Clinical and Ethical Considerations for Social Workers
Serving LGBT Youth
Susan Radzilowski, LMSW, ACSW
(NASW Michigan Chapter Ethics Committee Member)
Lance Hicks, Transgender Community Organizer
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Lesbian, Gay, Bisexual and Transgender (LGBT) youth face significant barriers to basic needs such as
educational opportunities, housing, food, medical care and access to mental health services. Due to the
additional stressors they face LGBT youth are in greater need of these services than other youth. In fact,
the numbers are staggering. Forty percent of homeless youth identify as LGBT. LGBT youth are also
more likely to encounter a hostile school environment, which ultimately leads to an increase in truancy
and a reduction in educational aspirations and achievement. Of all the client populations that Social
Workers serve, LGBT youth are among the most marginalized and vulnerable.
According to the Center for Disease Control, LGBT youth are also at increased risk for suicidal thoughts
and behaviors, suicide attempts, and suicide. A nationally representative study of adolescents in grades
7–12 found that lesbian, gay, and bisexual youth were more than twice as likely to have attempted
suicide as their heterosexual peers. Overall, the stresses experienced by LGBT youth also put them at
greater risk for mental health problems, substance use, and physical health problems.
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Table of Contents
Language Matters ............................................................................................... 4
Reflections on Serving LGBT Youth Within the Context of the NASW Code of
Ethics .................................................................................................................. 6
Cultural Competence .......................................................................................... 7
Managing Issues Around Consent....................................................................... 7
School Related Risk Factors ................................................................................ 7
Working with Families ........................................................................................ 9
In Conclusion ...................................................................................................... 9
Resources ......................................................................................................... 10
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Language Matters
The authors propose that a first priority for Social Workers serving LGBT youth is to become familiar
with language that is relevant to the LGBT community. Social Workers should be educated about the
potential negative and as well as potential affirming impact of words. We can choose avoid the use of
stigmatizing language and can instead opt for words that convey respect and help to establish rapport.
Learning the definition and usage of terms and language also helps social workers become more
knowledgeable about the LGBT community and the issues facing the community.
With regard to the following definitions please keep in mind that language is dynamic and constantly
changing. It’s also important to remember that there are many communities represented on this list.
Not everyone will agree with the definitions provided here, and many people will use words not
included on this list to describe their experiences. There is no “right” definition to these words, but
there are many different definitions. The best way to learn about the language of any community is by
listening to its members speak about their experiences.
 LGBT: the acronym for “Lesbian, Gay, Bisexual and Transgender”. While this acronym is
relatively short and easy to remember, it leaves out a number of identity groups, which are
sometimes included in a longer acronym, often affectionately referred to as the “alphabet
soup.”
 Ally: Any member of a privileged identity group who actively works to fight the oppression from
which they benefit. This includes white people who work against racism, straight people who
work to fight homophobia, or cisgender people who struggle against transphobia.
It is important to remember that, no matter how dedicated a person is to fighting oppression,
having privilege means benefiting from that oppression. To be white is to benefit from racism;
to be straight is to benefit from homophobia, to be cisgender is to benefit from transphobia—
regardless of whether or not a person “wants” to have that privilege. For this reason, some
people feel that the term “ally” causes more harm than good, since it implies that someone can
undo the harm caused by their privilege by taking a few small steps. Taking steps to fight
oppression (like educating yourself about your privilege, consuming media made by oppressed
people, or speaking out when you see or hear an injustice) are important actions Social Workers
should all take—but exercise caution when claiming the label of “ally,” and remember there’s
always more work to be done!
 Bisexual: a person who tends to form significant romantic, emotional, physical and/or sexual
attractions to two genders. While some bisexual people truly are attracted to only two genders,
many people use this term incorrectly. They use the term, “bisexual,” to describe themselves
because they have not considered the fact that there are more than two possible genders to
which they might be attracted. These people are more accurately referred to as “pansexual.”
 Pansexual: A person who has the capacity to be attracted romantically, physically, emotionally,
and/or sexually a person of any gender.
 Coming out: coming to terms with one’s sexual or gender identity, and then choosing if, when,
how, and with whom a person shares this information.
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 Gay Man: a man whose primary romantic, emotional, physical and/or sexual attractions are to
other men.
 Gender Identity: how one thinks of one’s own gender. A gender identity is your sense of self, as
it relates to your gender.
 Genderqueer: An identity label that describes someone who feels the terms “male” and
“female” to be inaccurate or incomplete descriptions of their gender.
