3

Promising Interventions in Personal, Carceral, and Care Systems

On the second day of the workshop, speakers, and participants discussed the current status of LGBTQ youth in state systems, including foster care and juvenile justice; examined research in this area and potential areas for action; and identified promising interventions.

LANDSCAPE: OUTCOMES, INEQUALITIES, AND KNOWN INTERVENTIONS

LGBTQ young people are disproportionately represented in multiple state-based systems, said Sarah Mountz (University at Albany). LGBTQ youth make up 19–34 percent of young people in foster care systems and 12–20 percent of youths in the juvenile justice system; the majority of these youths are young people of color. In both systems, high rates of sexual victimization and harassment are reported both inside and outside the facilities, said Mountz. Within the foster care system, LGBTQ youth are twice as likely to be placed in congregate-care facilities like group homes, they experience more movement while in care, and they are more likely to report being treated poorly within the system. LGBTQ youth in foster care face mental health and substance abuse disparities, educational disparities, and heightened barriers when they age out of the system. Within the juvenile justice system, said Bianca Wilson (UCLA), LGBTQ youth are kept in custody longer and experience more sexual victimization by their peers. Over half of girls in juvenile justice facilities identify as sexual minorities, said Wilson. The foster care and juvenile justice systems are interconnected, said Wilson, with youths in detention more likely to have a history of foster care (Irvine and Canfield, 2016).

Paired with the knowledge that schools are often hostile spaces for LGBTQ youth and youth of color (see Chapter 6), Mountz called the movement between systems a “revolving door.” Young people are shuttled between settings that fail to nurture and support them, and that criminalize their survival skills and community-building efforts. The impacts for child welfare and juvenile justice system-involved youths, said Mountz, are poorer health and wellness outcomes, lack of access to opportunities, ensnarement in punitive systems, exposure to interpersonal and state violence, and impaired transitions to adulthood. Despite these disparities and challenges, Mountz noted that these youths can flourish and become leaders in community initiatives that provide support and networks for themselves and others.

Wilson identified several existing interventions that can reduce disparities for child welfare and juvenile justice system-involved LGBTQ youth. However, she noted the lack of a strong empirical base for the programs and interventions being implemented. Some sites are both implementing and evaluating initiatives (e.g., Alameda County, Allegheny County), but there is a need for more research on interventions in this area. Wilson looked at interventions on three levels. First, interventions can target individuals who have direct interactions with young people, such as social workers, case managers, and officers in detention facilities. Second, interventions can try to make organizational and structural changes in the systems themselves. At the individual level, Wilson noted that there is often an overreliance on one-time trainings and an absence of ongoing coaching and structural support. Addressing these lacks could improve the capacities of individuals. At the organizational level, she noted the importance focusing on synergies between existing initiatives and new interventions. In addition, she said, a more thorough understanding of the current reform and abolitionist movements could help better illustrate the impacts of racism and classism as the root causes of disproportionality in the system. Finally, interventions can be aimed at implementing policies that require staff training, give young people the right to experience placement without discrimination, or that ensure individuals are housed in appropriate sex-segregated facilities. However, Wilson cautioned, disparities persist even in states with these protections. Thus, there is great value in evaluating existing policies, their implementation and impacts, and the appropriateness of their adaptation across contexts.

PATHS FORWARD IN RESEARCH

To understand the lives and perspectives of youths in the foster care system, Mountz called for “research justice.” There is a need to collect data through national systems (e.g., the National Youth in Transition

