We Need to Move Away from Systems to Community Engagement: Sexual and Gender Minority Youth in Foster Care

Background: The risk of suicide is 2-4 times higher among sexual and gender minority youth (SGMY) than their heterosexual, cisgender peers. Experiencing proximal or distal stressors related to their minority identity further compounds SGMY’s mental health disparities. The limited research about SGMY involved in the child welfare system has suggested that child welfare-involved SGMY are at higher risk for adverse mental health outcomes compared to non-SGMY. Moreover, the critical sources of support for this populations—affirming mental health providers, system workers, care providers (e.g. foster parents), chosen family, and biological family—are understudied. Thus, our NIH-funded community-based pilot study used mixed methods to explore the emotional and instrumental support available to and sought out by child-welfare involved SGMY and the impacts of these youths’ support networks on their mental and behavioral health in Cuyahoga County, OH.

Methods: Partnerships with multiple entities in Cuyahoga County—including the Division of Children and Family Services, A Place for Me, The LGBT Center of Greater Cleveland, and Kinnect—supported this study. An advisory board of SGMY with lived experience in foster care provided extensive input on the development of the project’s data collection tools, recruitment strategies, and study team training. Thirty-five current and former Cuyahoga County SGM foster youth, aged between 12-26 were interviewed. Two researchers (both identify as SGM) coded the interviews, moving from in vivo to axial coding. Finally, we used relational coding to investigate the co-occurrence of thematic codes with relationship type (e.g. biological parent; auntie; caseworker; queer friends).

Results: Our relational analysis revealed three key themes: Ruptures and Repair, Building a New Self, and Calls for Action. Each theme provided nuanced insight into how support may shift and fluctuate over time as relationships changed, namely with biological parents and relatives. Participants described ongoing and dynamic relationships with family of origin and their chosen family. While biological family played a paramount role in these youths’ lives, these relationships were constantly changing, moving between conditional and ambivalent to unconditional and unquestioned. Youth described betrayals and ruptures with social service and system workers and relations, which were shaped by a sense of being trapped or not having a way out. Youth described interventions, like therapeutic modalities, prescribed to them as well as ‘lifelines’ that they established with the SGM community.

Conclusion/Implications: Our findings complicate stereotypical narratives about child welfare involved-SGMY’s relationships with family of origin and demonstrate that connections to family of origin can be sources of support for child welfare-involved SGMY. Further, informal and formal peer supports were especially salient to SGMY’s ability to build supportive relationships outside of hetero/cis normative norms of family and relationships. Findings suggest a need for comprehensive access to peer support interventions that with the values of community-generated holistic mental healthcare to improve SGMY’s treatment engagement and behavioral health outcomes. Ultimately, participants necessitated a call to action to initiate research and programs that moves beyond the individual-level and considers systems and communities of care.