 Gender-neutral: Anything that does not imply a specific gender is gender-neutral. Some people
adopt gender-neutral pronouns, instead of "he" and "she," which are usually associated with
either male or female genders. Many progressive parents strive to provide their children with
gender-neutral clothing, toys, and activities, in order to foster self-determination at an early
age. Being gender-neutral should not be confused with the terms, "agender," or "genderless."
Not specifying a gender does not imply that no gender exists -- simply that no information about
gender has been provided.
 Gender Expression: Gender expression describes the way a person displays their gender identity
to the world. Gender expression can include clothing choices, makeup (or lack thereof), speech
patterns, hair style/length, or any other conscious decisions someone makes, in order to portray
their gendered self. Gender expression is the concept many gender theorists reference when
they note "gender is what you do."
 Heterosexism: This is the system of oppression that suggests that everyone is “straight until
proven otherwise.” Because we live in a heterosexist society, being straight is considered normal
(which is why people rarely have to “come out” as straight—it’s just expected).
 Heterosexual: a person who tends to form their strongest emotional, romantic, or sexual
attractions to members of the “opposite” gender.
 Homophobia: negative feelings, attitudes, actions or behaviors towards anyone who is not
straight, or towards anyone who is perceived to not be straight. Institutionalized homophobia
refers to homophobic laws, policies, and positions taken by social and governmental
institutions.
 Homosexual: A person whose primary romantic, emotional, physical, and/or sexual attractions
are to members of the same gender. Many people consider the term, “homosexual” to be
offensive, as it pathologizes people with these experiences, and was once labeled in the DSM as
a mental illness.
 Lesbian: a woman whose primary romantic, emotional, physical and sexual attractions are to
other women.
 Privilege: Privilege is the set of cultural advantages that someone gets, without having to do any
work, simply because of a fundamental part of who they are. Privilege is often described as an
“invisible knapsack” of helpful resources—things you benefit from, that are “invisible” to you,
because they’re considered normal in our society. Some privileges are: white privilege, straight
privilege, cis privilege, able-bodied privilege, etc.
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 Oppression: Oppression is the opposite of privilege. This is the set of cultural disadvantages
someone has to deal with, because of a fundamental part of who they are. Because our society
thinks of certain identities and experiences as normal and good, people who have different
identities or experiences must struggle to exist in a world that sees them (at best) as different or
(at worst) as bad. Some oppressed people include fat people, poor people, people of color,
people with disabilities, and LGBT people.
 Queer: A person who is not heterosexual may identify as queer. Originally used as a derogatory
slur, this is both a re-claimed term of empowerment and a new identity label designed to be
more all-inclusive than other terms.
 Sexual Identity: how one thinks of oneself in terms of to whom one is sexually or romantically
attracted.
 Sexual Orientation: A person’s tendency towards being romantically or sexually attracted to one
or more genders of people. Sexual orientation describes attraction—not experience—so it has
nothing to do with the genders of a person’s sexual partners.
 Transgender: An umbrella term that refers to people who do not conform to society’s
expectations about gender. Transgender people can include transsexual men (assigned female
at birth) and women (assigned male at birth), cross dressers, feminine men, or masculine
women—to name a few. This is a self-identified term. A person must claim the label
“transgender” in order for it to be appropriate.
It is estimated that between two to five percent of the population is transgender. Transgender
citizens are 28 percent more likely to experience physical violence than others. One in six
transgender people have been incarcerated and 41 percent have attempted suicide.
For transgender persons of color the statistics are even bleaker. Transgender women of color
are disproportionately targeted for transphobic violence, and many anti-trans hate crimes are
carried out under the guise of seeking revenge for the trans victim's "deception."
 Transsexual: A transsexual person is someone who feels that the choice to alter their body with
hormones, surgery, or other medical procedures would make them feel more comfortable with
their gender. Transsexual people can have a range of identities and experiences – they are not
just trans men and women.
 Transvestite: This is a term that describes a person who cross dresses to receive sexual
gratification. It is often used, incorrectly, to describe all cross dressers. Most cross dressers do
not receive sexual gratification from cross-dressing, and in most situations, this term is
considered to be out-dated and offensive.
Reflections on Serving LGBT Youth Within the Context of the NASW Code of Ethics
As social workers the NASW Code of Ethics which calls upon us to abide by the core value of social
justice, dignity and worth of the person, importance of human relationships, integrity and competence.
