A PrActitioners resource Guide:

Helping Families
to Support Their
LGBT Children

AcKnoWLedGeMents
A Practitioners Resource Guide: Helping Families to Support Their LGBT Children was prepared by
Caitlin Ryan, PhD, ACSW, Director of the Family Acceptance Project at San Francisco State University
under contract number HHSP233201200519P for SAMHSA, HHS.

DISC

The views, opinions, and content of this publication are those of the author and do not necessarily reflect
the views, opinions, or policies of SAMHSA or HHS.

PuBLic doMAin notice

All materials appearing in this publication are in the public domain and may be reproduced or copied without permission from SAMHSA. Citation of the source is appreciated. The publication may not be reproduced or distributed for a fee without the specific, written authorization of the Office of Communications,
SAMHSA.

This publication may be downloaded or ordered at http://store.samhsa.gov/. Or call SAMHSA at

1-877-SAMHSA-7 (1-877-726-4727) (English and Espaol).

RECO
Substance Abuse and Mental Health Services Administration, A Practitioners Resource Guide: Helping
Families to Support Their LGBT Children. HHS Publication No. PEP14-LGBTKIDS. Rockville, MD:
Substance Abuse and Mental Health Services Administration, 2014.

Table of Contents
I

critical role of Families in reducing

risk & Promoting Well-Being

Helping Families decrease risk &

increase Well-Being for their LGBt children

increasing Family support:

How to Help right now

11

resources for Practitioners and Families

12

endnotes

13

references

14

Introduction

ince the early 1990s, young people have increasingly

been coming out or identifying as lesbian, gay, and
bisexual, and more recently as transgender, during adolescence. This coincides with greater awareness and
visibility of lesbian, gay, bisexual, and transgender (LGBT)
people in society, the media, schools, congregations, and
communities. More widespread access to information about
sexual orientation, gender identity, and LGBT resources
through the internet has contributed to significant changes in
how children and adolescents learn about LGBT people and
their lives. And increasingly, this has helped young people
come out at much earlier ages than prior generations of
LGBT adults. (For information about sexual orientation and
gender identity, see Definitions on the following page.)
Coming out at earlier ages has important implications for how
practitioners work with children, youth, and families, how they
educate parents, families, and caregivers about sexual orientation and gender identity, and how services are provided to
LGBT children and adolescents. Historically, services for LGB
youth and later for transgender youth were developed to protect them from harm, including from parents and families that
were perceived as rejecting or incapable of supporting their
sexual minority children. As a result, services evolved over
several decades to serve LGBT adolescents either individually
like adults or through peer support, and not in the context
of their families (Ryan, 2004; Ryan & Chen-Hayes, 2013).
Even though families, in general, play a critical role in
child and adolescent development and well-being, and
connections to family are protective against major health
risks (Resnick et al., 1997), until recently little was known
about how parents reacted to their LGBT children from the
perspective of parents and caregivers (Bouris et al., 2010;
Diamond et al., 2012; Ryan, 2010) or how they adapted and
adjusted to their LGBT children over time. As a result, many
practitioners assumed that little could be done to help parents and families who were perceived as rejecting to support

their LGBT children. So few practitioners tried to engage or

work with these families (Ryan & Chen-Hayes, 2013). Nevertheless, earlier ages of coming out coupled with emerging
research which indicates that families of LGBT adolescents
contribute significantly to their childrens health and wellbeing call for a paradigm shift in how services and care are
provided for LGBT children and adolescents (Ryan, 2010).

Research findings that show the

critical role of family acceptance
and rejection and earlier ages of
coming out call for a paradigm
shift to serve LGBT children and
adolescents in the context of their
families.
This new family-oriented approach to services and care
requires practitioners to proactively engage and work with
families with LGBT children and adolescents. This includes
providing accurate information on sexual orientation and
gender identity for parents and caregivers early in their
childs development; engaging, educating, counseling, and
making appropriate referrals for families with LGBT children; and in particular, helping parents and caregivers who
react to their LGBT children with ambivalence and rejection
understand how their reactions contribute to health risks for
their LGBT children (Ryan & Chen-Hayes, 2013).
The overall objective in helping families learn to support their LGBT children is not to change their values or
deeply-held beliefs. Instead, practitioners should aim to
meet parents, families, and caregivers where they are, to
build an alliance to support their LGBT children, and to help
them understand that family reactions that are experienced
as rejection by their LGBT child contribute to serious health
concerns and inhibit their childs development and wellbeing (Ryan & Diaz, 2011; Ryan & Chen-Hayes, 2013).

