Some Canadian provinces provide additional protections such as Ontario’s Equity and Inclusive Education Strategy (St. John et al., 2014). Many Canadian high schools allow GSA members from multiple schools to come together for conferences, dances, and other networking opportunities (St. John et al., 2014). It is thought that by providing these opportunities GSA members can begin to compare themselves with other GSA members instead of with the heterosexual majority at their respective high schools. This in turn may lead to higher levels of self-esteem and lower levels of isolation (St. John et al., 2014). This might explain why youngadults graduating from non U.S. GSA+ high schools were less depressed than youngadults graduating from U.S. GSA+ high schools, although not significantly so. While it was beyond the scope of this study to provide a DSM depression diagnosis for individual participants, all four groups met the diagnostic criteria for subthreshold depressive symptoms, defined as having a CESD-R score of at least 16 (average score for all groups was 19).
Australia, Canada, and the UK. Some of the identified issues included institutionalized prejudice, social stress, social exclusion, homophobic and transphobic hatred, bullying, and violence (David & Knight 2008; King & Smith 2004; Kuyper & Fokkema 2011). Furthermore, there can be an increased susceptibility to alcohol and drug misuse as well as suicidality and issues related to self-harm (Cochran et al. 2003; Grant et al. 2011). In terms of sexual orientation, while most gay, lesbian, and bisexualyoung people develop positive coping strategies to manage the ensuing stress and become healthy, resil- ient adults, mentalhealth nurses should appreciate the relationshipbetween sexual orientation or gender identity and mental distress in order to be in a position to identify vulnerable individuals and promote mentalhealth among an already marginalized group of people (Chakraborty et al. 2011; King et al. 2003). In a study on suicide risk among transgender people (n = 153), 41% of transgender Correspondence: Edward McCann, Trinity College Dublin, School
their associations. However, there is still a need for action, particularly in regard to transgender and intersex people. An important step for the recognition of sexual diversity was made in 1990 when the General Assembly of the World Health Organization (WHO) removed homosexu- ality from the list of mental illnesses . At the end of 2019, the German federal cabinet banned interventions aimed at changing or suppressing a person’s sexual ori- entation or self-perceived gender identity (so-called con- version therapies) on the grounds that this type of inter- vention often causes psychological damage. From 2020, the ban will apply to minors and adults incapable of giv- ing consent and will also affect the public advertising, provision and mediation of such measures with the aim of safeguarding gender and sexual self-determination.
LGBTQ youth in care experience the same vulnerabilities as other youth. But their vulnerabilities are compounded by the high levels of abuse and rejec- tion they often experience in their families, their placements, among their peers, in their schools, and in their communities. This can have profound con- sequences for their mental and physical health. For example, a study of high school students in Massachusetts found that gay, lesbian, and bisexual students were three times more likely to report having been threatened or injured with a weapon at school (23.5% of sexual minority students vs. 7.8% of others) and more than five times more likely to have attempted suicide (40.4% of sexual minority students vs. 7.2% of others) (Goodenow, 2003). LGBTQ youth often experience violent abuse, based on their sexual orientation or their gender identity, at the hands of members of their family of origin. Thirty-three percent of gay men and 34% of lesbians report suffering physical violence from family members as a result of their sexual orientation (Gross, Aurand, & Addessa, 2000). Current research shows that rejection of LGBT youth by families and primary caregivers can lead to negative physical and mentalhealth outcomes for these young people (Ryan & Diaz, 2005). In the child welfare system, LGBTQ young people report experiencing incidents of violent abuse, rape, and harassment in their foster and group homes because of their sexual orientation and gender identities (Mallon, 1998).