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Social workers should take personal inventory of their personal values, faith traditions and social and
cultural beliefs so that each practitioner can increase his or her personal awareness. It is incumbent on
the social worker to “check their baggage” at the door so that any potential bias does not impede the
social worker’s ability provide services in an affirming and non-judgmental manner.
Social workers and human service organizations need to be certain to project a welcoming atmosphere
to LGBT youth. This can be accomplished in many ways. The agency should use affirming language in
their literature and forms. Agency forms should not assume a heterosexual norm and gender-neutral
pronouns should be included as options. If your agency forms do not offer this type of affirming
indicators it is appropriate for the social worker to advocate from within for these changes.
In addition to agency forms the organization should advertise in LGBT oriented magazines and web sites
and should support and sponsor LGBT community events such as Pride events and the Transgender Day
or Remembrance. It goes without saying that welcoming brochures, posters and artwork should be
visible throughout the agency or organization and most certainly within the social worker’s office.
Cultural Competence
A social worker who is unfamiliar with the needs and experiences of gay, lesbian, bisexual or
transgender youth should take steps to become further educated about the day-to-day challenges of the
LGBT youth. However, don’t use the client’s time in session with you to gain this knowledge and insight.
Remember, this is the youth’s opportunity to address their personal issues, thoughts and concerns NOT your opportunity to educate yourself as a professional about basic facts about your client’s identity.
Using the client’s time to educate oneself about LGBT issues is a form of exploitation of the client.
Exploring client issues related to their LGBT status is always appropriate. Social workers need to ask
themselves: “Am I addressing this topic to advance the youth’s issues and goals?”. If the answer is,
“Yes” then the social worker can feel confident proceeding in this direction with the youth.
Managing Issues Around Consent
When obtaining consent from a minor’s parent or guardian be careful to avoid sharing any information
about the youth’s status as LGBT unless the youth had given you their express permission to do so.
Some youth may be at risk of being pushed out of the familial home as a result of their LGBT identity.
“Coming out” to parents and extended family members is an appropriate treatment goal to negotiate
with the youth, utilizing role-play and letter writing, among other strategies. The youth needs to be
control of the management of this issue, with social worker serving as consultant/facilitator.
Remember, for many youth “Coming out” is a process and support given over time is appropriate.
School Related Risk Factors
School issues are a common factor among LGBT youth. School based stressors have been shown to
adversely influence the LGBT youth’s academic standing and overall mental health. On occasion the
social worker, in consultation with the youth and with parent consent in the case of a minor, may decide
to attend a student case conference at the school to discuss a youth’s concerns. The purpose of such a
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meeting would be to advocate for the youth and to collaborate with school staff for services and
interventions that would be provided at school.
Before making any school overtures the social worker must be sure to obtain a signed release form
permitting the reciprocal sharing of information between the social worker and the school. The social
worker will also want to discuss the exact information that will be shared with school personnel with the
youth. The youth should have the final word on the extent of disclosure. Keep in mind that is
reasonable a youth may feel reluctant to share his or her information on one occasion and may choose,
in time to share this information more broadly. The critical factor here is that decision belongs to the
youth, not the social worker.
As recently as December, 2012 two male Arizona high school students were forced to hold hands in
front of their classmates as punishment for fighting. A picture of the teenagers hiding their faces was
posted to Facebook. This type of public humiliation is completely inappropriate and can actually
traumatize the affected youth.
According to the 2011 National School Climate Survey administered by GLSEN (The Gay Lesbian Straight
Education Network) Many LGBT students avoid classes or miss entire days of school rather than face a
hostile school climate.
Here are some additional findings from the 2011 National School Climate Survey that will further
elucidate some of the issues LGBT students face in schools:
 Students who were more frequently harassed because of their sexual orientation or gender
expression had lower grade point averages than students who were less often harassed (2.9 vs.
3.2).
 Students who experienced higher levels of victimization in school because of their sexual
orientation or gender expression were more than twice as likely to report that they did not plan
to pursue any post-secondary education (e.g., college or trade school) than those who
experienced lower levels(10.7% vs. 5.1%).
 29.8% of students skipped a class at least once in the past month because they felt unsafe or
uncomfortable.
 31.8% missed at least one entire day of school in the past month because they felt unsafe or
uncomfortable.
 Students who experienced higher levels of victimization because of their sexual orientation
were three times as likely to have missed school in the past month than those who experienced
lower levels (57.9% vs. 19.6%).
 Students who experienced higher levels of victimization because of their gender identity were
more than twice as likely to have missed school in the past month than those who experienced
lower levels(53.2% vs. 20.4%).