A Practitioners resource Guide: Helping Families to support their LGBt children

Introduction

Aims of resource Guide

This resource guide was developed and is being disseminated
throughout health and social service systems to help practitioners who work in a wide range of settings to understand the
critical role of family acceptance and rejection in contributing
to the health and well-being of adolescents who identify as
lesbian, gay, bisexual, and transgender. This includes practitioners who work in primary care, behavioral health, schoolbased services, family service agencies, homeless and runaway programs, and foster care and juvenile justice settings.
Its intent is to help practitioners implement best practices in
engaging and helping families and caregivers to support their
LGBT children. The family intervention approach discussed
in this guide is based on research findings and more than a
decade of interactions and intervention work by the Family
Acceptance Project (FAP) at San Francisco State University
with very diverse families and their LGBT children.

E
A seminal study of LGB identity and adolescent development found that young people report having their first
crush or attraction for another person, on average, at
around age 10 (Herdt & Boxer, 1993). Subsequent studies on
LGB youth have reported comparable ages of first awareness
of sexual attraction (e.g., DAugelli, 2006; Rosario, Schrimshaw, & Hunter, 2009), and coming out at much younger
ages than prior generations of LGB adults. Among contemporary youth, researchers from the Family Acceptance
Project found that adolescents self-identified as LGB, on
average, at age 13.4. And increasingly, parents and families
report children identifying as gay at earlier ages between
ages 7 and 12.
Practitioners who work with transgender and gender nonconforming children and youth note that gender identity is
expressed at early ages (Brill & Pepper, 2008), most often by
age 3 (Leibowitz & Spack, 2011). As with LGB adolescents,
the internet and media have significantly increased awareness
of gender diversity and of the needs and experiences of transgender and gender non-conforming children, adolescents and
adults. Because children can express a clear sense of gender
identity at very early ages, many are able to communicate
their experiences to parents and caregivers, so there is greater
awareness among some families that a child or adolescent

D
Sexual Orientation a persons emotional, sexual, and/
or relational attraction to others. Sexual orientation is usually classified as heterosexual, bisexual, or homosexual
(lesbian and gay), and includes components of attraction,
behavior, and identity (Laumann et al., 1994). Sexual orientation is expressed in relationship to others to meet basic
human needs for love, attachment, and intimacy (Institute
of Medicine, 2011). Thus, young people can be aware of
their sexual orientation as feelings of attachment and connection to others before they become sexually active.
Gender Identity a persons internal sense of being
male, female, or something else. Gender identity is
internal, so it is not necessarily visible to others. Gender
identity is also very personal, so some people may not
identify as male or female while others may identify as
both male and female.
Gender Expression the way a person expresses their
sense of gender identity (e.g., through dress, clothing,
body movement, etc.). Young children express their
sense of gender through choices for personal items such
as toys and clothes, as well as hairstyle, colors, etc.
Gender Non-conforming or Gender Variant a person
whose gender expression differs from how their family,
culture, or society expects them to behave, dress, and act.
Transgender a person who feels that their gender
identity does not match their physical body and differs
from the gender that others observed and gave them at
birth (assigned or birth gender).
Source: Institute of Medicine, 2011; SAMHSA, 2012

might be transgender. As a result, more parents are seeking

accurate information about gender development and local
sources of support.
Still, many families have strict cultural expectations about gender role behavior for males and females and have great difficulty
tolerating gender non-conforming behavior in their children
and adolescents (e.g., Malpas, 2011). This includes children and
youth who are lesbian, gay, and bisexual, as well as heterosexual. A significant number of families have never heard of the
word transgender and have little understanding of the distress

