Mental Health Interventions and LGBTQIA+ Youth - MUSC ...

Mental Health
Interventions and
LGBTQIA+ Youth

Acknowledgements
  The Mental Health Assistance Program and this training have been
created and significantly impacted by our Queer Youth Approval Board.
The latter assist me in creating informative and up-to-date training for
                      mental health practitioners.

  Thank you to Avery,
 Erin, KK, Arin, Jeremy,
 Matt, Kennedy, Isa, and
           Ellie

Who is We Are Family?
                          *NEW* Mental Health Assistance
    Chandler                       Program

Massengale, LMSW         SafeSpace (Middle and High School
                                    Students)

  Mental Health               QueerSpace (18-24yo)

   Coordinator           The QTPOC Get Together (16-24yo)

                                   GSA Support
Pronouns: She/her
                                   ParentSpace
  and They/them
                                 Trans Love Fund

chandlerm@waf.org             Gender Affirming Gear

                              Name Change Services

The Effects of the Pandemic on
            LGBTQIA+ Youth
●   LGBTQIA+ people already experience higher rates of poverty, HIV, being
    without a home, and tobacco use than their cisgender, heterosexual peers.
●   Mental health conditions and symptoms are exacerbated by social isolation.
●   According to the Center for Southern Equality (2019), 71% of LGBTQIA+
    people in SC experience depression and 63% of them experience anxiety.
●   The Trevor Project (2019) cites that 39% of the LGBTQIA+ youth that they
    surveyed had seriously considered attempting suicide in the previous 12
    months.
●   Domestic Violence and Interpersonal Violence increased 5% in 2020 - SC
    has one of the highest rates of DV and IV in the country.

Let’s Talk Terminology!
   As clinicians and practitioners, we
understand the power of language, the
differences between intent and impact,
and that even with the best intentions
we can perpetuate cultural, emotional,
           and verbal violence.

Gender and Sexual Identities

● Recognize, respect, and VALIDATE all gender
  identities, romantic, and sexual orientations!
● If a person’s identity changes at any given time,
  go with it! VALIDATE it!
● Pay attention to pronouns!

Gender & Sex Terminology
●   Gender Expression/Presentation – the external display of one’s gender,
    through a combination of dress, demeanor, social behavior, and other
    factors, generally measured on scales of masculinity and femininity.

●   Gender (Identity) - A person's internal, deeply held sense of their gender.
    For transgender people, their own internal gender identity does not match
    the sex they were assigned at birth. Most people have a gender identity of
    man or woman (or boy or girl). For some people, their gender identity does
    not fit neatly into one of those two choices (see non-binary and/or
    genderqueer). Unlike gender expression, gender identity is not visible to
    others.

●   Gender Binary – the idea that there are only two genders – male/female or
    man/woman and that a person must be strictly gendered as either/or.

Gender & Sex Terminology
●   Sex Assigned at Birth – a medical term used to refer to the chromosomal,
    hormonal and anatomical characteristics that are used to classify an
    individual as female or male or intersex. Often referred to as simply “sex,”
    “physical sex,” “anatomical sex,”
●   Intersex [in-ter-seks] | noun (intersex people) - An umbrella term
    describing people born with reproductive or sexual anatomy and/or a
    chromosome pattern that can't be classified as typically male or female.
    While some people can have an intersex condition and also identify as
    transgender, the two are separate and should not be conflated. -from R29

●   AFAB - assigned female at birth

●   AMAB - assigned male at birth

Gender Identities
Transgender | adjective                            Transgender people have a
(transgender people)                               range of gender identities
                                                      – Agender
An umbrella term for people whose gender
identity and/or gender expression differs             – Gender
from what is typically associated with the
sex they were assigned at birth.                        Non-conforming/
People under the transgender umbrella may
                                                        Gender-queer
describe themselves using one or more of a wide       – Trans man
variety of terms — including transgender. Use
the descriptive term preferred by the person.         – Trans-masculine
Many transgender people are prescribed
hormones by their doctors to bring their bodies
                                                      – Nonbinary
into alignment with their gender identity. Some       – Two-spirit
undergo surgery as well. But not all transgender
people can or will take those steps, and a            – Trans woman
transgender identity is not dependent upon
physical appearance or medical procedures             – Trans-feminine

Gender Identities
Two-Spirit (2 Spirit): Adopted in 1990 at an
Indigenous lesbian and gay international
gathering, “Native American two-spirit people
were male, female, and sometimes intersexed
individuals who combined activities of both men
and women with traits unique to their status as
two-spirit people. In most tribes, they were
considered neither men nor women; they
occupied a distinct, alternative gender status. In
tribes where two-spirit males and females were
referred to with the same term, this status
amounted to a third gender. In other cases,
two-spirit females were referred to with a distinct
term and, therefore, constituted a fourth gender”
(Indian Health Service).

