Commissioned by a Board of Supervisors mandate in October 2015, this Scan of Los Angeles County’s efforts to provide high-quality, effective services and supports for LGBTQ youth and reduce disparities they face emerged out of series of facilitated convenings with the executive leadership from the 11 youth-relevant County departments. During the convenings, department leadership were informed about the disproportional number of LGBTQ youth in the child welfare system as well as their risks and barriers to health and wellbeing. The following two themes were noted:
- The answer to questions about LGBTQ-inclusive demographic data collection, intake, service planning, and case reviews rest with staff much closer to the work on the ground who are scattered across the 132 various divisions or bureaus, and
- Once they understood the risks, barriers and stigma LGBTQ youth face, they were now deeply interested in understanding how their own efforts to serve LGBTQ youth within their respective systems of care could support the reduction of LGBTQ youth disproportionality in the County child welfare system.
In response to these themes and proposals by this report’s authors, the Board of Supervisors, via the Office of Child Protection, shifted and expanded the scope of the project to support the creation of a construct for “preparedness” grounded in the literature against which the workforce would be measured. Gaps in that preparedness would be the focus of the report, and analysis of existing demographic data collection efforts, intake processes, service planning, case review processes, and training needs would be subsumed under that focus. The newly formed Office of Strategic Public Private Partnership coordinated a successful effort to rally the philanthropic community to raise funds to cover the new costs related to the transformed scope, and the more rigorous methodology required to survey the full breadth of the workforce directly. This frame of “preparedness” intentionally avoids the terminology of “cultural competency” because the latter is a long critiqued approach which tends to limit the field’s ability to identify and respond to actual roots of disparities and disproportionately.
We considered the overarching assessment question to be: “What is the current state of preparedness of Los Angeles County staff to work with LGBTQ youth and, where relevant, their families?” We define ‘preparedness’ as having three domains:
- Knowledge & Comfort: With regard to LGBTQ youth, is the department aware of needs, as well as national and local policies? Have the staff received training on LGBTQ youth issues or engaged in onsite discussions regarding facts, risk factors, needs, resources and policies for this population? How comfortable are staff working with this population?
- Applied Experience: Is the department aware of and actively observe the presence of LGBTQ youth? Have departments and staff actively managed issues of equity for LGBTQ youth?
- Structural Supports: Are there policies in place with regard to identification and treatment of LGBTQ youth? Do data systems collect and record information about SOGI according to best practices?
With this broader focus on county and department ‘preparedness’ to adequately serve LGBTQ youth, a new methodology that would determine quantifiable levels of the dimensions of preparedness and identify qualities and characteristics of these dimensions from the perspectives of those working within the system was needed. As such, we used a mixed-method approach, integrating open-ended interviews, survey data, and document analysis. We identified sub-units2 within each department that were most likely to encounter youth as well as those sub-units associated with policy, data collection and training related to youth populations. We then designed a semi-structured interview protocol for the heads of each of those sub-units (qualitative component) and an on-line survey (quantitative component) to send to 3-10 direct service staff members identified by the head of the unit.
The Scan included an assessment of staff knowledge, comfort, attitudes, experiences and awareness of system supports (policy, data collection, training) related to providing services for LGBTQ youth. Survey and open-ended responses were obtained in all these domains, and sample policy and data collection documents were collected. This Executive Summary highlights a few of the key findings in the main preparedness domains, identified overarching patterns and priority recommendations.
Knowledge & Comfort
- The majority of respondents felt knowledgeable about LGBTQ youth issues and comfortable explaining sexual orientation terminology.
- However, a test of SOGIE related terminology demonstrated that actual knowledge is lower than perceived knowledge.
- A higher proportion of respondents reported having less knowledge about the needs of LGBTQ parents and transgender or gender-nonconforming youth than knowledge about sexual minority youth.
- Most interviewees and survey respondents indicated they were comfortable with LGBTQ individuals, and it is not surprising that LGBT and direct-service respondents felt the most comfortable with LGBTQ youth. It also appears that higher education levels are associated with higher levels of comfort.
- Though there were many examples of affirming LGBTQ youth’s experiences and expressing awareness that there is a need to address them, there were also many examples of lack of preparedness to address these issues. Specifically, many respondents a) used and reported others using insensitive or incorrect terminology for LGBTQ people, b) reported colleagues who thought negatively about LGBTQ people, and c) espoused a “colorblind” philosophy that could render LGBTQ youth invisible and mask the need to address systemic barriers.
- Almost half of the respondents surveyed reported at least being somewhat experienced working with LGBTQ youth and most had not had experience with scenarios that required a more proactive and affirmative approach to working with LGBTQ clients.
- Eighty-six percent (86%) of the workforce surveyed knew their departments served LGBTQ children, but only 40% could give estimates of how many children were served overall and even fewer (10%) could answer questions about how many of those youth were LGBTQ.
- Overall, most Scan participants understood that LGBTQ individuals cannot be discriminated against based on sexual orientation or gender identity. Many were also able to point to a departmental nondiscrimination policy, particularly one aimed at staff. Some respondents were less sure about protections for children, youth, or volunteers.
- With the exception of LA County Department of Education’s extensive SB48 compliance work, almost no interviewed managers were aware of any of the eight State policies that support equity for LGBTQ youth.
- Overall, the majority of respondents felt their environment was at least somewhat welcoming to LGBTQ people.
- However, LGBT staff scored their work environment as less welcoming than non-LGBT staff, indicating that what might appear welcoming to non-LGBT people may not actually be so.
