Toward a Practice Framework With At-Risk LGBTQ-Identified Youth

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by Milka Ramírez, Ph.D., LCSW

     As of late, lesbian, gay, bisexual, transgender, and queer (LGBTQ) identified youth have become more visible in mainstream society. This is evidenced by recent debates about homophobic school bullying, gender-neutral school bathrooms, and the rise of an LGBTQ gender expansive youth culture.

    Although it is important to have a balanced approach that integrates risk and protective factors for LGBTQ-identified youth, many continue to face various risk factors that affect their ability to navigate different aspects of their lives. For instance, LGBTQ-identified youth are at higher risk for suicide attempts (when compared to heterosexual-identified youth) and are overrepresented in the child welfare system, criminal justice system, and in populations of youth that experience homelessness (Child Welfare League of America, 2006; Wilber, Ryan & Marksamer, 2006).

    The National Association of Social Workers (NASW) has issued a policy statement opposing discriminatory practices against LGBTQ people (NASW, 2013), and the Council of Social Work Education (CSWE) has issued a policy statement on reparative and conversion therapies addressing nondiscriminatory standards (CSWE, 2016). Still, BSW and MSW students continue to report that they feel “unprepared” to work with LGBTQ people (Martin et al., 2009).

    This article discusses a practice framework that integrates Gay Affirmative Practice (GAP) and the Strengths-Based Perspective (SBP), and recognizes and affirms that everyone’s coming out process is unique. However, for at-risk LGBTQ-identified youth, the coming out process may be challenging for the client and the entry-level practitioner to navigate. Therefore, this article offers entry-level BSW and MSW practitioners a framework within which to think about their work with at-risk LGBTQ-identified youth who may be facing difficulties in their coming out process.

Gay Affirmative Practice and Strengths-Based Social Work Practice

    LGBTQ individuals are a diverse group of people, so no one theoretical framework uniformly addresses the needs of this population. However, using a stance that is grounded in GAP is recognized as “best practice” (Crisp, 2006; Crisp & McCave, 2007; Hunter & Hickerson, 2003; Van Den Bergh & Crisp, 2004; van Wormer, 2000). Davies (1996) describes GAP as a model that affirms the healthy identity of LGBTQ people, whereby promoting cultural competency, self-examination of attitudes pertaining to LGBTQ people, knowledge about LGBTQ people, and the use of effective skills when working with LGBTQ people. Subsequently, GAP is a model that may help entry-level practitioners ground their work with LGBTQ-identified youth.

    A literature review on GAP appears to point to the following five major tenets of Gay Affirmative Practice:

    1. Emotional competency. This calls for practitioners to reflect and be aware of their attitudes and feelings about LGBTQ people, as well as an ongoing self-examination of socially embedded personal biases about LGBTQ people. This also calls for practitioners to address homophobic and heterosexist belief systems, and it  calls for practitioners to take responsibility for understanding the coming out process and identity formation pertaining to LGBTQ people.

    2. Intellectual competency. This calls for practitioners to obtain accurate and scientifically sound information, education, and training about LGBTQ people. Furthermore, this calls for practitioners to obtain information that addresses the multidimensional lives of LGBTQ people. Thus, intellectual competency underscores the importance of understanding the multidimensional aspects of diversity as it relates to LGBTQ people (e.g., race, ethnicity, socioeconomic status, citizenship status, gender identity, gender expression, and other factors).

    3. Practice environment. This calls for practitioners to create a practice environment that includes positive written acknowledgments of LGBTQ people, such as non-discriminatory policies, forms, and assessment tools. This also calls for practitioners to include written information and resources that address the needs and concerns of LGBTQ communities, as well as visible logos and signs that communicate to the client that the practice environment is a welcoming and safe place. This also calls for practitioners to develop a resource of relationships with LGBTQ people, to help establish a network of resources and support for themselves and their clients. Furthermore, this also calls for practitioners to take an active role in challenging heterosexist attitudes, practice techniques, and policies.  

    4. Respectful language. This calls for practitioners to use language that does not assume the sexual orientation of clients. In addition, practitioners are called upon to use inclusive and gender-neutral and gender expansive language when working with all clients. Some examples include using terms such as sexual activity versus sexual intercourse and relationship status versus marital status.