Database), but there is also a need to “listen beyond the numbers” to the nuanced narratives that young people share about their experiences at the intersection of identities and the interface of systems. This type of research creates opportunities for individual and collective counter-storytelling, harnesses the knowledge of young people, redistributes power, and counters “adultism.” As an example, Mountz shared her experiences working on a project called From Our Perspectives: Untold Stories of LGBTQ Youth in the Los Angeles Foster Care System. The project used a community-based participatory research (CBPR) approach and was conducted in collaboration with social work students, system-impacted youths, and foster care providers. The stories of 25 LGBTQ former foster youths were told through qualitative interviewing and photo-voice methodology; this culminated in a series of community-based art exhibits attended by over 500 people. The attendees included students, young people, systems-impacted young people and their families, providers, the public, artists, activists, a family court judge, and other scholars; this breadth demonstrates the ability of CBPR approaches to reach people outside of the research community. Mountz shared an example of photo-voice process, in which one participant gave the name “Paper Trail” to a picture of a binder stuffed with paper, and explained that, “I was pretty much a case and I had a long paper trail attached to me, so whenever I moved to group homes they weren’t necessarily looking at me as a character or person, they only looked at my paperwork. So, they never asked me what I thought I needed for my healing and process and me trying to get a home.” These types of visual approaches can tap into information and experiences that might not otherwise be accessible, and they can help draw the collective experience of a community, Mountz said.

In addition, listening to nuanced narratives can provide information behind the statistics of disproportionate representation. For example, while a common assumption is that the overrepresentation of LGBTQ youth in foster care is due to rejection by their families of origin, only 3 out of 25 study participants identified this as the reason for initial placement in foster care. Instead, participants more frequently referenced parental substance use, mental health issues, poverty, and racism as contributors to their placement in foster care. In addition, participants spoke more often about harms experienced while in the foster care system than about harms stemming from their families of origin. Young people who identify as trans, nonbinary, or gender expansive reported experiencing even greater harms in the system, such as a lack of access to appropriate resources and medical care, and a profound lack of competency among workers and caregivers with regard to gender-affirming language and practices. In addition, these young people experienced twice the rate of placement disruption compared to LGB youth. These narrative data, said Mountz, indicate that, rather than

settling into a single narrative, there is a need to expand our understanding to look at the roles of systemic and structural racism and state surveillance, as well as the harms perpetrated by the child protective system itself. This system has created intergenerational family fracture, particularly among communities of color, said Mountz.

Mountz emphasized the importance of researchers giving up some of their power in the research process and partnering with young people. In her experience, members of LGBTQ communities have a strong sense of accountability to their communities and a strong sense of social justice; involving them in research and storytelling is critical for improving our understanding of their experiences and beginning the healing process.

PROMISING INTERVENTIONS

Following the presentations on the landscape of systems research and potential areas for intervention, a panel of speakers presented information about specific interventions to improve the health and well-being of child welfare and juvenile justice system-involved LGBTQ youth.

Juvenile Carceral System Intervention: Youth Justice Agency Policies and Professional Development

Bernadette Brown (B. Brown Consulting) works with juvenile justice agencies to improve the health and well-being of detainees, including LGBTQ youth. Brown’s presentation described a model youth justice agency that she worked with to develop policies and procedures pertaining to LGBTQ youth and gender-nonconforming youth, to provide staff training and post-training technical assistance. The agency is in the South, where most young people in detention are youth of color. There is a relatively high number of LGBTQ youth in detention, particularly trans youth. Most of the security staff are people of color and multiple staff members have military backgrounds. Many of the staff also identify as religious. Brown noted that questions pertaining to religion come up frequently in her work, often under the false assumption that cisgender and heterosexual religious adults are anti-LGBTQ.

Her agency faced several immediate challenges, said Brown. First, external stakeholders discouraged her from accepting the project because they thought the work had insufficient support, either within the agency or within the facilities. Second, in certain parts of the state, many LGBTQ youth and their families, particularly youth of color, experienced a lack of external support and community connections. Finally, there was a tremendous amount of political opposition—primarily from the governor—which almost derailed the project before it began. Brown said that she

was inspired by the fact that the agency staff banded together to lead the resistance to the governor’s opposition.