Data Collection & Intake
- Only 25% of survey respondents indicated that their sub-unit collects demographic data as part of delivering services. These survey data correspond to the interview data in which most respondents could not name a data collection mechanism for demographic data, especially formal ones that include questions about SOGIE status.
- The most common method to learn about a youth’s sexual orientation and/or gender identity described by interview participants was relying on self-disclosure initiated by the youth themselves. Another approach that was reported was asking questions as part of documenting a new case or patient within social work, juvenile detention or health care settings.
Over-Arching Themes & Recommendations
Moving Beyond Training to Staff Development
While studies indicate significantly limited research exists assessing LGBTQ related knowledge and support, the trainings that have been implemented and evaluated tend to demonstrate an increase in comfort, awareness and knowledge about LGBTQ clients amongst professional staff. However, no research has demonstrated enduring effects of the traditional didactic training approaches when it comes to adequately addressing LGBTQ youth. It would behoove the County to move beyond requiring “training for competency” to framing future knowledge enhancement efforts as “staff development towards LGBTQ preparedness and bias reduction,” sometimes within and but also outside of a traditional training model. Based on the findings, these future staff development efforts should:
- Be targeted to make sure that basic knowledge enhancement is targeted for para-professional and those staff who work in non-direct service roles such as those in administration, training, policy and information systems divisions
- Include caveats and scenarios to ensure that county staff are relying on more than just their own lived experiences to support them in serving LGBTQ youth
- Be part of a plan to provide the education in on-going regular intervals to the workforce, rather than a “one and done” approach
- Triangulation of several staff development sources (e.g. graduate education, job training provided by the County, training provided by external sources or previous employment, professional conferences) should be considered, as having more than one training source was related to higher knowledge scores
- Have demonstrated evidence of knowledge retention and practice change
A Proactive, Practical Approach to Discussing SOGIE with Youth
The Scan indicates a general need to move beyond assessing knowledge or comfort perception as a result of trainings as we are seeing that, even those who are trained, do not necessarily have what they need to embody the practical skills needed when faced with “real life” in the field. There needs to be a focus on having service providers practice initiating conversations with all youth about SOGIE, such that the LGBTQ youth feel comfortable disclosing their orientations and identities and the non-LGBTQ youth feel that the conversations are routine and had with all youth.
The staff we surveyed called for more on-going training and coaching which includes:
- Understanding of real-life examples
- Hearing directly from LGBTQ youth and their caregivers
- Support for knowing what the policies are, where they come from, and when to invoke them
- Opportunities to practice being proactive about SOGIE with all youth rather than focusing on “LGBTQ 101”
Increasing Preparedness for Serving Transgender and Gender Non-Conforming Youth
While preparedness to serve LGB youth measured by knowledge and comfort was not high among staff, even higher levels of unpreparedness as it pertains to gender minority (transgender and gender non-conforming) youth stood out in both the survey and interview findings. Future staff development efforts must be tailored for emphasis on transgender and other gender minority youth, appropriate language to describe and address their needs, and their transition to adulthood. In this area, the County may still need a “basic training” approach.
A Need for Integrated Policy Education to Support Advocacy in Service Planning and Environmental Redesign
While non-discrimination was clear in a staff context, respondents were less sure about protections for children, youth, or volunteers. Therefore, policy communications and trainings should emphasize that those protections apply when speaking about youth, families and volunteers.
It is recommended that the County itself, as well as the policy units of all 11 departments, review the 8 state-level policies that protect LGBTQ youth and conduct a cross-walk of their internal policies that would be affected and modify those policies accordingly, including policy mechanisms to inform youth about their rights, field grievances, monitor compliance, and ensure confidentiality. Training curricula and resource guides purchased or provided by the County have updated policy information included.
Furthermore, data indicated that departments may not be as welcoming as they think. Customized technical assistance and funding should be targeted at supporting departments to evaluate their environments accurately in terms of inclusive communications at first contact; welcoming visual cues in offices, on websites and in materials; and hiring and affirming staff who openly identify as LGBTQ.
Building Capacity for SOGIE Data Collection
In line with current advances in the field, we recommend that all departments implement mechanisms to assess SOGIE as a demographic and obtain technical assistance to ensure those mechanisms strike the correct balance between mitigating any risk due to disclosure and transparency. It is recommended that the County encourage individual departments to plug into those efforts at the State level started because of AB 959 and begin a process translate them to their County information systems.
Each department should also analyze the demographic data it currently collects and shares so that SOGIE data (including preferred gender pronouns) is placed where that department would place other potentially stigmatizing demographic data (like race and ethnicity) while ensuring that it can be protected or private if needed and that clients can refuse to fill out the field if they do not wish.
A Coordinating Entity for a Strategic Implementation of Recommendations
In the last twenty years, dozens of excellent practice guides and reports with valuable recommendations have been created in the LGBTQ youth arena. It is unclear whether those have resulted in the reduction of disparities. At least, this has not been the case in Los Angeles County, where the disparities still existed as of 2014 in the context of one of the largest departments with the greatest amount of public dialogue on LGBTQ issues. To maximize the impact of this report and to ensure that actions that result from it are efficiently coordinated, the County must create a neutral coordinating entity to cull and prioritize the recommendations, collaboratively create a strategic implementation plan for the County as a whole and for individual departments, coordinate the execution of the implementation plans, and monitor/hold the gains sustainably over the next 5-10 years. This entity could also serve as a neutral clearinghouse for vetted and evidence-based approaches to training, coaching, policy development, demographic data collection modalities and resource directories. Lastly, this entity would manage future surveys of the LA County youth population to assess whether the implementation of recommendations is indeed having the impact intended.