    5. Open-ended questions. This calls for practitioners to be mindful when asking questions and emphasizes the use of carefully constructed open-ended questions. For example, practitioners may want to use some of the following questions: Who is important to you? What can you tell me about the persons who are significant in your life? What can you tell me about your relationships? Practitioners are also cautioned not to ask about causes of sexual orientation (Appleby & Anastas, 1998; Clark, 1987; Crisp, 2002, 2006; Davies, 1996; Hunter & Hickerson, 2004; Morrow, 2004; van Wormer, 2000).

    GAP is consistent with social work approaches that call for viewing clients from a strengths-based perspective, honoring an individual’s self-determination, grounded in consciousness raising and integration of the person-in-environment approach and contextual factors in the life of LGBTQ people (Crisp, 2002, 2006; Davies, 1996).

Strengths-Based Perspective

    Similarly, practicing from a SBP with LGBTQ people requires an authentic appreciation for the personal struggles that they face. Practitioners must be able to excavate stories of strengths that help LGBTQ people overcome adversity. To that end, it is imperative that social workers ground the worker-client relationship in an authentic appreciation for their clients’ uniqueness and help elicit their personal experiences, emphasizing the importance of resilience. This approach is important, because it builds a collaborative relationship that capitalizes on each individual’s distinctive strengths.

    To illustrate how practitioners may elicit, amplify, and reinforce the strengths of LGBTQ-identified youth who may be struggling with the coming out process, Saleebey’s (2013) five types of questions to assess strengths are highlighted below. Once again, in this article, the coming out process is emphasized because this is often a tumultuous process in the lives of at-risk LGBTQ-identified youth (Baams, Grossman, & Stephen, 2015; Child Welfare League of America, 2006; Daniel, 2016; Shara, 2015). As such, helping these youth navigate this process is critical. (It should be noted, however, that “coming out” is an ongoing process, not a one-time event). Also, Saleebey’s strengths-based questioning is highlighted because SBP is widely taught in BSW and MSW programs. Consequently, the SBP may be beneficial in helping entry-level BSW and MSW students conceptualize their work with at-risk LGBTQ-identified youth.

    The five types of questions, with examples of questions a social worker might ask an at-risk LGBTQ-identified youth who is struggling with the coming out process, are:

    1. Survival questions. When coming out, how did you face rejection from others? Throughout your coming out journey, how have you dealt with the loss of friends and/or family members and other significant people in your life? What strategies did you use to overcome rejection or the threat of rejection? What kept you going?

    2. Support questions. Who in the LGBTQ community provides you with support? Where does your internal support come from? Where does your external support come from?

    3. Exception questions. Are there instances when you stood up for yourself? Are there instances when you disclosed your sexual orientation and/or gender identity to someone and felt affirmed?

    4. Possibility questions. How willing are you to explore LGBTQ networks that can lead you to find people who might be more accepting? Is it possible to find new and more accepting circles of support? Is there a possibility to initiate a family of choice? What may this family of choice look like?

    5. Esteem questions. What does your coming out journey say about your ability to stand up for yourself? What does it say about your ability to face opposition? What does it say about your ability to take pride in yourself? What does it say about your ability to take pride in your community?

Final Thoughts

    Incorporating a GAP stance that integrates SBP into one’s practice framework requires that social work practitioners draw upon stories of oppression and resistance. The integration of these approaches also calls for social worker practitioners to understand and assess the various challenges faced during the coming out process, as well as other factors affecting the lives of LGBTQ youth. Social work practitioners must be knowledgeable about the strengths that are inherent in LGBTQ communities, as well as LGBTQ history, which has been grounded in resistance. The best way of achieving this is through active involvement with the LGBTQ community.

    Practicing from this approach requires that social work practitioners also acknowledge that LGBTQ-identified youth have power and inherent internal and external resources that can be harnessed and mobilized to create change and healing.

References

Appleby, G. A., & Anastas, J. W. (1998). Not just a passing phase: Social work with gay, lesbian and bisexual people. New York, NY: Columbia University Press.