There were also factors working in favor of the project, said Brown. First, the leader of the initiative within the facility was well respected by his colleagues and was mindful about selecting supportive staff to participate in the effort. Second, the many military veterans on staff were receptive to the changes required by the initiative. Brown said that, while civilian staff sometimes push back against changes, military veteran staff tend to accept the training more readily, viewing it as preparation for fulfilling a new duty. Third, Brown explained that staff were generally open to discussing racism and anti-LGBTQ beliefs and attitudes. Staff members with strong religious beliefs, said Brown, often expect that she will tell them to “put aside all of their beliefs.” Instead, Brown emphasizes to staff that her job is not to change their personal beliefs but to help them fulfill their professional responsibilities and obligations. Key successes included the adoption of policies and procedures to support LGBTQ and gender-nonconforming youth in the youth justice agency. Following trainings, staff are also better equipped to locate resources for LGBTQ and gender-nonconforming youth in the community. Trans youths are now regularly assigned to a placement that aligns with their gender identity. Brown said that this change is “highly unusual” and “phenomenal,” and is due in part to the commitment of people in leadership roles, including individuals new to leadership roles in the agency.

One unexpected success of her work with this agency, said Brown, was spontaneous youth training on sexual orientation, gender identity, and gender expression. Her planned training was geared toward the adult staff, but a last-minute emergency called most of the staff away. Brown quickly adapted the training to serve a group of youths who were unable to attend their recreation time without available staff. The young people actively participated in the session, which was also attended by a mental health clinician. As a result, the young people felt empowered and became ambassadors for themselves and for the safety of others within their facility. For example, a trans girl had been assigned to a unit for boys and was experiencing harassment and bullying. The trained youths became advocates for this girl and pushed for changes in her treatment and housing. Staff soon realized that making the facility safer for this trans girl also made the facility safer for everyone else and made staff roles easier, said Brown.

Brown identified several actions that are critical for improving the health and well-being of LGBTQ youth in juvenile justice facilities:

• Aligning new LGBTQ-supporting policies and procedures with the core values of the facilities (e.g., the “three C’s”: care, custody, and control, or the “three S’s” of safety, security, and supervision).

• Involving agency counsel in policy development from the beginning to ensure that policies will be implementable.
• Providing training/professional development for staff, even if a policy is not yet in place. Training all types of staff—including security, medical, management, kitchen, and maintenance staff—because every role contributes to the culture of a facility. Partners in other agencies would also benefit from training.
• Providing post-training assistance to support staff who encounter resistance from colleagues when trying to implement new policies.
• Making age-appropriate trainings available for youth. This may require thoughtful explanations to guardians about the role training plays in the overall educational curriculum of the facility.
• Engaging in work to secure appropriate post-detention placements; some youths, particularly trans youths, may end up back in the system because they have no options or support.

Brown noted that partnering with community-based organizations can be a useful approach for improving the well-being of LGBTQ youth in juvenile justice facilities. However, she cautioned that traditional LGBTQ community centers do not typically have a racial justice lens, nor do they generally serve youths who are involved in the juvenile justice system. Instead, she highlighted the importance of helping justice-focused organizations, including faith-based programs, to understand and address sexual orientation, gender identity, and gender expression. Brown emphasized that attendance at LGBTQ community centers should not be a condition of probation; if youths encounter racism and discrimination at a center and choose not to attend, they can be rearrested and detained. Brown encouraged LGBTQ centers to continue to develop a strong racial justice lens and to find ways to support and serve system-involved youths.

Brown concluded her remarks by highlighting key lessons, including the time-intensive nature of cultivating relationships with agencies, the importance of being aware of juvenile corrections staff unions and their views on new policies, and the need for more housing options for youths returning from incarceration.

Child Welfare System: The American Civil Liberties Union of Illinois and the Illinois Department of Children and Family Services

Ghirlandi Guidetti (Legal Aid of Los Angeles) shared the lessons learned from his previous role working on behalf of the American Civil Liberties Union (ACLU) of Illinois, to improve care for LGBTQ youth in custody of the Illinois Department of Children and Family Services (DCFS). DCFS is a statewide system that relies heavily on private contractors, said Guidetti.

In most cases, young people interact almost exclusively with employees of the private contractors. There has been a great deal of instability in the leadership of DCFS, he said, which makes it difficult to implement changes—particularly cultural changes. Guidetti noted that DCFS has, at least on paper, a strong policy regarding the support and well-being of LGBTQ youth. However, the policy is located deep in an appendix of the organization’s procedures. Guidetti’s work with the ACLU involved both litigation and a collaborative roundtable; he said that the combination of approaches has been effective at improving care for LGBTQ youth in the care of the DCFS.