Sexual and Romantic Identities
●   Asexual Spectrum (ace-spec): is a
    group of sexual orientations that all fall
    under the umbrella term of asexula.
    Folkel on the asexual spectrum may
    completely lack sexual attraction or feel it
    so little that they relate more to the
    asexual experience than to the allosexual
    experience. The common link between
    folx on the asexual spectrum is that they
    do not feel the "standard" amount of
    sexual attraction or feel it in the
    "standard" way.

●   Aromantic Spectrum (aro-spec): The
    Aromantic Spectrum or Aromantic
    Umbrella is a group of romantic
    orientations that all fall under the
    umbrella term of aromantic. People on
    the aromantic spectrum may lack
    romantic attraction. The common link
    between people on the aromantic
    spectrum is that they do not feel the
    "standard" amount of romantic
    attraction or they don't feel it in the
    "standard" way, that alloromantic
    people do.

Sexual and Romantic Identities
Bisexual (often shortened to Bi): refers to
someone who is attracted to two or more
genders. It is also sometimes defined as the
attraction to genders both the same as and
different to one's own. Bisexuality encompasses   Biromantic (sometimes shortened to
a wide spectrum of attraction. Bisexual people    biro):refers to someone who is romantically
                                                  attracted to two or more genders or to people
may or may not have a preference and may or
                                                  whose genders may be the same or different
may not feel a difference between their           than theirs. They may or may not also be
attraction to different genders.                  sexually attracted to two or more genders.
                                                  Biromantic people may or may not have a
                                                  preference and may or may not feel a
                                                  difference between genders.

Other Key Terms

Allosexual                          Homophobia
Assigned Female at Birth (AFAB)     Latinx
Assigned Male at Birth (AMAB)       MLM/WLW (Men Loving Men/Women
Cisgender                           Loving Women)
Coming Out                          Masc
Femme                               Misgender(ing)
Gender Affirmation                  Minoritized (Group)
Gender Confirmation Surgery         Outing
Gender Expansive                    Personal Gender Pronouns (PGP)
Gender-Fluid                        Transphobia
Gender Inclusive                    T for T
Hormone Replacement Therapy (HRT)

Misogynoir                         Transmisogynoir:
(mis-soj-uh-nwar):                 the oppression of trans women
Coined by Moya Bailey in           of color, and trans feminine
2008; the specific hatred,         people of color, more
dislike, distrust, and prejudice   generally. It exists at the
directed toward Black women        intersection between
(often used attributively)         transphobia, misogyny, and
                                   anti-blackness.

Intersectionality

● Term created by Kimberlé Crenshaw
● Intersectionality is the intersection of 2 or more
  identities and explains
   ○ How identities affect each other
   ○ How their combination affects your life
   ○ How they affect you systemically
   ○ How it’s impossible to separate identities and
     experiences

Intersectionality
Identities people hold come in a variety of
layers, from internally to institutionally.
Each identity interacts with each other at the
same time.
The ones most important or prominent to
you change depending on your environment.

Go around the wheel and fill in each spoke
with your identities.
Answer the questions in the middle of the
wheel.
How do your identities affect your perception
of others, and their perception of you?

Some identities hold more privilege (unearned benefit from belonging
                to various social groups) than others.
 Different types of privilege can include age, able-bodied, language,
 heterosexual, class, religious, male, white, and cisgender privilege.
 On the flip side, some identities face more oppression (unjust and
                 cruel exercise of power over others).
Different types of oppression can include heterosexism, homophobia,
ableism, racism, sexism, colorism, xenophobia, cisgenderism, ageism,
                      transphobia, and classism.
Intersectionality relates to in-group and out-group dynamics, including
                                 language.

Intersectionality is important because each person and
community within the overall LGBTQIA+ community face
unique challenges and hold unique privileges.
For example:
   Trans people face transphobia from straight and queer
   cisgender people
   Queer people of color face racism from white straight
   and queer people
   Bisexuals face biphobia from straight and gay people

What to Do if You Use the Wrong Pronouns, Name,
or Terminology
●   That’s okay! Apologize, Correct Yourself, and Move On.
●   Do not over apologize. We all make mistakes and learning from
    them is important.
●   Do not make excuses (i.e., “I knew you before you openly identified
    this way,” “It is hard for me to remember to use that term,” “You
    don’t look that way”).
●   If you can’t apologize in the moment, or realize your mistake later,
    tell the person privately that you are sorry and will use the correct
    pronoun, name, or terminology in the future.

Reframing of “Risky Behaviors” in
Reference to Trans and Queer Youth
● Actions characterized as “risky behavior patterns” are essential to
   the survival of many trans and queer lives. These actions should
   be met with a care-frontive/encouraging approach instead of a
   confrontive/shaming approach.
   Examples: Adolescent Drug Use (ex. tobacco, alcohol, etc.)
              Runaway Youth/Youth Without Homes
              Sex work
              Improper Intravenous Administration of HRT

Engrained Threats to Resilience, Especially
     During the COVID-19 Pandemic
●   Health care access challenges
●   Access to education
●   Mental Health/ Substance Abuse challenges
●   Emotional and Social isolation
●   Verbal, Physical, and Sexual Violence
●   Employment discrimination
●   Discriminatory policies like HB2, S.1, H3477, identification
●   Limited access to financial resources
●   Being without a home, physically and/or emotionally
●   Sex-working for sustainability
●   Gender policing and the criminalization of trans bodies

