PTTC Post Article - June 2023

Supporting and Affirming LGBTQI+ Youth:

 Evidence and Action from the New SAMHSA Report

Author: Cele Fichter-DeSando, MPM
 

“Like all youth, lesbian, gay, bisexual, transgender, queer, questioning, and intersex youth and other sexual-and gender-diverse children and adolescents (LGBTQI+ youth) deserve to grow up in supportive environments absent stigma and discrimination that allow them to thrive and achieve their human potential. When seeking behavioral health treatment (both mental health and substance use interventions), these children and adolescents, like their peers, and their families deserve the best evidence-based care from knowledgeable health providers without the risk of harm (SAMHSA, 2023) .” 

This opening statement from the executive summary of the newly released SAMHSA report Moving Beyond Change Efforts: Evidence and Action to Support and Affirm LGBTQI+ Youth highlights the importance of providing behavioral health providers, educators, researchers, policymakers, and other audiences with current, accurate knowledge about LGBTQI+ youth.
In recognition of Pride Month, the June PTTC Post provides detailed information about this March 2023 report, including the key findings and recommendations.

 

Audience

Thumbnail that states: Moving beyond change efforts: Evidence and Action To support and affirm LGBTQI+ Youth with a diverse group of young people on the imageThe Moving Beyond Change Efforts report is written for multiple audiences and has information and recommendations for behavioral health providers, pediatric and primary care professionals, educators and school professionals, policymakers, and researchers. Resources and support information are also provided for families, parents, caregivers, and community leaders. The report is a comprehensive research overview and provides important information on behavioral health concerns for LGBTQI+ youth along with details on helpful and harmful interventions in clinical, community, family, and school settings. Outlined in the report is a section on understanding sexual orientation and gender identity in children and adolescents and a research overview of the development, behavioral health, and beneficial therapeutic approaches with youth of diverse sexual orientation and/or gender identity. 

 In particular, the report documents that attempts to change an individual’s sexual orientation and gender identity (SOGI; pronounced “SO-gee” change efforts) are harmful and should not be provided. 

 

LGBTQI+ Youth Behavioral Health Concerns

An estimated 11.4 to 12.2 million adults identify as LGBTQ+ in the United States, a number roughly equivalent to the population of Ohio. An estimated 1.99 million adolescents ages 13 to 17 identify as LGBT in the United States, which is roughly equivalent to the combined populations of Dallas, Texas, and Detroit, Michigan.

As a result of experiencing discrimination, stigma, a lack of awareness, and isolation along with the developmental milestones of adolescence, some LGBTQIA+ youth are at increased risk for experiencing:

  • Psychological distress (e.g., depressive symptoms, anxiety, and behavioral disorders)
  • Substance use
  • Suicidal ideation and attempts
  • Victimization, violence, and homelessness 
  • Involvement with child welfare services, often stemming from family rejection 
  • Involvement in juvenile justice programs

 

Several factors contribute to these inequities and result in minority stress, which is harmful to behavioral health, including:

  • Stigma 
  • Negative social attitudes
  • Systemic barriers in health care for LGBTQI+ people
  • Rejection and lack of support from families, caregivers, and communities 
  • Bullying and harassment, and lack of recognition and support in schools 

 

Key Findings

The key findings and conclusions in the report are based on research and professional consensus statements from a panel of experts in behavioral health, research, education, and policy (The Panel) and include evidence-informed policy options that could improve the overall health and well-being of LGBTQI+ youth.

 

The Panel reaffirmed that:

  • Variations in sexual orientation (including identity, behavior, and attraction) and variations in gender (including identity and expression) are part of the normal spectrum of human diversity and do not constitute mental disorders.

 

The Panel concluded that:

  • No available research supports the claim that SOGI change efforts are beneficial to children, adolescents, or families. 
  • Available research indicates that SOGI change efforts are not effective in altering sexual orientation. Further, no available research indicates that change efforts are effective in altering gender identity. 
  • Available research indicates that SOGI change efforts can cause significant harm. 
  • SOGI change efforts are inappropriate, ineffective, and harmful practices that should not be provided to children and adolescents. 