FAP has also developed a six-question tool (FAPrisk) for providers to quickly assess the level of family rejection and related health risks in LGBT youth. This FAPrisk tool will help school counselors, pediatricians, nurses, social workers, and mentalhealth providers to ask youth about their relationships with families, foster families, and caregivers. These questions came from the FAP research study. They are highly accurate in identifying high levels of family rejection. They also quickly identify related risk for depression, suicide, substance abuse problems, and risk for HIV and STDs in LGBT young people. These questions give providers a place to start to ask LGBT youth about their family relationships. And they quickly help providers identify families in need of education and support. This tool is one of the first
A life course perspective considers the integral role of socioeconomic contexts as well as the interplay among individuals’ social relationships and interacting identities (Elder, 1998), especially the unique influence of gender and sexual identities. Our study demon- strated how LGBTQ youngadults’ social environments and socioeconomic contexts cre- ated distinctive social convoys (e.g., nuclear and extended family relationships) in shaping their pivotal life course transitions (Moen & Hernandez, 2009). The intricate dynamics of family relationships and the shifting quality of these relationships across the life course are important factors in determining how well youngadults are able to cope with life’s chal- lenges (Needham & Austin, 2010). Much research has documented the widespread familial conflict experienced by homeless LGBTQ youngadults (Castellanos, 2016; Gattis, 2009), and LGBTQ youngadults in the general population also endure familial discord related to their gender and/or sexual identities (LaSala, 2010). Family rejection, however, can have enduring adverse consequences for LGBTQ young people, such as harming mentalhealth outcomes in later life and constrained social support networks (Puckett, Woodward, Mere- ish, & Pantalone, 2015). The context of socioeconomic status, therefore, provides further clarity on how young people cope with familial rejection, particularly if they can draw from campus-based supportive resources (Poynter & Tubbs, 2008) or are pushed to pursue more risk-laden subsistence strategies on the street (Bird et al., 2017).
family acceptance during adolescence and its effect on LGBT health in youngadults (2010). Familial acceptance has a lasting influence on LGBT individuals’ emotional and physical health, particularly LGBT adolescents (Ryan et al., 2010). Factors that influence one family member even on the individual level have repercussive effects on those relationships (Bavelas & Segal, 1982), which is made evident by research showing an association between increased risk of suicide attempts and mental illness in the LGBT community with increased rejection by family members (Ryan et al., 2009). These risks, however, can be lowered significantly with stronger interpersonal relationships (Ryan et al., 2010). Looking specifically at parents’ relationships with their children, Halpern and Perry-Jenkins (2016) discuss the transference of gender roles from parent to child in their longitudinal study of children within the United States. Gender stereotypes and ideologies vocalized by parents greatly affect a child’s understanding of gender roles and their attitudes towards either gender (Paul Halpern & Perry-Jenkins, 2016). Furthermore, purely addressing parent-child relationships, adolescent men whose parents communicate health concerns and discuss health care with them are more likely to use the health care system (Marcell et al., 2007).
examined 51 transgender MTF ethnic minority adolescents and youngadults 16 to 25 years of age in Chicago and found that 22% were HIV-positive. Contributing factors included history of incarceration (37%), homelessness (18%), exchanging sex for resources (59%), nonconsensual sex (52%), and dif ﬁ culty accessing health care (41%). Among HIV-positive MTF transgender individuals, 98% reported having had sex with men, including unprotected receptive anal intercourse (49%). The study also noted that 53% had had sex while under the in ﬂ uence of drugs or alcohol and 8% had used injection drugs. Twenty-nine percent had injec- ted liquid silicone (as part of their MTF transition) in their lifetime; 8% had shared needles for hormone or silicone injection, increasing HIV trans- mission risk. For transgender individu- als who purchase or obtain transgenic hormones (estrogen or testosterone) on the street or from the Internet, there may be signi ﬁ cant health problems if used improperly, even if they are pure. 94
The American Academy of Pediatrics issued its last statement on homosexuality and adolescents in 2004. Although most lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youth are quite resil- ient and emerge from adolescence as healthy adults, the effects of homophobia and heterosexism can contribute to health disparities in mentalhealth with higher rates of depression and suicidal ideation, higher rates of substance abuse, and more sexually transmitted and HIV infections. Pediatricians should have of ﬁ ces that are teen-friendly and welcoming to sexual minority youth. Obtaining a comprehensive, con ﬁ dential, developmentally appropriate adolescent psychosocial his- tory allows for the discovery of strengths and assets as well as risks. Referrals for mentalhealth or substance abuse may be warranted. Sexually active LGBTQ youth should have sexually transmitted infection/ HIV testing according to recommendations of the Sexually Transmitted Diseases Treatment Guidelines of the Centers for Disease Control and Pre- vention based on sexual behaviors. With appropriate assistance and care, sexual minority youth should live healthy, productive lives while transitioning through adolescence and young adulthood. Pediatrics 2013;132:198 – 203
Authorization of Consent to Medical Treatment of Minor. A legal parent, guardian, or managing conservator can authorize another adult to consent to medical care for their child. When both parents in a same-sex couple are not legally recognized as parents, the legal parent can authorize the other parent to consent to care for the child. This form can be important to ensure that the non-legal parent can consent to emergency medical treatment for the child if the legal parent is not available. The couple should give a copy of the authorization to their child’s doctor and carry a copy with them at all times. For lesbian couples who are about to have children, it is very important to complete this document before the birth mother goes into the hospital. While this form may not be legally binding, hospitals will often honor the authorization.