Increasing Resilience
        ●   Increasing their ability to define and
            affirm their gender and
            sexual/romantic identity
        ●   Proactive agency and access to
            supportive educational, health,
            mental health systems
        ●   Having supportive care system,
            including friends and family
            members
        ●   Connection to a trans- and
            queer-affirming community
        ●   Reframing of mental health
            challenges

The Mental Health Practitioner’s Role
• Affirming or acknowledging resilience/coping
• Normalizing people’s experiences
• Getting educated!
  –Educate yourself by going to trainings or surfing the web
  –Advocate for trainings within your organization
  –Identify CEU’s that are run by and talk about LGBTQIA+ people
• Serve clients with cultural humility & sensitivity
  –Recognizing that clients should not serve as your educator, but that each
   trans/queer experience is unique
  –Practice needs-based, non-violent communication
  –Demonstrating buy-in actions and becoming a stakeholder in affirmative care
• Challenge gender “norms” and gendered language in your professional
  and personal lives

Challenging Gender and Sexuality “Norms” &
          Gender Language in Your Practice
●   Who introduces themselves including their pronouns and ask others for
    theirs if they are comfortable sharing?
●   Whose assessment and intake forms include a place for pronouns?
●   Whose forms and notes include a space for chosen name? And how do
    you use a client’s legal name?
●   Whose forms include gender options for more than just male and female?
●   Does your practice description include allied practice methods (Are you
    trans allied? Sex worker allied? Are you non-binary allied?
    Non-monogamous relationship allied?)
●   Does your specialty include “LGBTQIA+ issues” or does it use language
    such as “LGBTQIA+ affirmative therapy?”

We Can’t Forget About Family Involvement!
As practitioners who work with youths, we
know that family involvement is generally
important for positive outcomes.

The Family Acceptance Program created
infographics for parents/guardians/family
members with LGBTQIA+ youths to
examine both the positive and negative
outcomes of accepting and non-accepting
behaviors.

Resources
○   Solutions Focused Therapy CEU               ■    The Transgender Teen: A Handbook for
                                                    Parents and Professionals Supporting
○   Trans Student Educational Resources             Transgender and Non-Binary Teens by
                                                    Stephanie Brill and Lisa Kenney
    (Gender Unicorn)
                                                ■     Beyond the Binary by Alok Vaid-Menon
○   Family Acceptance Project                   ■   My Shadow is Pink by Scott Stuart
                                                ■   A Clinician's Guide to Gender-Affirming
○   Refinery29                                      Care: Working with Transgender and
○   Educational Resources                           Gender Nonconforming Clients by Sand C.
                                                    Chang, PhD
○    South Carolina Telehealth Counselors       ■    The Reflective Workbook for Parents and
    Facebook Group                                  Families of Transgender and Non-Binary
                                                    Children: Your Transition as Your Child
○   Indian Health Service LGBTQ2S+ Health           Transitions by D. M. Maynard
                                                ■   God and the Gay Christian: The Biblical
○   SAIGE Rainbow Certification                     Case in Support of Same-Sex
○   Educational/Affirming Books:                    Relationships by Matthew Vines
                                                ■    How to Support Your Non-Binary Family
     ■     A Quick & Easy Guide to                  Member Zine
          They/Them Pronouns by Archie          ■   Exploring the Impacts of Ableism: A
                                                    COVID-19 Photo Essay Series by
          Bongiovanni and Tristan Jimerson          Cuéntame
     ■     A Quick & Easy Guide to Queer &
          Trans Identities by Mady G and
          Jules Zuckerberg

Citations
Family Acceptance Project (2020). Family Acceptance Project Poster to Build Healthly Futures for LGBTQ &

    Gender Diverse Children & Youth. https://familyproject.sfsu.edu/poster

Harless, C., M. Nanney, A.H. Johnson, A. Polaski, and J. Beach-Ferrara (2019). The Report of the 2019 Southern

    LGBTQ Health Survey. Campaign for Southern Equality.

    https://southernequality.org/wp-content/uploads/2019/11/SouthernLGBTQHealthSurvey–FullReport.pdf

Paley, A. (2020). The Trevor Project National Survey on LGBTQ Youth Mental Health 2020. The Trevor Project.

    https://www.thetrevorproject.org/survey-2020/?section=Introduction

Pan, L. (2017, August 18). Gender grammar. TSER. Retrieved October 13, 2021, from

    https://transstudent.org/graphics/gendergrammar/

Citations
Pan, L., & Moore, A. (2021, February 7). Gender unicorn. TSER. Retrieved October 13, 2021, from

     https://transstudent.org/gender/

The Qube- LGBTQIA+ Resource Center (2021). In Person 2021 Safespace. [PowerPoint slides]. University of
     Wisconsin: Stout.
     https://docs.google.com/presentation/d/1rzewpQkLTcGLiYdi_nMWB3AlUyZATeTt/edit#slide=id.p3