A Practitioners resource Guide: Helping Families to support their LGBt children

Introduction

that children who are gender non-conforming may experience

on a daily basis. This may include parents and families who
have less access to accurate information, based on sociocultural and linguistic backgrounds and/or geographic location.
These early ages of self-awareness and coming out as LGBT
during childhood and adolescence call for practitioners to ex-

pand their approach to care from serving LGBT young people

either alone as individuals or through peer support to providing
services and support in the context of their families and caregivers (Ryan & Chen-Hayes, 2013). This need is heightened by
the lack of available services and trained practitioners to provide family-oriented services and support for LGBT children
and adolescents across practice disciplines and care settings.

Critical Role of
Families in Reducing
Risk & Promoting
Well-Being

efore research was conducted that included LGBT

adolescents, parents, foster parents, and other key
family members, perceptions of how parents and
families would react to their LGBT children were predominantly negative (Ryan, 2010). However, an in-depth
study of LGBT adolescents and families found that family
reactions to their LGBT children were much more varied
and hopeful than had been previously assumed (Ryan, 2004;
Ryan & Chen-Hayes, 2013). This study found that:

Family reactions to their LGBT adolescents range from

highly rejecting to highly accepting. Thus, a proportion
of families respond with acceptance, and more with
ambivalence, to learning about their childs LGBT
identity and not with uniform rejection as had been
previously assumed.

Rejecting families become less rejecting over time,

and access to accurate information is a critical factor in
helping parents, families, and caregivers learn to support their LGBT children.

My son is a gift. My role as a

parent has been to give him
space to unfold just as he is
into a happy, caring young gay
man. Ive learned so much from
him. Hes helped me grow as a
parent and as a person.
Hugo, father of 14-year old gay youth

A Practitioners resource Guide: Helping Families to support their LGBt children

Critical Role of Families in Reducing Risk & Promoting Well-Being

Parents and families want to help their LGBT children

and to keep their families together, but many do not
know how.
Parents and caregivers who are perceived as rejecting their LGBT children and who engage in rejecting
behaviors (e.g., trying to change their childs sexual orientation and gender expression) are motivated by care
and concern for their LGBT children and by trying to
help their LGBT child fit in, have a good life, and
be accepted by others.

When my daughter was little I

spent so much time fussing over
how she looked. I should have
been concerned about how she
felt. We didnt know about transgender but I know how sad and
depressed she got right before
middle school. The school helped
us find a counselor and thats
when we found out how hopeless
she felt. I wanted to make sure
she wasnt rejected by others, but
instead, I was the one who was
rejecting her. Im so grateful I
could change things before it was
too late.
Brianna, mother of 12-year old transgender youth

Negative outcomes for many LGBT youth, including

suicide, homelessness, and placement in foster care or
juvenile justice facilities, can be prevented or reduced if
parents, families, and caregivers can turn to a knowledgeable source for guidance, accurate information, and
support.
Many parents and families whose children end up out
of home (e.g., homeless or in custodial care) want to reconnect and to have an ongoing relationship with their
LGBT children despite assumptions by others that they
do not want to have any involvement with their LGBT
childrens lives.

R
Research has also found that parents and caregivers play a
critical role in their LGBT childrens health and well-being
(e.g., Ryan et al., 2009; Ryan et al., 2010). In particular,
families help protect against suicidal behaviors (Eisenberg
& Resnick, 2006; Mustanski & Liu, 2013; Ryan et al.,
2010). Research with LGBT youth and families, foster families, and caregivers has identified more than 100 specific
ways that parents and caregivers express acceptance and
rejection of their LGBT children (Ryan, 2009; Ryan, 2010).
This includes behaviors such as preventing LGBT youth
from learning about their LGBT identity versus connecting
them with a positive role model to show them options for
the future (see Ryan, 2009). These family reactions were

FAMiLy rejection & HeALtH risKs

(Ryan et al., 2009)

LGBT young adults who reported high levels of

family rejection during adolescence were:

8.4 times more likely to report having

attempted suicide

5.9 times more likely to report high levels

of depression

3.4 times more likely to use illegal drugs, and

3.4 times more likely to report having engaged

in unprotected sexual intercourse

compared with peers from families that reported

no or low levels of family rejection

FAMiLy AccePtAnce & WeLL-BeinG

(Ryan et al., 2010)

Family acceptance helps:

protect against depression, suicidal behavior,

and substance abuse

promote self-esteem, social support, and

overall health

A Practitioners resource Guide: Helping Families to support their LGBt children

Critical Role of Families in Reducing Risk & Promoting Well-Being

then measured in a follow up study of LGBT young adults

to assess the relationship of family acceptance and rejection
during adolescence to health and mental health in young
adulthood.
This research found what many providers have known intuitively for years: that LGBT young people whose parents
and caregivers reject them report high levels of negative
health problems (Ryan et al., 2009), and those whose parents
support them show greater well-being, better general health,
and significantly decreased risk for suicide, depression, and
substance abuse (Ryan et al., 2010). Additional research from
this project provides key information on school-based and
faith-based experiences, including the relationship between
condemnation, victimization, and support of LGBT adolescents and their health and well-being in young adulthood.

I
Working closely with many racially and ethnically diverse
families, LGBT youth, and young adults in applying this
research showed that families even those who were very
rejecting could learn to modify rejecting behavior and

increase support for their LGBT children. This requires practitioners to provide education, guidance, and support in ways
that resonate for them (Ryan, 2010). Several years of intervention and resource development work has led to the generation of a series of multicultural family education materials;
research-based family intervention videos; assessment tools;
and intervention strategies to help diverse families support
their LGBT children (see Resources, p. 12).
Grounded in a strengths-based perspective, this family
intervention framework (Ryan & Chen-Hayes, 2013; Ryan
& Diaz, 2011) views families and caregivers as potential
allies in reducing risk, promoting well-being, and creating a
healthy future for their LGBT children. This approach views
the familys cultural values including deeply-held beliefs
as strengths. Research findings are aligned with underlying
values to help families understand that it is specific behaviors and communication patterns that contribute to both their
LGBT childs risk and their well-being. In expanding their
frame to proactively engage and work with families, practitioners may find the assumptions in Figure 1 useful to build
an alliance and to help parents, foster parents, families, and
caregivers to support their LGBT children.

FiGure 1

FAMiLy AccePtAnce Project core AssuMPtions

(Ryan & Diaz, 2011)

Assumes that families love their children and want them to have a good life. At the same time, we acknowledge that
their hopes and dreams for their childrens future are shaped by cultural and religious beliefs that may be at odds
with their child or adolescents sexual orientation and gender identity/expression.

Meets families where they are. This includes starting at the familys level of knowledge, expectations, and beliefs
about their childs sexual orientation and gender identity/expression.

Uses a strengths framework to align our research findings, education and prevention messages, and family support
approach with the parents and caregivers values about family, and the role of family in their culture and religious
practice.

Supports the need for families to be heard and understood. A critical aspect of our work is to provide a nonjudgmental space where parents and caregivers can tell their story and share their experiences and expressions of care and
concern for their childrens well-being that are rooted in culture, values, and specific beliefs such as faith traditions.

A Practitioners resource Guide: Helping Families to support their LGBt children

Critical Role of Families in Reducing Risk & Promoting Well-Being

FiGure 1, continued

FAMiLy AccePtAnce Project core AssuMPtions

(Ryan & Diaz, 2011)

Recognizes that parents and caregivers who are seen as rejecting their LGBT child are motivated by care and concern to help their child fit in, have a good life, and be accepted by others.

Understands that family behaviors are not isolated incidents, but occur in a cultural context aimed at socializing their
children and adolescents to adapt and be successful in a hetero-normative (heterosexual) society. These family behaviors aim to protect their children from harm, including victimization due to their LGBT identity and gender expression.

Uses FAP research findings to link family reactions to their childs LGBT identity with health, mental health, and wellbeing. Beyond building a strong alliance between families and providers, family awareness of the consequences of
their behavioral reactions is the most important mechanism of change.

