Oregon Juvenile Detention Centers LGBTQI Training The Moss

Oregon Juvenile Detention Centers LGBTQI Training The Moss Group, Inc. 1

Introduction The Moss Group, Inc. 2

Welcome! o Mykel Selph o Kuma J. Deboo o Participants The Moss Group, Inc. 3

Group Agreements & What You Expect to Learn The Moss Group, Inc. 4

Objectives: o Increased knowledge of the challenges faced by LGBTQI residents; o Increased knowledge of sexual orientation and/or gender identity and gender identity; o. Increased knowledge of the medical and mental health concerns of LGBTQI residents, and the medical treatments available for transgender youth; o Increased understanding of how best to interact with LGBTQI residents so as to avoid causing harm; o Think critically about facility policies as they relate to LGBTQI youth. The Moss Group, Inc. 5

6 Why Are We Here? o. Approximately 1 in every 13 -15 youth in confinement self-identify as LGBTQI o. Many of these youth are not “out” o. A higher percentage will be perceived by others to be LGBTQI Your actions can impact the mental and physical health of these youth, and may impact their lives far into the future. Sources: Hidden Injustice: LGBTQI Youth in Juvenile Courts (2009) Locked Up & Out: LGBTQI Youth in Louisiana’s Juvenile Justice System (2010) The Moss Group, Inc. 6

7 Why Are We Here? 2009 BJS report: In comparison to heterosexual youth, non-heterosexual youth reported: sexual victimization (all) at almost twice the rate (14. 3% compared to 8. 9%) sexual victimization by facility staff at a rate (7. 5% compared to 7. 8%) sexual victimization by another youth at ten times the rate (10. 3% compared to 1. 5%) The Moss Group, Inc. Sources: BJS Special Report: Sexual Victimization in Juvenile Facilities Reported by Youth, 2008 -09 7

8 What Does This Mean? Does this mean that LGBTQI youth are ALWAYS victims? Does this mean that LGBTQI youth can ONLY be victims (vs. aggressors)? No The Moss Group, Inc. 8

9 What Can We Do? Security Treatment Operations The Moss Group, Inc. 9

Practice Considerations 1. Know the definitions of terms 2. Be familiar with current research and court decisions 3. Educate all staff 4. Develop policy and procedure specific to the issues 5. Consult with community and advocacy groups 6. Safety first base decisions on safety of ALL residents and staff The Moss Group, Inc. 10

Definitions o It’s difficult to discuss an issue in any depth without knowing the appropriate terminology o The terminology used for this issue is constantly fluctuating o If you don’t know what a word means, ask! The Moss Group, Inc. 11

LGBTQI-GNC L = Lesbian G = Gay B = Bisexual T = Transgender Q = Queer I = Intersex GNC = Gender Non-conforming * There has been a push to use the term “Queer” as an umbrella term by the LGBTQI community. It is felt to be empowering because they are taking a term that once was a pejorative and reclaiming it for their own. 12 The Moss Group, Inc.

Group Exercise: LGBTQI Definitions The Moss Group, Inc. 13

14 Why Should We Care LGBTQI youth are perceived by society (their family, their friends, their teachers and classmates, strangers on the street) as being different than heterosexual or gender-conforming youth Therefore, they are often treated differently, and they have different experiences. Our experiences shape who we are: how we view the world, the assumptions we make, and how we interact with others – our attitudes, values and beliefs. The Moss Group, Inc. 14

15 Statistics: Why Should We Care We look at statistics to gain an understanding of the experiences undergone by LGBTQI youth before they find their way to, and to try to understand how they view the world around them. The Moss Group, Inc. 15

16 LGBTQI Residents: Relevant Statistics Suicide Risk: Suicide is the leading cause of death among gay and lesbian youth. Gay and lesbian youth are 2 -6 x more likely to attempt suicide than heterosexual youth. ◦LGBTQI youth are 4 x more likely to report making a suicide attempt that required medical attention ◦LGBTQI kids who experience high levels of family rejection are: ◦ 8. 4 x more likely than other LGBTQI kids to have attempted suicide ◦ 5. 9 x more likely to report high levels of depression Note additional risk factors: ◦Psychiatric disorders, depression and anxiety ◦Previous victims of sexual abuse Sources: Locked Up & Out: LGBTQI Youth in Louisiana’s Juvenile Justice System (2010), Sullivan, Irene. “Judges Counsel Discusses Gay Youth, Checklists for Judges, ” Youth Today, Aug. 18, 20011. U. S. Department of Health and Human Services, “Report of the Secretary's Task Force on Youth Suicide: Gay Male and Lesbian Youth Suicide. ” (1989) The Moss Group, Inc. 16