Baams, L., Grossman, A.H. & Stephen, R. (2015). Minority stress and mechanisms of risk for depression and suicidal ideation among lesbian, gay, and bisexual youth. Developmental Psychology, 51(5),688-696.

Clark, D. (1987). The new loving someone gay. Berkeley, CA: Celestial Arts.

Child Welfare League of America. (2006). LGBTQ youth in child welfare, a special issue of child welfare: Supporting permanency for LGBTQ youth in foster care. Retrieved February 4, 2017, from https://www.childwelfare.gov/CWIG/includes/display_objects/fostercaremonth/more/LGBTQYouth.pdf

Council on Social Work Education. (2016). Position statement on conversion/reparative therapy. Retrieved from: https://bit.ly/2ICRwJx

Crisp, C. (2002). Beyond homophobia: Development and validation of the Gay Affirmative Practice Scale (GAP). Dissertation Abstracts International, 64, 074. (UMI No. 3099441).

Crisp, C. (2006). The gay affirmative practice scale (GAP): A new measure for assessing cultural competence with gay and lesbian clients. Social Work, 51(2), 115–126.

Crisp, C., & McCave, E. (2007). Gay affirmative practice: A model for social work practice with gay, lesbian and bisexual youth. Child and Adolescent Social Work Journal, 24(4), 403–421.

Daniel, C.H. (2016). The role of institutional placement, family conflict, and homosexuality in homelessness pathways among Latino LGBT youth in New York City. Journal of Homosexuality, 63(5),601-632.

Davies, D. (1996). Towards a model of gay affirmative therapy. In D. Davies and C. Neal (Eds.). Pink therapy: A guide for counselors and therapists working with lesbian, gay and bisexual clients. Philadelphia, PA: Open University.

Hunter, S., & Hickerson, J.C. (2003). Affirmative practice: Understanding and working with lesbian, gay, bisexual and transgender persons. Washington DC: NASW Press. 51(2), 115–126.

Martin, J.I., Messinger, L., Kull, R., Holmes, J., Bermudez, F., & Sommer, S. (2009). Council on Social Work Education-Lambda Legal study of LGBT issues in social work. Alexandria, VA: Council on Social Work Education. Retrieved July 1, 2017, from http://www.cswe.org/File.aspx?id=25675

Morrow, D. F. (2004). Social work practice with gay, lesbian, bisexual, and transgender adolescents. Families in Society, 85(1), 91–99.

NASW. (2003). Lesbian, gay, and bisexual issues. Social work speaks: National Association of Social Workers policy statements 2003-2006 (6th ed.). Washington DC: NASW Press, p. 224-235).

Saleebey, D. (Ed.). (2013). The strengths perspective in social work practice (6th Ed.).

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Shara, S. (2015). Coming out, being out: Reconciling loss and hatred in becoming whole. Psychoanalysis, Culture & Society, 20(3),250-260.

Van Den Bergh, N., & Crisp, C. (2004). Defining culturally competent practice with sexual minorities: Implications for social work education and practice. Journal of Social Work Education, 40(2), 221–238.

van Wormer, K., Wells, J., & Boes, M. (2000). Social work with lesbians, gays, and bisexuals: A strengths perspective. Boston, MA: Allyn and Bacon.

Wilber, Ryan & Marksamer (2006). Serving LGBTQ youth in out of home of care: CWLA best practice guidelines. Child Welfare League of America:Washington, DC.

Wornoff, R., Estrada, R. Sommer, S. (2006). Out of the margins: A report on regional listening forums highlighting the experiences of lesbian, gay, bisexual, transgender, and questioning youth in care. CWLA & Lambda Legal. Retrieved from https://www.lambdalegal.org/sites/default/files/publications/downloads/out-of-the-margins.pdf

Milka Ramírez, Ph.D., LCSW, has a Ph.D. in Philosophy of Social Work from the University of Illinois Chicago. She is the Associate Dean at the Institute for Clinical Social Work in Chicago. She has practice experience in child welfare, schools, juvenile justice, and community practice. Her research focuses on gender/sexuality, social work practice, and performing arts as a vehicle for social change.