Understands that parents and families experience their lack of knowledge about LGBT issues as inadequacy that
feels disempowering and shameful. Many families perceive their childrens LGBT identity as a loss, particularly as
a loss of control over their childrens future. Providers should help families validate and address these feelings by
affirming the importance of family support to build their childs self-esteem, to promote their childs well-being, and to
buffer rejection and negative reactions from others.

Recognizes that when rejecting and accepting behaviors co-exist, parents and caregivers experience ambivalence,
and their struggle to validate their LGBT child results in decreased support and increased risk. Education and learning how their reactions affect their LGBT children can improve communication and help parents and caregivers
respond in ways that help their LGBT child feel supported and loved rather than misunderstood or rejected.

From: Family Acceptance Project: Intervention guidelines and strategies by Caitlin Ryan and Rafael Diaz. San Francisco: Family
Acceptance Project, 2011. Copyright 2011 Caitlin Ryan, PhD. Reprinted with permission.

A Practitioners resource Guide: Helping Families to support their LGBt children

Helping Families
Decrease Risk &
Increase Well-Being for
Their LGBT Children

eyond building an alliance and showing families

that a practitioner respects their values and beliefs,
the primary mechanism for change is helping families understand that there is a powerful relationship between
their words, actions, and behaviors and their LGBT childs
risk and well-being. Parental and caregiver reactions to an
LGBT child or adolescent also affect their whole family.

When I put my head on the pillow

at night, I think about my daughter and just hope shes safe. I
dont know where she is. I havent
heard from her since I threw her
out of the house when she told
me she was lesbian. I didnt know
what to do. I wish I had acted differently. I would give anything to
be able to change that now.
Monica, mother of 16-year old lesbian youth

Families respond to their LGBT children based on what

they know, what they hear from their family, clergy, close
friends, and information sources, including providers who
may also have misinformation about sexual orientation and
gender identity, especially in childhood and adolescence. As
a result, parents and families who believe that homosexuality and gender non-conformity are wrong or are harmful for
their LGBT children may respond in a variety of ways to try
to prevent their children from becoming gay or transgender.
This may include: preventing their child from having
an LGBT friend, learning about their LGBT identity, or
participating in a support group for LGBT youth (such as a
Gay Straight Alliance or school diversity club), or excluding

their child from family events and activities. Families and

caregivers who respond in these ways do so without understanding that these reactions are experienced as rejection by
their LGBT children and that they are significantly related
to attempted suicide and other serious health concerns for
LGBT young people (e.g., Ryan, 2009).
Parents and families who engage in these behaviors are
typically motivated by helping their children and protecting them from harm. In this case, families are trying to
prevent their children from adopting what they perceive as
a lifestyle or choice that they believe will hurt them.
Understanding that specific reactions that parents and
families think are caring but that LGBT youth experience as
rejecting and harmful and that contribute to serious health
problems helps motivate parents, families, and caregivers to modify and stop rejecting behaviors, to support their
LGBT children (Ryan, 2009; Ryan & Diaz, 2011).

Approach to Working with Families

Several key approaches can help families learn to support their LGBT children, across a wide range of practice
settings and service systems (Ryan & Diaz, 2011). These
include the following:
Engage, approach, and connect with families and caregivers by meeting them where
they are, and view each family as an ally.
Each family brings different dynamics, experiences, and
strengths to learning that their child is lesbian, gay, bisexual,
or transgender. Some families can quickly learn to support their LGBT children. Some were accepting before they
knew or perceived that their child was LGBT. Others need
individual support to adjust to having a gay or transgender
child. Some need counseling, and others may need family
therapy.

A Practitioners resource Guide: Helping Families to support their LGBt children

Helping Families Decrease Risk & Increase Well-Being for Their LGBT Children

All families need education about how family reactions relate

to their LGBT childrens health and well-being. Families who
are accepting are eager to learn new ways of supporting their
LGBT children. For most families, learning about specific behaviors to protect and support their LGBT children will be new
information. In addition, many families who believe they are

Give families respectful language to talk

about sexual orientation and gender identity.