 

The Panel found that:

  • Gender affirmation, including social transition, and gender-affirming medical care are appropriate and beneficial for many gender minority youth. 

 

The Panel confirmed that: 

  • Family and community negativity toward sexually diverse sexual orientation and/or gender identity, especially family rejection and school bullying and harassment, can cause harm to the behavioral health of this population. 
  • Rejection and lack of social and emotional support from families and caregivers, schools, and communities negatively affect the health of sexual and gender minority youth. 

 

The Panel determined that: 

  • Policies that stigmatize, restrict, or exclude sexual or gender minority youth are harmful to children and adolescents. 
  • Legal prohibitions on gender-affirming care (including medical treatment) are harmful to LGBTQ+ children and adolescents. 

 

The Panel recommends approaches that:

  • Provide accurate information on sexual orientation, gender identity and expression, and variations in sex characteristics. 
  • Identifying sources of distress, including internalized stigma and minority stress, and working with children, adolescents, families, and caregivers to reduce the distress LGBTQI+ youth experience. 
  • Support adaptive coping to improve psychological well-being. 
  • Support youth as they learn more about their sexual orientation and gender identity, and support families in accessing gender-affirming care for their transgender child when indicated. 
  • Help children and adolescents navigate their sexual orientation, gender identity, and gender expression within the context of their cultural, religious, and other identities. 

 

The Panel recommends policies that:

  • End harmful and ineffective efforts such as SOGI change efforts and ensure access to evidence-based care 
  • Promote behavioral health through protective and anti-discrimination policies 
  • Improve behavioral health by facilitating increased support from families, schools, and communities 
  • Conduct research that increases knowledge of health inequities with the goal to improve care 
  • Pass state legislation to ban SOGI change efforts or provide supportive resources
  • Introduce federal legislation to ban SOGI change efforts or provide supportive resources
  • Ban licensed behavioral health providers from engaging in SOGI change efforts
  • Restricting the use of state funds and proposing the restriction of federal funds for these efforts 
  • Defining SOGI change efforts as consumer fraud

 

Report Summary 

At the conclusion of the Moving Beyond Change Efforts Report, SAMHSA states that it is “committed to eliminating health inequities experienced by marginalized communities, including LGBTQI+ youth” and asserts the need for, families, caregivers, providers, and educators to have access to resources and accurate information to inform healthy decision making. 

Two key strategies are identified that can help prevent adverse outcomes and support healthy development for LGBTQI+ youth.

  1. Strong and positive family, school, and community engagement. 
  2. Appropriate and supportive therapeutic interventions by physical and behavioral health providers. 

Included in the report are a glossary of terms, extensive references, and online and print resources designed for specific populations to help carry out the key strategies.

 

Conclusion

The report concludes that in order to reduce health inequities and improve the health and well-being of LGBTQI+ youth behavioral health providers, medical health providers, educators and school professionals, community leaders, families, parents, caregivers, and policy-makers must work together to

  • build greater social acceptance of LGBTQI+ youth across all environments where they live, learn, and play; 
  • go beyond ending harmful change efforts to adopt appropriate and supportive interventions;
  • provide targeted resources and accurate developmentally informed information for children, adolescents, their families, and providers; and
  • build better supportive environments and work to eliminate negative social attitudes. 

 

“Like all youth, lesbian, gay, bisexual, transgender, queer, questioning, and intersex youth and other sexual-and gender-diverse children and adolescents (LGBTQI+ youth) deserve to grow up in supportive environments absent stigma and discrimination that allow them to thrive and achieve their human potential. When seeking behavioral health treatment (both mental health and substance use interventions), these children and adolescents, like their peers, and their families deserve the best evidence-based care from knowledgeable health providers without the risk of harm (SAMHSA, 2023) .” 


References

Substance Abuse and Mental Health Services Administration (SAMHSA): Moving 
Beyond Change Efforts: Evidence and Action to Support and Affirm LGBTQI+ Youth
. SAMHSA Publication No. PEP2203-12-001. Rockville, MD: Center for Substance Abuse Prevention. Substance Abuse and Mental Health Services Administration, 2023. https://store.samhsa.gov/sites/default/files/pep22-03-12-001.pdf

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