17 What Can We Learn From This? Not all LGBTQI youth are depressed or suicidal. HOWEVER, more LGBTQI youth are seriously, clinically depressed than their straight counterparts. Why might this be? ◦Experiences with family ◦Experiences in school ◦Experiences with religion ◦Perceptions of how they are viewed by society The Moss Group, Inc. 17

18 LGBTQI Youth: Relevant Statistics Substance Abuse: ◦The odds of substance abuse for LGB youth are 190% higher than with heterosexual youth ◦ 60% of gay/bisexual young men are substance abusers Running Away: ◦ 40% of street youth identify as LGBTQI ◦ 28% of LGBTQI youth detained before seeing a judge are detained for running away from their home or placement versus 12% of detained heterosexual Sources: Locked Up & Out: LGBTQI Youth in Louisiana’s Juvenile Justice System (2010) The Moss Group, Inc. 18

19 What Can We Learn From This? Substance abuse often results from an inability to cope with external pressures LGBTQI youth often face rejection from: ◦Family ◦Class-mates ◦Community at large The majority of LGBTQI youth report alcohol and drug use as common mechanisms for coping with feelings of severe isolation. Sources: New York State Office of Children and Family Services Guidelines for Childcare Practices with Lesbian, Gay, Bisexual, Transgender and Questioning Youth The Moss Group, Inc. 19

20 LGBTQI Youth: Relevant Statistics Discrimination in the Criminal Justice System Running away/truancy leads to 1. Higher ratings in standard risk assessments used in detention hearings 2. More likely to be detained in a facility before trial How might this impact youth placement in Oregon detention facilities? LGBTQI youth are over-represented in the juvenile justice system: ◦They represent 2 -10% of the general population ◦They represent 13 -15% of detained population Sources: Locked Up & Out: LGBTQI Youth in Louisiana’s Juvenile Justice System (2010), Sullivan, Irene. “Judges Counsel Discusses Gay Youth, Checklists for Judges, ” Youth Today, Aug. 18, 2011. The Moss Group, Inc. 20

Burning Issues The Moss Group, Inc. 21

Questions The Moss Group, Inc. 22

Module 1: National Development of LGBTQI Issues The Moss Group, Inc. 23

The Issue of Rights All detained youth have rights under ◦US Constitution ◦State and Federal statutes ◦Prison Rape Elimination Act (PREA) Standards Understanding how these rights apply to the LGBTQI population will help you to develop polices and procedures that ensure safety for staff & residents, to not violate civil rights, and mitigate the risk of agency and staff liability. The Moss Group, Inc. 24

25 Landmark Cases Doe V. Bell (New York – 2003) ◦Right of transgender individual to wear specific clothing ◦No “reasonable” accommodation was made by the facility Sources: New York Law School Law Review (Vol. 50 – 2005 -2006) The Moss Group, Inc. 25

26 Additional Landmark Cases R. G. V. Koller (Hawaii – 2006) ◦Improper use of isolation ◦Deliberate indifference Sources: AELE. org/law and ACLUnc. org/law The Moss Group, Inc. 26

Gammett v. Idaho State Board of Corrections o Offenders are entitled to hormone therapy o GD, left untreated, is a life-threatening mental health condition o Resulted in development of policies by the Idaho Department of Corrections The Moss Group, Inc. 27

28 Other Cases to Note o Limon v. Kansas o People v. Antoine D. o Mariah L. v. ACS o Rodriguez v. OCFS The Moss Group, Inc. Sources: ACLU. org; NCLR. org; UC Davis Journal of Juvenile Law & Policy; Equity Project 28

29 More Recently: LP v Philadelphia et al (Department of Human Services and the Youth Study Center) August 2011 Settlement reached in Pennsylvania case: o. Protections for transgender youth o. New policies and procedures o. New staff training practices o. Monetary award The Moss Group, Inc. Sources: ACLU. org; NCLR. org; UC Davis Journal of Juvenile Law & Policy; Equity Project 29

30 At the Federal Level In September 2011, the Federal Bureau of Prisons(BOP) reached a settlement in the case of Vanessa Adams, a transgendered woman detained since 2005. As a results of the settlement the BOP will: o Issue new policies and procedures – specifically putting an end to their “freeze frame” GD policy. o Provide Ms. Adams with appropriate treatment for GD. The Moss Group, Inc. Sources: NCLR. org; FBOP Memorandum 30

An Update to a Massachusetts Case In 2012, a federal judge ruled… o. Denying sex reassignment surgery constitutes violation of 8 th amendment right o. Court injunction to “take forthwith all of the actions reasonably necessary to provide [the defendant] sex reassignment surgery as promptly as possible. ” In January 2014, that decision was reaffirmed by a three-judge panel. In May 2014, the State of MA filed an appeal and won a rehearing before the full appeals court on May 8, 2014. The outcome is pending. The Moss Group, Inc. 31