The ACLU’s involvement with DCFS began in 1988, when the ACLU filed a class-action lawsuit. The lawsuit argued that the 14th Amendment rights of youth in care were being violated because DCFS was not protecting children from physical and psychological harm. This lawsuit settled in 1991 with a consent decree, a court-supervised agreement between the ACLU and DCFS. While the case was not LGBTQ specific, said Guidetti, the consent decree gave the ACLU the right to represent all youth in the custody of DCFS, including LGBTQ youth. In 2016, after hearing stories about the experiences of LGBTQ youth in state care, the ACLU asked DCFS to identify the LGBTQ youth in its care. However, DCFS did not have a process for collecting data on sexual orientation, gender identity, or gender expression. Guidetti said that the lack of data collection was driven by fear of misuse of the information but may also have been driven by concern that the data would document known disparities in treatments and outcomes. While information about gender and sexual identity is highly sensitive, said Guidetti, child welfare systems already collect and protect a great deal of other sensitive information about children, such as history of sexual abuse.

The ACLU eventually identified a number of LGBTQ youth by working with community service providers, state contractors, and a statewide LGBTQ specialist. Guidetti reported that, in initial conversations with youths, “virtually none of them” was aware of their rights within the child welfare system. Most youths had experienced discrimination but did not know there was an anti-discrimination policy in place, did not know there was an LGBTQ specialist, and did not know how to contact anyone for help. Guidetti shared examples that he said were illustrative of what they saw in the child welfare system. “Colin” was placed with a foster family and was experiencing bullying from his foster siblings because of his identity. His foster parents took no action, so he reached out to his case worker to report that he felt unsafe. Rather than working with the family or changing the situation, the case worker told him he should feel “lucky” to be in a foster home rather than in congregant care, and suggested that Colin “try to make the best of the situation.” Colin later told his case worker that he

was suicidal, knowing that this would result in his removal from the foster home. He ended up in a psychiatric hospital and was kept there beyond the period of medical necessity. Trans youth in the system reported that medically appropriate care was often delayed as a result of DCFS holding up necessary medical consents and processes, and medical advisors and therapists used by DCFS often did not have the experience or qualifications to treat trans youth, said Guidetti. He relayed the story of a youth in care who began questioning their gender identity at 12 years old. As a result, their favorite staff person at their residential facility started treating them differently, and this had a negative impact on the youth.

Guidetti identified several lessons learned from his experience with the ACLU lawsuit and the work that followed. First, he suggested that collecting data on sexual orientation, gender identity, and gender expression is critical for enforcement of nondiscrimination policies, for protecting youth, and for comparing outcomes against non-LGBTQ peers. LGBTQ youth cannot be protected if no one knows who they are, and every young person who comes out deserves a safe and affirming placement, said Guidetti. On the system level, disparities cannot be addressed unless data are collected and sorted by LGBTQ identity. The second lesson, he said, is that youth voices are powerful drivers of change. As part of its advocacy work, the ACLU shared stories of LGBTQ youth in care with administrators, legislative partners, and other stakeholders; one direct result was a legislative resolution calling for a performance audit of DCFS’s care of LGBTQ youth. The resulting report was released in February 2021 and gave DCFS a failing grade.

Guidetti shifted gears to discuss his work on the Illinois LGBTQ Roundtable. The Roundtable is a coalition of DCFS-contracted providers, LGBTQ advocates, and child welfare advocates. Their priority issues include:

• Mandatory training of DCFS, service providers, and foster families;
• Meaningful implementation of the anti-discrimination policy (i.e., “Appendix K”);
• Data collection on sexual orientation, gender identity, and gender expression;
• Matching of LGBTQ youth with affirming placements; and
• Allocation of resources to adequately address the needs of youth in care.

Many of these actions are under development and being implemented soon, said Guidetti. Training has been a challenge—DCFS originally developed its own content in-house, but other stakeholders found training content to be inadequate. New content was developed with the help of a subject-matter expert. Data collection will begin shortly and was expedited

by an Illinois legislative mandate that requires all state agencies to collect information on gender and sexual identity. A “Chief of LGBTQI Services” position is being created within the Office of Affirmative Action, which will allow collaboration across departments to ensure system-wide changes and policy implementation. In addition, DCFS is establishing an LGBTQ Youth Advisory Board, which Guidetti said is the direct result of decision makers realizing the importance of listening to the stories and perspectives of young people in the system.