Most families and many providers lack understanding of

normative development of sexual orientation and gender
identity in children and adolescents. Many families and
caregivers have not talked about these issues in a way that
is not disparaging. For others, cultural silence
about homosexuality is the norm, and talking
Family rejection & risk for suicide
about these issues may feel shameful and
LiFetiMe suicide AtteMPts By LGBt younG AduLts
uncomfortable.
rejected By FAMiLies in AdoLescence
Ages 21-25

LOW
rejection

MODERATE
rejection

HIGH
rejection

Level of Family Rejection

Source: Supportive Families, Healthy Children: Helping Families with Lesbian, Gay,
Bisexual & Transgender Children by Caitlin Ryan, Family Acceptance Project, San Francisco State University, 2009. Copyright Caitlin Ryan, PhD. Reprinted with permission.

accepting are actually ambivalent about their

childs sexual orientation and gender identity.
Rather than expressing support, these families
are instead giving their child mixed messages
that contribute to health risks and diminished
self-esteem.

FAP has developed research-based multicultural education resources to teach providers

how to talk about these issues with families, to
educate families on sexual orientation and gender identity, and to show them ways to help and
support their LGBT children (see Resources,
p. 12). These materials were developed with
extensive guidance from families, LGBT youth
and informed linguists and literacy experts
to use language that is not derogatory and
is readily understood and respectful, to help
parents and families understand new research
on family reactions and adjustment to having
an LGBT child. For some families, these topics

Family rejection & risk for HiV

RIS

Let parents and caregivers tell

their story.
Research and intervention work has found
that few parents and caregivers have had the
opportunity to talk about their experiences,
concerns and hopes for their LGBT child
with a supportive, nonjudgmental professional (Ryan & Chen-Hayes, 2013). Parents and
caregivers also need to express their anxieties and fears about how others might treat or
hurt their LGBT child. This step is critical
to building an alliance and to understanding
their perspective.

LOW
rejection

MODERATE
rejection

HIGH
rejection

Level of Family Rejection

Source: Supportive Families, Healthy Children: Helping Families with Lesbian, Gay,
Bisexual & Transgender Children by Caitlin Ryan, Family Acceptance Project, San Francisco State University, 2009. Copyright Caitlin Ryan, PhD. Reprinted with permission.

A Practitioners resource Guide: Helping Families to support their LGBt children

Helping Families Decrease Risk & Increase Well-Being for Their LGBT Children

are distressing and may never have been discussed in a neutral

way. Helping families start to frame these issues differently
will enable them to talk about them with their LGBT children.
Talking with their LGBT child about their childs identity (even
when they are uncomfortable) is a supportive behavior that
helps protect against risk and promote well-being (Ryan, 2009).
Educate families on how family rejecting
behaviors affect their LGBT child.
This approach has found that helping parents and families
understand the serious health risks related to family rejection
lays the groundwork to focus on reducing their LGBT childs
risk, to provide support and to accept their LGBT child (see
Resources, p. 12). For families that are rejecting and ambivalent, in particular, learning that behaviors they thought
were helping their child are instead putting their child at risk
is sobering, disturbing, and even shocking. This includes
common rejecting behaviors such as trying to discourage
or change their childs sexual orientation or gender expression or blaming them when others mistreat them because
of their LGBT identity. Few parents and families want to
intentionally hurt their LGBT children, and learning about
this research helps parents understand their critical role in
protecting their child from harm. It also helps
them understand how these rejecting behaviors contribute to family conflict.
Educate families on how supportive and accepting behaviors affect their LGBT child.
Families typically think that loving their child
will build their childs self-esteem and protect
them from harm. However, it is how parents,
foster parents, and caregivers treat or respond
to their LGBT children that matters. In other
words, the specific behaviors that families
and caregivers engage in or how they love
their LGBT children contribute to serious
health risks or help protect them from harm
and promote their well-being.
More than 50 family accepting behaviors were
identified that are related to better overall

10

I didnt understand how hurtful

it was to tell my son that being
bisexual was just a fad. I pushed
him away when he was trying to
share an important part of himself with me. I didnt understand
about sexual orientation
I thought I could pressure him to
be straight. But instead, I made
him think I was rejecting him. Ive
spent a lot of time listening to
him now and learning.
Ben, father of 14-year old bisexual youth

health, higher self-esteem and significantly lower levels of depression, suicidal behavior, and substance abuse (Ryan et al.,
2010). These include a range of behaviors such as supporting their childs gender expression, welcoming their childs
LGBT friends to family events and activities, and helping
their congregation become more welcoming of LGBT people
(for information on key behaviors, see Ryan, 2009).

