about “safe sex.” This includes discussion of a range of options including abstinence, nonsexual intimacy, and sexual activity with the use of condoms or other contraceptives. Parents should contact their child’s pediatrician or local health department for the “facts” on safe sex. Additionally, the attentive parent or caregiver will pay particular attention to ensuring that their child’s pediatrician is “LGB- friendly,” meaning that he or she is sensitive to and respectful of LGB youth. If families live in more urban areas, chances are there will be an LGB community center or a publication with some references to LGB-friendly physicians. These community centers or physicians can be contacted about referrals to similarly As mentioned, one of the negative consequences of a youth coming out is the lack of acceptance by the family. At the extreme, this nonacceptance manifests with verbal and physical abuse, including ordering the child to leave the home, resulting in the child’s homelessness. In such cases it is hoped that the proper authorities, including child welfare social workers (and in extreme cases, the police), become involved in these youths’ lives to ensure their safety, well-being, and access to a permanent, stable place to reside. When youth enter the child welfare system, they may receive care in a variety of settings, including foster care or group homes. It is important that the care providers have received proper diversity training on sexual orientation (as well as on gender identity). Fortunately, the major private nonprofit organizations and public entities (e.g., the National Foster Parent Association, the Child Welfare League of America), and increasingly the federal government, have excellent supports and resources for helping LGB youth in care. One such resource is T wenty Things Supervisors Can Do to Support Workers to Competently Practice with LGBTQ Children, Youth, and Families (National Resource Center for Permanency and Family Connections, 2014). Child welfare Impact on youth However, despite these good intentions, LGB youth in care are often at the mercy of the culture of individual child welfare constituencies with respect to supporting them. Foster parents have been found to have a range of attitudes, from acceptance to rejection (Clements & Rosenwald, 2007). Further, a national study of child welfare agencies found similarly mixed results. This is particularly alarming considering that when children of different genders or race enter care, it is assumed that child welfare agencies do not discriminate; yet, with respect to sexual orientation and gender identity, such prejudice and discrimination are alive and well (Rosenwald, 2009). As this
sensitive pediatricians if there are none immediately identified. In more rural areas, a search on the Internet, followed by a telephone or in-person screening, can also help ensure that an LGB-friendly physician is found. Although this course focuses on the needs of LGB youth, it is important to note in this section that those transgender youth who are interested in physically transitioning from male to female (MTF) or female to male (FTM) are only legally able to do so as adults. A similar search for a respectful and knowledgeable pediatrician or physician is paramount for addressing these youths’ medical needs. issue receives more and more attention, LGB-friendly foster homes, group homes, and emergency shelters are slowly becoming more realistic options for LGB youth. Given that initial experiences of child maltreatment may have already traumatized LGB youth, placement planning needs to include considerations for sexual orientation and gender identity so that these children do not experience additional homophobia and other discrimination in supposedly safe environments. Family response The notion of “family response” in this context needs to be expanded to include the foster parents, group home staff, and the larger community’s support for LGB youth. As mentioned, agency and state mandates vary as to what they require for youth. It is incumbent on childcare professionals (foster parents, group home staff, etc.) to be comfortable working with and being respectful of LGB youth. The National Foster Parent Association and the Child Welfare League of America have excellent materials for working with these newly constructed families. Not all LGB youth who reside in foster care stay there. For some, it is a temporary situation and the youth returns home, under supervision, as long as the parents can ensure their safety and agree (whether voluntarily or under court mandate) to address the factors that resulted in the past maltreatment. Various professionals will commonly be involved in monitoring the family’s functioning, and will provide family therapy (discussed in the next section) to help identify the family dynamics that led to the abuse and ensure that these dynamics are changed so the maltreatment is not repeated. Other youth, unfortunately, become homeless and need community services. In these cases the community needs to think about the need for creating homeless shelters and transitional living services, for both LGB youth and LGB young adults, to help provide structure and increased optimism for their lives and well-being.
FAMILY THERAPY
Practitioners working with LGB youth and their families are invited into the families’ lives, and even their homes, to assist them with, at times, very intimate and sometimes very painful information during tumultuous periods in their individual and Practitioner readiness Prior to the following presentation of the three family therapy models discussed in this course, four considerations must be addressed. First, the concept of the identified patient from family therapy is useful when working with any family, regardless of the model to be used. The identified patient is the family member who is assumed, typically by the relative arranging the family therapy, to be the reason for all of the problems and distress that the family is experiencing. The family systems view, however, holds that no one person is responsible for the existence of a problem. Rather, the family must be viewed in its entirety as a system wherein members each play a role in the maintenance of a problem as well as its solution. Second, it is important for practitioners to be mindful that they (the practitioners) are providing assistance to the families; they
family development. Although it might seem daunting to help an entire family, the skilled family practitioner is well equipped to provide assistance.
are not solving problems for them. It is up to families themselves to define what they want to work on and then to do this work. This honors self-determination , and all of the models of family therapy rely on this perspective. Third, practitioners have a range of models to select from in their work with families. Practitioners choose models they are familiar with and are competent to practice, and which have underlying assumptions that best match their own worldview. Practitioners often consider the fit of a model with each family’s unique presenting issues. The fourth consideration, countertransference , is particularly important for practitioners working with LGB youth and their families. Regardless of the model of practice used, families will typically look to the therapist as the “expert” and imagine
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