Adopting a Trauma Informed Approach for LGBTQQIA+ Youth

1. Adopting a Trauma Informed Approach for LGBTQQIA+ Youth Jeff Zacharias ACSW, LCSW, CSAT, CAADC Preferred Pronouns: He/Him/His

2. #Saytheirname 2018 Christa Leigh Steel-Knudslien (42) Viccky Gutierrez (33) Zakaria Fry (28) Celine Walker (36) Tonya Harvey (35) Phylicia Mitchell (45) AmiaTyrae Berryman (28) Sasha Wall (29) Carla Patricia Flores-Pavon (26) Nino Fortson (36) Gigi Pierce (28) Antash’a English (38)

3. #Saytheirname 2018 Diamond Stephens (39) Cathalina Christina James (24) Keisha Wells (54) Sasha Garden (27) Dejanay Stanton (24) Vontashia Bell (18) Shantee Tucker (30) Londonn Moore (20) Nikki Enriquez (28) Ciara Minaj Carter Frazier (31) Tydie Keanna Mattel (36)

4. #Saytheirname 2019 Dana Martin (31) Jazzaline Ware Ashanti Carmon (27) Claire Legato (21) Muhlaysia Booker (23) Michelle “Tamika” Washington (40) Paris Cameron (21) Chynal Lindsey (26) Johana “Joa” Medina Leon (25) – ICE Custody Chanel Scurlock (23) LayleenPolanco (27) – Killed in Rikers Island Zoe Spears (23)

5. #Saytheirname 2019 Ellie Marie Washtock, 38 Brooklyn Lindsey, 32 Denalie Berries Stuckey, 29 Tracy Single, 22 Kiki Fantroy, 21 Pebbles LaDime Doe, 24 Jordan Coffer, 22 Bailey Reeves, 17 Bee Love Slater, 23 Elisha Chanel Stanley, 46 Itali Marlowe, 29 Briana “BB” Hill, 30

6. Tolerance vs Acceptance vs Affirmative Tolerance: “You can be here as long as………..” Acceptance: “You can be here even if…………...” Affirming: You can be here because you are….”

7. Language is Everything Attachment from parents and caregivers Start of not feeling safe/cared for/respected Messages we heard – school, institutions, peers, family, etc. Stereotypes Let’s all step away from binary constructs!!! How do others hear you? How do you practice cultural humility? Connection and intimacy are the antidotes!

8. LGBTQQIA Youth Overview Over 150,000 transgender students in schools 75% feel unsafe at school 70% avoid restrooms because of safety concerns Only 13 states have non-discrimination policies 39% of youth have considered suicide in the past year 2 in 3 youth have reported someone tried to convince them to change (conversion therapy ban) 76% said current political climate is impacting their mental health/safety 73% have received verbal/physical threats due to their actual or perceived identity

9. How do LGBTQQIA Youth Experience: • Stigma (Isolation, social exclusion, discrimination) • Shame (I’m bad and fundamentally flawed) • Gender: Getting out of the binary • Power: To have and/or do not have • Privilege: To have and/or do not have • Oppression: Individual, Institutional, Cultural (Intersectionality) • Sexism, racism, ageism, anti-semitism, classism, heterosexism, ableism, islamaphobia, etc

10. Micro aggressions and Macro aggressions Language, name, pronoun use Transphobic comments Assumptions Eroticization Discomfort/disapproval Gender normative/binaried beliefs (“passing”) Denial of transphobia (individual and systemic) Denial of bodily privacy Environmental micro aggressions Goal of eliminating pathology only Providing treatment without competency Harassment, overt hostility, physical threat Pathologizing

11. Mental Health Issues • Suicide, depression, anxiety, bullying, internalized homophobia, internalized transphobia, addiction, body image issues/dysmorphia, grief/loss, relationships/sexual activity/dating different from peers •  Trans or Gender Non-Conforming – 41% •  Lesbian, Gay or Bisexual – 20% •  Overall Population – 4.6%

12. Multiple Stories – LGBTQQIA Youth Gender identities, gender expressions, roles, experiences Work Family of origin Friends Chosen family Faith community Clubs/groups Home Strangers Vacation Coming out experiences

13. Gender and Sexuality Basics Gender is who you go to bed AS Sexuality is who you go to bed WITH Biological: Body, brain Social: Cultural messages, life circumstances Psychological: Personal experience, reflection

14. The Vicious Cycle • Dehumanization of LGBTQQIA People • Lack of family acceptance • Hostile political climate • Cultural marginalization and invisibility

15. The Vicious Cycle • Denial of opportunity for LGBTQQIA People • Setbacks in education • Employment discrimination • Exclusion from healthcare and social services • Barriers to legal identification • Barriers for immigrants/refugees/asylum seekers • Unequal policing and criminal justice system