2. Are steps being taken so that a change in sex or gender is reflected on birth certificates, medical records, and government-issued identification cards? What steps are there to carry out the Plan of Action against Homophobia and Transphobia discussed in the August 2012 meeting between the Sexual Diversity Community and Vice-Ministry? 26 What plans does the State have to ensure there is equality before the law with respect to political rights? What measures is the State taking to promote equality for LGBT people with respect to:
16. Also in May 2010, with the support of those organizations advocating for the human rights of persons having a non-normative sexual orientation and/or gender identity, the State created the Sexual Diversity Division, under the Social Inclusion Secretary. The new body has as its goals i) to promote eradication of sexual orientation and gender identity based discrimination; ii) to encourage knowledge about sexual diversity through information, sensitization and the elimination of bias about lesbians, gays, bisexuals, and trans persons; iii) to promote the creation of public policies guaranteeing those basic human, economic, social, civil and political rights that every citizen enjoys to persons with diverse sexuality (lesbian women, gay men, bisexual, transsexual, transgender and travesti individuals); and iv) to promote the creation of services and spaces free from homo, lesbo or transphobia, and of any other form of discrimination based on sexual orientation and gender identity, where all persons are treated with the same dignity and respect 23 . According to the representative of Asociacion “Entre Amigos”, lesbian, gay, bisexual and transgender community activists have been able to talk to State representatives and have been involved in the design and implementation of public policies against discrimination 24 . With the support of non-governmental organizations, the above mentioned Secretary plans to organize training courses for public health and security
The InterLaw Diversity Forum for Lesbian, Gay, Bisexual and Transgender (“LGBT”) Networks (“InterLaw Diversity Fo- rum”) is an inter-organisational forum for the LGBT networks in law firms and all personnel (lawyers and non-lawyers) in the legal sector, including in-house counsel, and has over 1,000 members and supporters from more than 70 law firms and 40 corporates and financial institutions. The InterLaw Diversity Forum welcomed the JAC study but wished to see similar re- search undertaken about the experiences and perceptions of LGBT people. With the support of the Law Society and the Bar Council, the InterLaw Diversity Forum approached the JAC with a proposal to use the JAC Barriers Report questionnaire (the “JAC questionnaire”) as the basis for a study of LGBT ex- periences and perceptions of barriers to application for judicial appointment. The JAC generously gave its support. This report (the “InterLaw Diversity Forum Report”) is the result.
2 The acronym LGBTI describes a diverse group of people who do not conform to conventional or traditional notions of male and female gender roles. LGBTI people are also sometimes referred to as “sexual, gender and bodily minorities”. A lesbian is a woman whose enduring physical, romantic and/or emotional attraction is to other women. Gay is often used to describe a man whose enduring physical, romantic and/or emotional attraction is to other men, although the term can be used to describe both gay men and lesbians. Bisexual describes an individual who is physically, romantically and/or emotionally attracted to both men and women. Transgender describes people whose gender identity and/or gender expression differs from the sex they were assigned at birth. The term intersex covers bodily variations in regard to culturally established standards of maleness and femaleness, including variations at the level of chromosomes, gonads and genitals. Homosexual refers to women or men who are attracted primarily to people of the same sex. The term is considered by many to be derogatory.
