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An Innovation Project Addressing LGBTQ Homeless Youth

By: Jayme, Molly, Flo and Cass

Cassaundra Fees

on 5 June 2013

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Transcript of An Innovation Project Addressing LGBTQ Homeless Youth

Identifying The Problem Addressing The Issue Safe At Home: An Innovation Project Addressing LGBTQ Foster Youth By, Jayme, Molly, Flo, and Cass Current Need • 10% of youth identify as LGBT.

• 20% - 40% of homeless youth identify as LGBT.

• A disproportionate percentage of LGBT identifying youth are homeless.

• The higher rates of discrimination, victimization, and stress experienced by the LGBT homeless youth population are associated with higher rates of mental illness. • 41% of homeless LGBT meet criteria for major depressive disorder.
• 73% have experienced suicidal ideation.
• 57% have made at least one suicide attempt. Cochran, Stewart, Ginzler, & Ana Mari, 2002; Whitbeck, Chen, Hoyt, Tyler, & Johnson, 2004; Rosario, Schrimshaw, & Hunter, 2012; Van Leeuwen et al., 2006; Walls, Potter, & Van Leeuwen, 2009; National Alliance to End Homelessness, 2007; Ray et al., 2007; Van Leeuwen, Boyle, Salomonsen-Sautel, Baker, & et al., 2006 Current Need • Suicidality multiplied when youth are additionally subject to enormous amounts of stress, violence and discrimination.

• When in crisis many feel unable to access services due to services being primarily intended for heterosexual and adult consumers.

• LGBT youth are at greater risk for suicide, higher risk sex, victimization, and parental rejection, and these problems exacerbated for homeless.

• Homeless LGBT youth experience discrimination from social workers, shelter staff and experience high rates of bullying from other homeless youth, making accessing services difficult, aversive, and at times dangerous. Current Need • Limited mental health service resources exist in shelters and walk-in clinics for homeless youth.

• One study confirmed that 9% of homeless youth had accessed mental health services.

• Another study of homeless and runaway youth revealed gaps in utilization of support services. Ryan, 2003; National Alliance to End Homelessness, 2007; Ray et al., 2007. Slesnick, & Prestopnik, 2005; Berdahl, Hoyt, & Whitbeck, 2005. Barriers Within The Foster Care System Half of a LGBT youth sample who had been in out-of-home care settings stated they had spent periods of time living on the streets in preference to the hostile environments they had found in these settings.

Under the California Foster Care Nondiscrimination Act:
All group home administrators, foster parents, and department licensing personnel must receive initial and ongoing training on the rights of foster children not to be discriminated against.

Social workers and foster care providers are trained on the "rights of foster children not to be discriminated against" but not on how to create a non-discriminatory environment or how to affirmatively work with LGBTQ youth. NCLR, 2006 Goals and Program Targets of Proposed Innovation Project
• Assist LGBTQ youth to consider foster care an option.

• Assist LGBTQ youth to be able to stay in foster care

• Increase LGBTQ youth's knowledge and trust in the HSASF and foster system.

• Increase the capacity for all county service providers and related staff to be aware of, sensitive to and knowledgeable about the unique needs and challenges homeless and foster LGBTQ youth face.

• Address their higher rates of mood disorders and substance abuse while in foster care.

• Assist them in finding supportive peer support while in foster care.

• Create systems of responsive help when foster LGBTQ youth feel they are experiencing homophobia or transphobia while in foster placement. Part A: LGBTQ Youth-Oriented Programs Part B: Service and Shelter Provider-Oriented Programs Who: HSASF
What: Be informed and knowledgeable about LGBTQ youth
What: Able to provide services that are welcoming and sensitive to LGBTQ youth

Who: Foster homes in which LGBTQ youth are placed (caregivers)
What: Be informed and knowledgeable about unique needs of their LGBTQ Youth
What: Able and willing to provide a sensitive, welcoming home

Who: Specific identified social workers to serve as "local experts" within the county
What: Increase local knowledge of LGBT homeless youth within the county, provide specific contacts to intervene for LGBT foster youth.

Who: Bay Area Service Providing Agencies
What: Aware of improvements in the HSASF and foster care systems that will resulting in increased capacity to offer culturally competent and sensitive care to LGBTQ youth in foster care. Goal #1 Goal #2 Goal #3 Work plan for Service Providers and Foster Families Gather Stake-Holder Data • Who: LGBTQ youth and representatives of community organizations.

• What:
Identify perceived discrimination, microaggressions and frank homo/transphobia from the service providers, experienced by LGBTQ youth.
Identify examples of perceived discrimination, microaggressions and homo/transphobia from the service providers.
Determine what reporting methods would feel safe to consumers.

• Why: Inform best practices for LGBTQ homeless youth.