FAMiLy AccePtAnce durinG AdoLescence &

PercePtions oF BeinG A HAPPy LGBt AduLt
Level of Family
Acceptance
EXTREMELY
accepting

92%

VERY
accepting

77%

A LITTLE
accepting

59%

NOT AT ALL
accepting

35%

Source: Supportive Families, Healthy Children: Helping Families with Lesbian, Gay,
Bisexual & Transgender Children by Caitlin Ryan, Family Acceptance Project, San Francisco State University, 2009. Copyright Caitlin Ryan, PhD. Reprinted with permission.

A Practitioners resource Guide: Helping Families to support their LGBt children

Helping Families Decrease Risk & Increase Well-Being for Their LGBT Children

Framing for Families that Are struggling

or uncertain about Having an LGBt child
Practitioners should help parents and caregivers separate their
personal reactions to having an LGBT child from their childs
need for love, safety, and support. For families that are struggling and may initially be rejecting or ambivalent, specific
framing discussed below can help parents and caregivers
provide support while integrating their childs sexual orientation, gender identity, and gender expression with their values,
perceptions, and beliefs (Ryan, 2009; Ryan & Rees, 2012).
This framing includes the following:
Families that dont accept their childrens
sexual orientation and gender identity can still
support their LGBT children and decrease rejecting behaviors to protect them from harm.
Parents and caregivers who believe that homosexuality or
gender non-conformity are wrong can still support their
gay or transgender child by modifying or changing rejecting behaviors that increase their LGBT childs risk, without
accepting an identity they think is wrong. FAP has been
developing specific family education materials and ap-

proaches to help families support their LGBT children while

maintaining their values and deeply-held beliefs (e.g., Ryan
& Rees, 2012).
A little change makes a difference in decreasing family rejecting behaviors and in
increasing support for their LGBT children.
Research shows that high, moderate, and low rejection are
related to dramatically varying levels of risk. For example,
LGBT youth from highly rejecting families were 8.4 times
more likely to report having attempted suicide at least once
by young adulthood, while those from families that were
moderately rejecting were twice as likely to attempt suicide
(compared with peers who reported no or low levels of
specific family rejecting behaviors) (Ryan et al., 2009).
Similarly, nearly all young adults who reported high levels
of family acceptance believed they could have a good life as
an LGBT young adult, compared with only about 1 in 3 of
their peers who reported no acceptance from their family or
caregiver during adolescence (Ryan, 2009). Perceptions of
the future are very important for self-care, for health promotion, for decreasing risk-taking, and for career and personal
aspirations.

Increasing Family
Support: How to
Help Right Now

iven the early ages of coming out and the critical need for family education and guidance, the dearth of targeted
services to help diverse families support their LGBT children is a significant barrier to addressing the prevention,
care, and support needs of LGBT children and adolescents. Until such services are widely available, practitioners
and agencies can take several basic steps to respond to these needs in the following ways (Ryan & Diaz, 2011):

Provide training on engaging and supporting families with LGBT children for all practitioners and agencies that work
with children, youth, and families (see Resources, p. 12).

11

A Practitioners resource Guide: Helping Families to support their LGBt children

Increasing Family Support: How to Help Right Now

Include LGBT young people and families when describing populations served in agency literature, brochures, outreach
activities, and websites to ensure that LGBT youth and families know that your agency welcomes them and will provide
services for them.

Include information on the importance of family support and on the relationship between family acceptance and rejection
and health risks and well-being for LGBT youth in all parent and caregiver education resources, activities, and programs.