Allen et al. (2016) described the high rates of homeless LGBT youth involved with the juvenile justice system and how those experiences resulted in unfair treatment during incarceration. Ironically, the experience of discrimination is one of the primary reasons homeless LGBT youth are more likely to engage in sexual acts to earn money in order to pay for food, to have a place to sleep, or to pay for other basic necessities (Klein, Holtby, Cook, & Travers, 2015; Kubicek et al., 2013). The experiences of discrimination and unequal treatment and lack of accommodations for homeless LGBT youth sends the message that their needs are not important. The numbers of LGBT youth in the juvenile justice system is imprecise due to lack of data collection systems that focus on this population (Irvine, 2010). Improved attitudes and perceptions about this population could result in improved conditions for LGBT youth who are involved with the juvenile justice system and could also act as a protective factor against adverse mentalhealth outcomes, such as depression and suicide ideation (Ryan et al., 2010).
Minority status often leads to a minority identity, in this case, self-identifying as gay, lesbian, or bisexual (box e). A minority identity leads to stress related to how an individual views himself or herself as a stigmatized member of society (box f). Viewing oneself as part of an oppressed minority group can lead to expectations of rejection, concealing identity, and internalized homophobia (box f). Minority stressors can have a greater impact on mentalhealth when the LGB identity is a primary identity (box g), but identifying as LGB can be a source of strength, as it gives individuals access to coping and social support resources, both on the individual and community level (box h), which can reduce experiences of stress. It is important to consider that many LGB older adults come into a sexual minority identity later in life, are less likely to access supports, and are more likely to experience internalized homophobia than younger cohorts (Meyer, 2003). The result of maintaining this stress, both internal and external, is mentalhealth outcomes (box i). Coping skills (box h) and positive characteristics of a minority identity (box g) can moderate levels of stress and increase positive mentalhealth outcomes.
The collection period occurred from July 2013 to May 2014. Articles published between 2004 and 2014 were surveyed. The analysis followed the predetermined eligi- bility criteria. The inclusion criteria were: articles pub- lished in the selected databases; manuscripts written in English or Portuguese; articles on the LGBT population’s access to health services; and original articles with full text available online. The exclusion criteria were: re- search reports published on non-scientific websites; studies in the modality of literature review and com- ments; not original articles, such as editorials, opinions, preface and brief communication; and essays on access to LGBT health services as a result of HIV/AIDS, the latter criterion justified by the fact that the discrimin- ation directed to patients with the disease is a still present phenomenon in society, regardless of sexual orientation.
For each survey item, participants indicated whether their parents or caregivers reacted in the way specified by the item “many times,” “a few times,” “once or twice,” or “never.” For the current analysis, however, we dichotomized responses to each item into never (0) or ever (1). We dichotomized item responses because, at this point in the research program, it is unclear whether the frequencies of different rejecting reactions are equivalent with respect to potential health impact. For example, are multiple acts of exclusion from family activities equivalent to multiple disparaging comments made by the family about LGB persons? We plan to address these questions in subsequent analyses. In addi- tion, the dichotomous scoring of items facilitated com- parison of the mean number of different types of family rejecting reactions for different gender and ethnic sub- groups. Dichotomized scores were then added to create a family rejection score, with values ranging from 0 to 51 (mean: 20.91; SD: 15.84). Reliability analyses indicate that the FAP Family Rejection Scale has high internal consistency (Cronbach’s ␣ ⫽ .98).
providers’ bias and sexism aimed at the LGBT individual. For this reason, Kurt Lewin’s Change Theory was applied. This theory has three concepts: driving forces, restraining forces and equilibrium (Lewin, 1935). Driving forces are those elements that move and cause change. Restraining forces hinder change. Equilibrium is the space in between driving and restraining forces (Sarayreh, Khudair & Barakat, 2013). By studying the aforementioned constructs, one can understand the three principles of the change theory: unfreezing, change and freeze. During the “unfreezing” stage, the participants are
Twenty-two adoption agencies were contacted via telephone, where the goals of the study were addressed. A letter of support was requested from the agencies, then the researchers sent agencies who agreed to participate a link to access the survey. Although 13 adoption agencies offered their support during the initial contact, only five California adoption agencies sent their letter of support to researchers. These agencies were sent the 18-question survey. The criteria for research participation was that participants must be current adoption interns, workers, family recruiters, family consultants, supervisors or program directors. It is important to collect data from a sample of workers who directly impact parent selection, which fit the above criteria. These workers predict the outcome and family type for adopted children, therefore it is important to assess the attitudes adoption workers have towards LGBT