Child Welfare System: National Quality Improvement Center

Angela Weeks (University of Maryland School of Social Work) presented her work with The National Quality Improvement Center on Tailored Services, Placement Stability, and Permanency for Lesbian, Gay, Bisexual, Transgender, Questioning, and Two-Spirit Children and Youth in Foster Care. This was a 5-year project designed to build the evidence base for LGBTQ youth and family programming, with the specific purpose of increasing stability, increasing permanency, and improving well-being. When the program started, Weeks said, there was a lack of data about the types of programming useful for this population. Many programs did not have written documents describing their design or practices, so one of the Center’s goals was to develop programs that could be replicated on a wide scale. Over the course of 5 years, the Center worked with partners to implement a number of interventions, including staff and caregiver training, data collection, and clinical interventions for families and young people. At the outset of the work, some projects were already developed, others were in development, and many did not yet exist. Now, said Weeks, nearly all of their interventions have been implemented and evaluated.

Weeks shared the lessons learned from her experiences with the Center. Many interventions, she said, begin with LGBTQ-focused trainings for staff. These trainings often focus on changing knowledge, attitudes, and behavior. The evaluations conducted by the Center found that, while training could initially produce changes in all three areas, most people reverted to their previous attitudes and behaviors within 3 months of training. Weeks said that this evidence suggests that an “annual booster” approach to training may not be sufficient, and that quick follow-up after initial training may be necessary. The next set of lessons centered around the differences between group and individual clinical interventions. Group interventions were 2-hour sessions, held weekly for 8 weeks, with a clinician and a group of people discussing a topic. These sessions had higher rates of participation, engagement, and graduation; Weeks hypothesized that this was due in part to the interventions having set start and end dates, which people felt they could commit to. In addition, the group setting may have been less

stigmatizing for attendees. However, she said, the group sessions were not the best intervention for families who were struggling with a child’s sexual orientation or gender identity. Weeks and her team found that individual interventions were most successful when they were conducted before the child was removed from the home, and Weeks emphasized that prevention is key to helping families and youths navigate conflict over gender and sexual identity. The third lesson was that there are no impossible families. Weeks said that staff often believe that certain families—because of their beliefs, culture, or personal biases—will never make the changes necessary to accept and support their children. This is an area in which a paradigm shift is needed, said Weeks. In fact, she explained, all families are capable of change if they can engage in the right intervention at the right dosage. What often happens, she said, is that agencies do not have the necessary programs in place or staff do not have the necessary resources, skills, and tools needed to help a family. Rather than recognizing this gap, service providers may instead label a family as “impossible.”

The final lesson from Weeks’ work is that staff discomfort can present a key challenge to collecting data on sexual orientation, gender identity, and gender expression. She noted that, while child welfare staff often ask very personal questions of young people and their families, conversations around sex and gender are new and staff require support to incorporate these questions into their work. In addition, she said, it can be helpful for staff to have the ability to refer young people to appropriate programs or resources in direct response to information collected about sexual and gender identity. This can help staff feel that there is a purpose in asking these sensitive questions. As an example of a successful multilevel intervention strategy, Weeks described a systems-change effort in Cuyahoga County, Ohio, focused on implementing the collection of sexual orientation and gender identity and expression (SOGIE) data in child welfare systems. The program developed a three-phased approach to training that became more in-depth over time and incorporated intensive, educational coaching and supervision. The program provided staff with scripts and held sessions during which staff could role-play and practice conversations. They also developed methods for reporting SOGIE information in ways that were as confidential as possible while still informing and improving the allocation of resources. In addition, said Weeks, the program incorporated innovative ideas that were informed by the youths in its care, for example, a pronoun campaign. Through this integrated and comprehensive approach, she said, the issue of supporting LGBTQ youth was consistently present in the minds of staff. Weeks noted that the success of this program is demonstrated by the increase of young people in this foster program’s care who openly identify as LGBTQ.