• How: Center for Social Innovation. Work plan for Service Providers and Foster Families Staff "Expert" Point Staff Who: 2+ social workers

What: Identify and hire key service personnel and train new and incoming staff with the training developed by CSI.

Why: Address the immediate and ongoing needs of LGBTQ youth who are moving into or are already placed in foster care.

Serve as special liaisons to LGBTQ youth moving into or in foster care that youth can contact with concerns regarding placement, are experiencing bullying, discrimination at home or school, or feel that their foster family doesn’t understand their unique needs.
Make referrals to specific mental health treatment, support and social groups. Work plan for Service Providers and Foster Families Train Foster Parents Who: All foster parents, and foster home staff regardless of the age, gender or sexual orientation of the foster child or foster parent.

What: Provide caregivers with skills to support foster youth, including those who may find themselves coming out while in foster care, or who have not revealed their sexual orientation as part of the placement program.

Why: To address problems in a foster home after youth are placed.

How: Require units on the basics of LGBTQ youth needs (including discrimination, need for peer support, higher rates of substance use and mood disorders, minority stress and bullying), and sensitivity to LGBTQ youth as part of the foster parent training. Youth & Public Trust Work plan for Service Providers and Foster Families Who: Greater Bay Area Service Provider Agencies and LGBTQ homeless and foster youths

What: Increase awareness about San Francisco County’s HSA and foster care system's new services and increased ability to offer sensitive, knowledgeable services in the foster care and social service system.

Contract a local public relations firm to develop messages that are specific to LGBTQ youth.
Develop a press release, brochures and a dedicated website.
Distribute to local organizations, service providers and gathering places for homeless LGBTQ youth.
Partner with HSASF to include a dedicated page on their website specifically to LGBTQ youth in foster care which:
Outlines their rights.
Key personal that they can contact.
Lists services available and other resources which may be useful both as foster youth and as LGBTQ youth.

Why: Increase LGBTQ homeless and foster youths' trust in social services and foster care as a safe place to seek services. Innovations' Goals: Program Targets: Purpose of Proposed Innovation Project To:
Decrease mental health care disparities
Increase access to services for LGBTQ homeless youth.
Increase the quality of services, including better outcomes
And promote interagency collaboration

For lesbian, gay, bisexual, transgender, queer and questioning youth who are entering and continuing foster care in San Francisco County Contributions To Learning New training programs and mental health care practices that will improve the quality of care for LGBTQ foster youth and help them stay in placement by increasing trust, educating workers and providing support.

No county foster programs have attempted a multi-modal approach to reducing the crisis of LGBTQ youth leaving foster care in great numbers.

Some counties have attempted to recruit greater numbers of LGBT foster parents, or have trained social workers in the rights of LGBT youth in foster care.

However, none have attempted to meet the needs of youth by simultaneously creating a more sensitive welcoming environment, increasing trust in the system, and attempting to address some of the unmet needs that LGBTQ youth in foster care face. Timeline

1.Hire core Safe At Home directors and support staff (Month 0-2)

2.Assess sociopolitical context (Month 1-3)

3.Hire marketing firm (Month 1, & ongoing)

4.Identify relevant consumer organizations currently and/or potentially associated with the child welfare system as potential stakeholders and program advocates (Month 0-3)

5.Initiate active inter-organizational networking (Month 2-6, & ongoing)

6.Assess agencies/organization (Month 6-12 & ongoing)

7.Define measures to assess Safe At Home's progress, efficiency, and goal-oriented impact (Month 6-12) Phase 1: Exploration (Month 0-6). Timeline 1. Tie Safe At Home goals to state and federal policies and incentive programs (Month 6-12)

2. Network with Safe At Home advocates (Month 6-12, & ongoing)

3. Assess current information transmission routes (Month 6-12)

4. Integrate agencies into Safe At Home (Month 6-12, & ongoing)

5. Contract local public relations firm (Month 2, & 6-12) Phase 2: Adoption/Preparation. Timeline Phase 3: Implementation. 1. Train service providers (Month 10-16, & ongoing)

2. Train foster parents (Month 10-16, & ongoing)

3. Peer mentorship (Month 10-16, & ongoing)

4. Communicate system changes (Month 10-18, & ongoing, as necessary)

5. Provide mental health services and support resources (Month 11, & ongoing) Timeline Phase 4: Sustainment. 1. Maintain oversight of funding use and efficacy (Ongoing)

2. Assess workforce stability impacts of the Safe At Home program (Month 18, & ongoing)

3. Incorporate data and stakeholder feedback to amend and or adjust the Safe At Home strategies and services (Month 18, and at 6 month increments)

4. Monitor feasibility (Month 18, & ongoing)

5. Monitor Safe At Home fidelity (Month 18, & ongoing) a. Value and integrate stakeholder perspectives
b. Utilize assessment data
c. Maintain ongoing positive relationships
i. Address logistic challenges and concerns
ii. Provide ongoing participation and outcome incentives a. Conduct qualitative interviews a. Track and utilize qualitative data derived from county staff and foster parents a. Distribute public relation materials through direct, indirect, and consumer advocacy groups regarding anticipated changes and observed changes (a.) Engage youth in services
(b.) Individual therapy
(c.) Group therapy
(d.) Peer-support group (e.) Parent support group
(f.) Responsive and supportive care (g.) Assess mental health services Proposed Budget Thank You! Address the mental health needs of LGBT youth once in the foster system to help them stay in.