16. The Vicious Cycle • Increased risk factors • Intimate partner violence and sexual assault • Poverty and homelessness • Physical and mental health disparities • Engagement in survival sex work

17. Theories in working with LGBTQIA Youth Biopsychosocial systems perspective, including family systems and the impact on child/adolescent development (ACES Test) Impact of abuse/neglect (educational, medical, physical, emotional, sexual, etc) and the resilience of the youth Intersectionality Strengths Based Perspective and positive youth development Adolescent development compounded by LGBTQQIA identities

18. The 3 E’s Of Trauma Individual trauma results from an event, a series of events, or a set of circumstances that is experienced by an individual as physically or emotionally harmful or threatening and that has lasting adverse effects on the individual’s functioning and physical, social, emotional or spiritual well being. Event – Experienced - Effects

19. Trauma • How do we know if our LGBTQQIA+ youth have had/are currently experiencing trauma? • What’s covert trauma? • What’s overt trauma? • EX: Sexual violence, physical abuse, intimate partner violence, institutional harrassment, secondary/vicarious trauma, bullying, religious trauma, invisibility

20. Types of Trauma • Acute • Chronic • Physical • Emotional/Behavioral – Attachment disruption due to perceived/open sexual orientation, life lived in secret due to shame over orientation (“don’t tell anyone”) • Sexual – HIV survivors • Endurance – prolonged sense of feeling unsafe, neglect by primary caregivers • Caused naturally • Caused by people: Accidents/technological catastrophes • Caused by people: Intentional acts (suicides – witnessed through social media?, coverage of politics – IN/TX/NC, cyber-bullying)

21. What Is Trauma Informed? • A program, organization or system that is trauma informed: • Realizes the widespread prevalence and impact of trauma • Understands potential paths for healing • Recognizes signs/symptoms of trauma and how trauma not only impacts the client but all people within the organization including parents, teachers, friends, etc. • Responds by fully integrating knowledge about trauma into practices, policies, procedures and environment.

22. Risk Factors for Traumatic Response • How recent or distant in time the abuse happened • Whether or not the survivor was believed • How much support and validation or blame and rejection were received • Cultural norms/rituals/values towards abuse • Intellectual or developmental capacity to understand the abuse

23. Implications of Complex Trauma • Impact on the individual and relationships • Sense of self/self-esteem • Social support network • Sense of safety in the world/trust toward others and trusting systems • Suicide risk/self-harm • Substance use • Increased depression/anxiety

24. Trauma-specific Intervention • Trauma-informed programing recognizes... • The survivor's need to be respected, informed, connected, and hopeful regarding their own recovery • The interrelation between trauma and symptoms of trauma such as substance abuse, eating disorders, depression, and anxiety • The need to work in a collaborative way with survivors, family and friends of the survivor, and other human services agencies in a manner that will empower survivors and consumers.

25. Trauma Informed Care Emphasizes:  Safety Trustworthiness and transparency Peer support Collaboration and mutuality Empowerment, voice and choice Cultural, historical, and gender Issues

26. Social Work 101 • Meet the client where they’re • Assess for safety • What is their priority? • Tell me what I need to know about • Tell me what you don’t want me to know • What does healthy sexuality look like? • Medication adherence – education • Tap into resiliency through family of choice • How do you get connection?

27. Support People Dignity Respect Inclusivity Empathy Listen

28. Educate Others Don’t Be Afraid Focus on the positive Celebrate Medication – talk about it, ask about it, learn

29. Be A Role Model Don’t be afraid Be a mentor Be an innovator Inspire change

30. Recommendation to Develop Protective Factors LGBTQ community support (e.g., GSAs, support groups, etc.) Family acceptance Communities of faith Self-Determination Pride Resilience Diversity Creativity Resourcefulness Courage

31. Tools and Resources • If you don’t know something, ASK! • Listen for signs of Intimate Partner Violence (IPV) • Operate from a multicultural perspective • Resiliency, collaboration, non-judgmental, wise mind path, examine the spectrum of healing

32. The Need For Addressing Cultural Humility Mistreatment within the medical and mental health fields Access to trained clinicians Sharing the duty Lack of training Lack of understanding Access to referrals for mental health/medical interventions

33. Therapist Qualities (Attitudes) Affirm gender identity, expression, presentation and diversity beyond a male-female binary Acknowledge own biases Recognize intersections of identities Refute pathology of gender dysphoria Understand ongoing nature of humility and empathy building Affirm mental health/medical care needs of trans/GNC individuals