REFLECTIONS

Following the panelist presentations, planning committee member Aisha Canfield (Ceres Policy Research) led a question-and-answer session with panelists. Workshop audience members were also invited to submit questions for panelists via the virtual livestream. Canfield started by asking the speakers to dream with her about a world in which liberation is the model system. Given the ongoing discussions about abolishing police, closing youth detention centers, and ending foster care as we know it, she asked speakers to discuss the opportunities and drawbacks for LGBTQ youth of color in the interventions highlighted by the panelists. Canfield emphasized the importance of contextualizing this work in the current political climate and allowing young advocates to set the tone for future work in the field. Weeks responded by saying that, in her project, most of the youths are Black and most of the workforce is White, which creates dynamics that require careful attention and navigation. The National Quality Improvement Center, Weeks explained, works within the current framework to improve the foster care system and reduce harm, rather than working to dismantle the system itself. Weeks noted that it can be difficult to strike the correct balance between trying to improve the current system through interventions and getting out of the system entirely, and that her team constantly grapples with this challenge. Guidetti concurred with this tension, noting that he often wonders if he is reinforcing the system in a way that will make abolition more difficult. Weeks added that, early in the pandemic foster care agencies were forced to shift to virtual services. Communities of color reported feeling relief at the reduced presence of foster care system staff in their neighborhoods, as well as relief in the absence of unsolicited in-person visits. Brown said that this topic comes up often in her work, and she believes the ability to create profit through incarceration must be eliminated. She suggested that when a region’s economic security and viability are based on incarceration, it is enormously difficult to change. Brown urged people to begin the change process by engaging with corporations and individuals that are profiting from the carceral system.

A workshop participant asked speakers to comment on how to get agencies to incorporate mandatory and consistent professional development for supporting LGBTQ youth. Guidetti responded that there are often hard-working advocates within the foster care system who do not have the authority or the resources necessary to make such changes; assisting these people and creating outside pressure on the agencies to support them is critical for change. Weeks noted that some of her sites used anonymous surveys to give leadership and staff information about situations occurring in their programs. Reports from young people detailing how they were treated

had a much greater impact on staff than did data from outside studies, and this information helped build traction and buy-in.

During their presentations, several speakers discussed how the structures of the systems they work in contribute to the marginalization of LGBTQ youth. Canfield asked the speakers whether these deficits were due to a lack of resources or a lack of political will. Brown responded that resource issues are a matter of political will. “When people want to get stuff done, they get it done,” and when they do not, they generate reasons why they cannot, she explained. Guidetti agreed and said that, despite living in a state with an anti-discrimination policy in place, a pro-LGBTQ governor, and DCFS directors who support LGBTQ initiatives, “there is a lot of lip service but not a lot of action.” Weeks observed that some of the difficulty stems from the fact that foster care systems were not built to protect and serve people, but rather to police families. Making structural changes to the system itself is an overwhelming and difficult process, but Weeks expressed gratitude that some agencies are engaging in this work.

Another workshop participant noted that Latinx and Black girls in the child welfare and juvenile justice systems are at high risk of multiple negative outcomes and these disparities persist into adulthood; the participant asked speakers to comment on the unique factors that may increase these risks. Weeks responded that the intersection of multiple systems of oppression plays a key role in these outcomes. Latinx and Black girls experience sexism, racism, and anti-LGBTQ biases, while navigating child welfare and juvenile justice systems that were built for cisgender, heterosexual boys. In addition, there is an extreme lack of services for this population, she said. Weeks suggested the need for more culturally adaptive programs that meet the specific needs of Latinx and Black girls, but that there is not enough research to support evidence-based development of such programs. Brown added that Latinx and Black LGBTQ girls are often held to cultural norms involving how girls should behave and dress, and that society also “adultifies” these girls at young ages (i.e., views them as less innocent than their White peers). Brown concluded her comments by highlighting the importance of trainings and laws to counter the role of misogyny and racism in shaping the treatment of child welfare and juvenile justice system-involved sexual- and gender-minority Latinx and Black girls.