Create a network of support that is LGBT foster youth specific to help them stay in their placements. Who: LGBTQ Youth in Foster System Goal #1 Goal #2 Who: All foster LGBTQ youth.

What: Individual therapy.

Why: To address the higher prevalence rate of mental illness among LGBTQ youth.

How: Individual mental health services will be provided at Larkin Street Youth Center and LYRIC in San Francisco. Work Plan A: For Youth Individual Therapy Expected Change Utilization of Mental Health Services: Homeless Youth LGBT Homeless Youth Additional Barriers for LGBTQ Homeless Youth: Mental Health Services Current Need Who: Identified county staff: front line staff, social workers, supervisors, administrators and others.

What: 10 hour training to train trainers to provide in-service staff to be responsible for creating ongoing trainings for new staff and for current staff when updates are needed.

Why: To increase sensitivity to LGBTQ youth experiences and needs.

How: CSI Work plan for Service Providers and Foster Families Train Service Providers The innovation work plan will be developed in collaboration with the following sets of stakeholders:

County Agencies:
Child and Family Services (CFS) of the Human Services Agency of San Francisco (HSASF)
The Division of Housing and Homeless,
The Department of Public Health

Current Foster Families
Current LGBTQ youth in foster care and homeless
Service providers and non-profits serving LGBTQ

Larkin Street Youth Center
LYRIC Description of Community Program Planning and Local Review Processes Assessments Phase 1
Sensitivity to LGBTQ youth experiences/needs, for county staff and foster parents.
Foster parent support skills, specific to LGBTQ needs
Peer-mentorship support & administrative skills (monitoring & meeting LGBTQ youth's needs)
LGBTQ homeless youth's knowledge of, experience with, trust in, and utilization likelihood of the foster care system, available programs, mental health services, and protective resources.
Knowledge in and application of LGBTQ homeless youth-specific crisis intervention

Peer support groups
Parent support groups

Measure consumer satisfaction using Session Rating Scale at each use

Measure youth consumers symptom severity using validated measures for:
depression, anxiety, suicidality, PTSD, substance abuse/dependence, and applicable symptom patterns

Measure foster-parent baseline and post group stress levels at each parent-support group encounter, using validated and reliable assessment tool. Assessments Phase 3 Other Assessments and Measurements Yearly Reports
Number of consumer's served, mental health diagnoses/prevalence rates, and changes in symptom and/or distress severity
Fiscal statements

Posted on the Innovation Program's home webpage
Public access Define measures to assess Safe At Home's progress, efficiency, and goal-oriented impact: Assess mental health services (Month 11, & ongoing) Measures to assess response to: Identify psychological assessment batteries to assess mental health symptom presentations.

Identify brief symptom inventories, to be administered at each occasion an LGBTQ youth uses individual mental health services. Who: Peer mentors and the "expert" social workers

What: Learn to recognize signs and symptoms of suicidality and making appropriate referrals for LGBTQ youth.

Why: To address the high prevalence rates of suicidality in LGBTQ youth.

How: 6 hours of training in crisis intervention. Work Plan A Specialized Training Who: Foster LGBTQ youth.

What: Match a foster care youth with one who has already "graduated" from the program.

Why: To help support the youth through the foster process on a peer level.

How: Assigning peer mentors to youth. Who: LGBTQ foster youths who have recently transitioned to foster care homes.

What: Provide group peer support.

Why: The function of this group is to provide support in helping LGBTQ youths transition and adjust to a new family and environment. Who: Parents of LGBTQ foster youths.

What: Provide Peer support groups for foster parents.

Address difficulties in adjusting to their new roles as foster parents of LGBTQ youth.
Address problems or conflicts that are unique to LGBTQ foster youth (like bullying at school).
Provide a social support network for foster care parents.
Provide a space for foster care parents to share and discuss ideas and solutions to their problems. Work Plan A: Youth Peer Support Work Plan A: Youth Peer Support Groups Work Plan A: Foster Parents Peer Support Who: Specific identified social workers to serve as "local experts" within the county

Why: Create a system that dynamically responds to changes in LGBTQ foster youth care and increase trust in county systems.

How: To train all agency staff in providing LGBT sensitive care, to create point ("expert") positions for social workers as contact points for LGBT youth in foster care and to create a PR campaign. Ensure Ongoing Expertise Work Plan A Goal #4
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