34. Therapist Qualities (Attitudes) Trans/GNC affirmative care and support increases the potential for positive life outcomes Understand that we may misstep/make mistakes Acknowledge that both trans/GNC and cis-gender therapists are vulnerable to concerns in the therapeutic relationship and clinical humility with trans/GNC clients

35. Cultural Humility: How Is It Observed? Developing an awareness of gender identity and transitioning issues Empathy, compassion, care, sensitivity, support, directness, flexibility Experience in working with specific populations/areas (expertise) Knowledge of resources, referrals, processes Foster self acceptance/validation and coping with painful experiences Challenge without prescribing Confidentiality Understand potential long term treatment need for therapy

36. Cultural Humility: Training Textbook knowledge isn’t enough Supervision, consultation, training, CEU’s Familiarization with WPATH and other published guidelines Ongoing consultation and professional development Consider differential/co-occurring diagnoses Distress isn’t pathology Psychological assessment instruments Acknowledge experiences, training and expertise working with gender issues at the start of engagement

37. Cultural Humility: Further Skills Awareness of the following: Expectations of others around the binary Complexities/ongoing nature of the coming out process Transphobia, heterosexism, sexism, cisgenderism at individual/institutional/systemic levels Variance of expression across the lifespan Distinct/interrelated nature of gender identity and sexual orientation Social, biological, familial, cultural, psychological, economic factors that influence development, identity and distress

38. Cultural Humility: Further Skills Various ways of living consistently with one’s gender identity Trans/GNC positive resources/referrals in your area such as support groups, providers for individual/partner/family/group, medical providers for general/transitioning, voice training, legal, spiritual Multiple identities Climate of community you provide services in Individuals/groups we can seek collaboration/consultations from

39. Cultural Humility: Further Skills Consider differential/co-occurring diagnoses Distress isn’t pathology Psychological assessment instruments Acknowledge experiences, training and expertise working with gender issues at the start of engagement

40. Therapeutic Relationship: Client and Therapist Identities Therapeutic relationship holds identity differences Looks at individual/systemic differences around power, privilege and oppression Discussion of differences/similarities in identities and how they may impact the relationship Privileged identities of the therapist Therapists gender identity, expression and concepts are relevant to and influence the relationship

41. Therapeutic Relationship: Other Factors Discuss the following: Name and pronoun usage which can be ongoing Restroom access in your space Feelings of comfort/safety in your space like how the client will “show up” How clients will be identified in your system Awareness of: Language, how it evolves, clients wishes/desires Presenting issues may not be related to gender identity

42. Therapeutic Relationship: Other Factors Openness to discussing experiences of discrimination and oppression What does your space look like? What message does your space send? Do your clients see you practice watch you preach?

43. Cultural Empathy Defined as: Empathic responses capable of transcending cultural differences Ability to understand/accept/feel the clients situation while separating own person/cultural experience Boundary between self and other Don’t expect clients to adopt your values We understand empathy from our own position influenced by our own experiences/identities/values/cultures

44. Cultural Empathy Importance of understanding the context for trans/GNC individuals Acquire knowledge needed Ability to recognize what we don’t know and how to obtain that information Acknowledge we cannot genuinely understand the clients unique positions

45. Cultural Empathy: Development Seek out perspectives/narratives of the trans/GNC community Understand/accept the context of family/community for clients of different backgrounds Incorporate providers/practices familiar with or requested by the clients Learn about the historical/political backgrounds of the community Seek knowledge about psychosocial adjustment to new environments/situations Oppression related to intersecting identities Position yourself as an ally/advocate

46. Advocacy Social justice and advocacy should be part of our work Use our position to advocate for institutional changes Educate professionals/students/supervisors Empower clients in underprivileged/devalued positions Advertise yourself, be visible, network, build a reputation

47. Reading Material The Transgender Teen: Stephanie Brill Becoming Nicole: Amy Ellis Nutt Beyond Magenta: Susan Kuklin Helping Your Transgender Teen: Krieger Trans Ally Workbook DaceySlascko How To Understand Your Gender: Alex Iantaffi New Gender Workbook: Kate Bornstein You And Your Gender Identity: Dara Hoffmann-Foxx Second Son: Ryan Sallan The Teaching Transgender Toolkit: Eli Green A Guide To Gender: Sam Killerman

48. Organizations WPATH: World Professional Association for Transgender Health National Center For Transgender Equality The Center Of Excellence for Transgender Health FORGE Rad Remedy Gender Spectrum The Trevor Project Gender Diversity PFLAG GLAAD GLSEN Family Acceptance Project It Gets Better GSA Network Human Rights Campaign

50. THANK YOU!!!! Jeff Zacharias ACSW, LCSW, CSAT, CAADC Jeffrey.zacharias@gmail.com 773-720-0068 Jeffrey@new-hope-recovery.com 773-883-3912