclusivity Dialogue Spaces Intersectionality Community LGBTQ+ Services Community Colleges Protective Factors Health Providers Counseling Centers Academic and Career Advisors Conclusion Key Knowledge Points Recommendations for Practitioners References 9 Medical Care Centers as Beacons of Hope for LGBTQ+ Youth Hiram Rivera-Mercado, PsyD; Kevin Carrión, PsyD; & Taymy J. Caso, PhDRole of Hospitals in Serving LGBTQ+ Youth and Emerging Adults Some Services Included Primary Care Pediatric Endocrinologist Behavioral Health and Mental Health Services Obstetrics and Gynecology Policies and Their Function Training of Personnel Community Partnerships and Resources Creating a Welcoming Environment Physical Environment Registration and Documentation Processes Language and Communication Conclusion References 10 Improving Child Welfare and Foster Care Outcomes for LGBTQ+ Youth Kellen Grayson, PsyD, LMFT & Mira Krishnan, PhD, ABPPFamily Rejection, Abuse, and Homophobia LGBTQ+ Youth and Polyvictimization Poverty and LGBTQ+ Youth Vulnerability Overrepresentation of LGBTQ+ Youth in Child Welfare Services The State of Foster Care and Child Welfare Systems Policies and Practices in Child Welfare Services Training and Oversight of Foster Parents and Child Welfare Workers Gaps in Care Transition-Age Youth The Landscape for Change Religious Freedom Restoration Acts and Child Welfare Considerations for Clinicians Conclusion References 11 LGBTQ+ Youth Experiencing Homelessness (Catherine Forbes, PhD, Carrie Mounier, LCSW, & Kaitlin Venema, PhD)Literature Review and Gaps in Research: LGBTQ+ Youth Experiencing Homelessness Figure 11.1. Risk Factors for Homelessness Shared with Cisgender/Heterosexual Youth and Unique for LGBTQ+ Youth Clinical Considerations and Recommendations for Practice in Mental Health and Substance Abuse Treatment Trauma-Informed Care Interdisciplinary Programs for LGBTQ+ YEH Evidenced-Based LGBTQ+-Affirming Therapeutic Services Group Therapy Approaches Alternative Programming for LGBTQ+ YEH Medical Interventions Structural Competency and Service Systems for LGBTQ+ YEH Impact of Structures on Patient Health Influence of Structures on the Clinical Encounter Respond to Structures in the Clinic Respond to Structures beyond the Clinic Structural Humility Practice and Policy Recommendations Healing-Centered Engagement and Structural Violence Restorative Justice and Structural Violence Positive Youth Development and Structural Violence Harm Reduction and Structural Violence Gaps and Future Directions References 12 Gender Expansive and Sexual Minority Youth and the (In)Justice System Macy Wilson, PsyD; Jessica Ward, MA; & Roberto L. Abreu, PhDIncidence and Prevalence Risk Factors School-to-Prison Pipeline “No Promo Homo” Laws and a Heterosexual-Cisgender School-Based Curriculum A Failed Welfare System The (Il)legal System Disproportionate Representation Unequal Injustice Gender Differences Youth of Color Microaggressions Mediating Factors Mental Health Behaviors While Incarcerated Self-Harming Behaviors Aggression toward Others Toward a Socially Just System: Ensuring Safety for LGBTQ+ Youth Incorporating a Holistic Approach to Care Constitutional Rights Legal Rights of LGBTQ+ Youth in the Justice System Recommendations Key Knowledge Points References 13 Services for Youth and Emerging Adults at LGBTQ+ Centers and Other Community-Based Organizations Tangela Roberts, PhD; Zari Carpenter, MA; & Kat Schuette, MAAuthors’ Note LGBTQ+ Youth and Emerging Adults of Color Transgender and Gender-Nonconforming (TGNC) Youth and Emerging Adults Challenges for LGBTQ+ Youth and Emerging Adults Healthcare Challenges Mental Health Sexual Health Interpersonal Challenges Coming Out Building Community Dating and Relationships Intimate Partner Violence Vocational Challenges Career Development Employment Discrimination Workplace Identity Management Method Sample of LGBTQ+ Community Centers Table 13.1: Number of LGBTQ+ Community Centers in the United States by State Results Physical Health Services Mental Health Services Services for Queer Youth and Emerging Adults of Color (QYAOC) Services for Transgender and Gender-Nonconforming (TGNC) Youth and Emerging Adults Emotional Support Social Support Services Related to the Provision of Basic Needs Housing Stability Food Insecurity Services Related to Educational and Vocational Assistance Auxiliary Services Discussion Areas of Improvement in Serving LGBTQ+ Youth and Emerging Adults Availability of Services by Geographical Region Access to LGBTQ+ Community Centers LGBTQ+ Youth and Emerging Adults of Color Considerations for Clinical Practice Policy Recommendations References 14 Independent Practice Gary Howell, PsyD; Arlene Noriega, PhD; & Julie Williams, MS Ed, MAIndependent Practice Solo Practices Group Practices Integrated Practices Nuances with LGBTQ+ Affirmative Practices Consultative Roles Barriers to Care Healthcare Disparities Sociopolitical Factors Social Determinants of Care Eliminating Barriers to Care Cultural Competence Intersectional Approach Centering Marginalized Voices Advocacy Integrated Approach Impact of the Affordable Care Act Impact of COVID Successes Challenges Research Gaps and Future Directions Considerations for Practice Key Knowledge Points Recommendations for Practitioners References Conclusion: Increasing Health and Well-Being of LGBTQ+ Youth and Emerging Adults: Lessons Learned, Questions Unanswered Richard A. Sprott, PhD; G. Nic Rider, PhD, LP; & Cristina L. Magalhães, PhD, LMHCSummary of Findings and Lessons A Possible Agenda for Research, Clinical Treatment, and Policy More Resources and Funding Train Mental Health Providers Systems-Based Approach Refinement Summary References Appendix: List of Resources BibliographyIndexAbout the Authors