 LGBT youth are also more likely to suffer with a poorer psychological well being as a result of a
hostile school climate.
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Working with Families
Dr. Caitlin Ryan, PhD., ACSW started the Family Acceptance Project (FAP) in 2002. The FAP was
developed to as a research-based family model of wellness, prevention and care for LGBT children and
adolescent. The FAP engages in research, intervention, education and policy initiatives that work to
prevent health and mental health risks for lesbian, gay, bisexual and transgender (LGBT) children and
youth in the context of their families.
The FAP uses a culturally grounded approach to help ethnically, socially and religiously diverse families
to support their LGBT children. The approach uses a research-based model of wellness, prevention and
care to strengthen families and promote positive development and healthy futures for LGBT children
and youth. The FAP model represents advances in working with families of origin of the LGBT youth to
strengthen familial relationships. Improved familial relationships lead to better mental health
outcomes, improved access to education and a reduced rate of homelessness in LGBT youth.
According to the FAP: “Attention to family reactions is critical since increasingly, youth are coming out
at younger ages which significantly increases risk for victimization and abuse in family, school and
community settings, and provides opportunities for helping to support and strengthen families.
Victimization has long-term consequences for health and development, and impacts families as well as
the targeted individuals. Early intervention can help families and caregivers build on strengths and use
evidence-based materials to understand the impact of acceptance and rejection on their child’s well
being.”
The Family Acceptance Project is designed to: 1) study parents’, families' and caregivers’ reactions and
adjustment to an adolescent's coming out and LGBT identity; 2) develop training and assessment
materials for health, mental health, and school-based providers, child welfare, juvenile justice, family
service workers and community service providers on working with LGBT youth and families; 3) develop
resources to strengthen families to support LGBT children and adolescents; and 4) develop a new model
of family-related care to improve health and mental health outcomes for LGBT adolescents. Findings will
be used to inform policy and practice and to change the way that systems of care address the needs of
LGBT adolescents.”
More information about the Family Acceptance Project is available in the “Resources” section at the end
of this article.
In Conclusion
Social workers should educate themselves about the needs, characteristics and bio-psycho-social risk
factors experienced by LGBT youth in preparation for providing professional services. This education
should occur via formal continuing educational courses or through independent study. A wealth of
information can be located on line. A list of National resources has been provided at the end of this
article.
LGBT youth are at increased risk for social, emotional and pragmatic difficulties, partially due to
environmental stresses they encounter. Social workers should take inventory any personal bias so they
can be certain to be sure that personal bias does not influence the professional relationship with the
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youth. Social workers should be an advocate for GLGT youth within their personal and professional
communities.
LGBT youth will benefit from social work support across multiple dimensions – especially those targeting
home and school relationships as well as access to mental health care, housing, food, job training,
transpiration and medical care.
Resources
GLSEN (Gay Lesbian Straight Education Network): http://www.glsen.org
GLSEN is the leading national education organization focused on ensuring safe schools for all students.
GLSEN.org has free resources for teachers, parents and students. The SE Michigan chapter of GLSEN
offers community speakers, staff development, technical assistance and youth support.
PFLAG: (Parents and Friends of Lesbians and Gays): http://community.pflag.org
Founded in 1972 with the simple act of a mother publicly supporting her gay son, PFLAG is the nation's
largest family and ally organization. Made up of parents, families, friends, and straight allies united with
people who are lesbian, gay, bisexual, and transgender (LGBT), PFLAG is committed to advancing
equality and societal acceptance of LGBT people through its threefold mission of support, education and
advocacy. PFLAG now has over 350 chapters and 200,000 members and supporters crossing multiple
generations of American families in major urban centers, small cities and rural areas in all 50 states.
The Trevor Project: http://www.thetrevorproject.org
The Trevor Project is determined to end suicide among LGBTQ youth by providing life-saving and lifeaffirming resources including our nationwide, 24/7 crisis intervention lifeline, digital community and
advocacy/educational programs that create a safe, supportive and positive environment for everyone If
you are a youth who is feeling alone, confused or in crisis, please call The Trevor Lifeline at 1-866-4-UTREVOR for immediate help.
The Family Acceptance Project: http://familyproject.sfsu.edu/home
The Family Acceptance Project™ is a research, intervention, education and policy initiative that works to
prevent health and mental health risks for lesbian, gay, bisexual and transgender (LGBT) children and
youth, including suicide, homelessness and HIV – in the context of their families. We use a researchbased, culturally grounded approach to help ethnically, socially and religiously diverse families to
support their LGBT children.
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