Ask adolescent patients and clients about their sexual orientation and gender identity.1 Ask about family reactions to
their sexual orientation, gender identity, and gender expression, including specific behaviors that parents, families, and
caregivers use to respond to their childs sexual orientation and gender expression.2

Provide education, support, and counseling to parents, families, foster parents, and caregivers who are engaging in rejecting behaviors. This includes using educational materials to help them understand the impact of their behaviors on their
LGBT child (see Resources below), and providing coaching, counseling, peer support, and family therapy.

Include families and caregivers of LGBT children and youth on advisory groups for child, youth, and family service
programs and agencies.

Do outreach to invite and include families and caregivers of LGBT children and youth and their LGBT children in recreational, social, and community activities and events offered by practitioners, programs, and agencies that serve children,
youth, and families.

Include LGBT books, brochures, and posters in agency waiting rooms, offices, and care facilities. Many LGBT youth and
those who may be questioning their identity look for safe zone or rainbow stickers to indicate that a provider will be
open and respectful in providing support and addressing needs related to their LGBT identity.

Resources for
Practitioners
and Families

he Family Acceptance Project has worked with

many racially and ethnically diverse families, LGBT
youth, and young adults, and the practitioners who
care for them, to develop a series of multicultural family
education and guidance materials and assessment tools.
Information is available at: http://familyproject.sfsu.edu/
These include:
Family Education Booklets research-based guidance
materials that educate families, caregivers, and providers on

12

how family acceptance and rejection relates to health and

well-being for LGBT young people to help increase family
and caregiver support for LGBT children and youth. Currently available in English, Spanish, and Chinese, and some
faith-based versions; new versions are in development,
including low literacy, in other languages, and for families
from a range of faith backgrounds. These booklets are designated as a Best Practice for suicide prevention for LGBT
people by the Suicide Prevention Resource Center/American
Foundation for Suicide Prevention Best Practices Registry.

A Practitioners resource Guide: Helping Families to support their LGBt children

Resources for Practitioners and Families

Family Education Videos compelling short documentaries that show the journey of ethnically and religiously
diverse families from struggle to support of their LGBT
children, to give LGBT youth and families hope and to
show the process that helps families learn to support their
LGBT children. Designed to educate families, LGBT children, and youth, for community education, and for provider
training, these videos are based on research and practice
with LGBT youth and families from the Family Acceptance
Project.
Assessment and Training a research-generated screening
instrument (the FAPrisk Screener) was developed based on

findings from FAP studies to quickly identify LGBT youth

who are experiencing rejection from parents, foster parents,
and caregivers, with guidance to inform family interventions
and follow up care, including preventing homelessness and
placement in custodial care (Ryan & Monasterio, 2011).
The screener is highly predictive of health concerns related
to family rejection, including depression, suicide attempts,
substance use problems, and diagnosis with a sexually transmitted disease.
Training is available on using the screener and using family
education materials and family engagement and intervention
strategies.

professional associations routinely update standards of care

and policy statements on care of LGBT youth and adults.

E
1

Experts on care of LGBT children and youth in child welfare have developed guidelines for managing information
about a young persons sexual orientation, gender identity,
and expression which can help practitioners think about
these issues and provide guidance for asking young people
about their identities (see Wilber, 2013). In addition, many
health professional disciplines have directed their members
to ask adolescents about their sexual orientation, including the American Medical Association, which included a
directive to ask adolescents about their sexual orientation
20 years ago (e.g., Elster & Kuznets, 1994). Major health

13

The Family Acceptance Project has developed a clinical

assessment screening tool and training to help practitioners
quickly identify LGBT young people who are experiencing
various levels of family rejection and to help practitioners
develop a follow up plan to engage families to decrease
rejecting behaviors that are related to significantly increasing their LGBT childrens risk for serious negative health
problems (e.g., suicide, substance abuse, HIV, etc.) and
which can precipitate ejection and removal from the home
(see Ryan & Monasterio, 2011).

A Practitioners resource Guide: Helping Families to support their LGBt children

References

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A Practitioners resource Guide: Helping Families to support their LGBt children

HHs Publication no. PeP14-LGBtKids