32 Federal Laws Civil Rights Statutes: o 1969 Federal Hate-Crime Law o Matthew Shepard/James Byrd, Jr. o. Hate Crimes Prevention Act (2009) Sources: US Dept. of Justice – FBI The Moss Group, Inc. 32

33 Relevant Laws Civil Rights Statutes (in general): o 45 states and DC have statutes criminalizing various types of biasmotivated violence and intimidation. 32 of them cover sexual orientation, and 28 cover gender. 11 have transgender/genderidentity specific language in their laws. Civil Rights Statutes (in Oregon): o. The Oregon Equality Act passed in 2007 “forbids discrimination based on sexual orientation, gender identity or expression. ” Mandatory Reporting: o. Oregon requires people in certain professions to report suspected abuse or neglect of a child. Sources: Lambda Legal, Oregon. gov The Moss Group, Inc. 33

34 Legal Rights of LGBTQI Youth Case-law driven national perspective Based on US Supreme Court rulings and 14 th and 8 th amendments RG v. Koller and other cases: o. All young people in state custody have a right to be safe from physical, emotional and sexual abuse by other youth or facility staff o. In the institutions or facilities where they are held o. Youth have a right not to be isolated from other youth in the facility The Moss Group, Inc. Sources: ACLU. org; NCLR. org; UC Davis Journal of Juvenile Law & Policy; Equity Project 34

35 PREA Standards Related to this Issue o§ 115. 315 Limits to cross-gender viewing and searches. o§ 115. 331 Employee training. o§ 115. 341 Obtaining information from residents. o§ 115. 342 Placement of residents in housing, bed, program, education, and work assignments. o§ 115. 386 Sexual abuse incident reviews. The Moss Group, Inc. 35

36 Policy Implications for Oregon Detention Facilities As a result of these external influencing factors, and the growing understanding around the country agencies need to be proactive in their approach to the management and supervision of this population. Do your facilities have policies that address LGBTQI issues? The Moss Group, Inc. 36

Questions The Moss Group, Inc. 37

Module 2: Agency Mission & Values The Moss Group, Inc. 38

How important is training on the supervision of LGBTQI residents for you and your staff at your facility to be able to provide a safe environment for LGBTQI residents? 1. Very important 2. Somewhat important 3. Not important The Moss Group, Inc. 39

How important is training on the supervision of LGBTQI residents for you and staff at your facility to be able to provide an environment that allows LGBTQI residents to address their issues/behaviors? 1. Very important 2. Somewhat important 3. Not important The Moss Group, Inc. 40

Do you believe that supervising LGBTQI residents is different from supervising other residents? 1. Yes 2. No The Moss Group, Inc. 41

How prepared are you to supervise lesbian, gay or bisexual, intersex, and gender non-conforming residents? 1. Very 2. Somewhat 3. Not at all The Moss Group, Inc. 42

How prepared are staff in this agency to supervise non-traditional sexualities? 1. Very 2. Somewhat 3. Not at all The Moss Group, Inc. 43

How prepared are you to supervise transgender or gender nonconforming residents? 1. Very 2. Somewhat 3. Not at all The Moss Group, Inc. 44

How prepared are staff in this agency to supervise transgender residents? 1. Very 2. Somewhat 3. Not at all The Moss Group, Inc. 45

How accepting are staff in this agency of non-heterosexual residents? 1. Very 2. Somewhat 3. Not at all The Moss Group, Inc. 46

How accepting are residents in this agency of other non-heterosexual residents? 1. Very 2. Somewhat 3. Not at all The Moss Group, Inc. 47

How accepting are volunteers in this agency of LGBTQI residents? 1. Very 2. Somewhat 3. Not at all The Moss Group, Inc. 48

How accepting are staff in this agency of transgender or gender nonconforming residents? 1. Very 2. Somewhat 3. Not at all The Moss Group, Inc. 49

How accepting are residents in this agency of other transgender residents? 1. Very 2. Somewhat 3. Not at all The Moss Group, Inc. 50

How accepting are volunteers in this agency of transgender or gender non-conforming residents? 1. Very 2. Somewhat 3. Not at all The Moss Group, Inc. 51

Staff in this agency believe sexual orientation and/or gender identity is a choice. 1. All 2. Most 3. Some 4. None The Moss Group, Inc. 52

Staff in this agency believe they should not affirm residents to be gay/lesbian/bisexual/ transgender. 1. All 2. Most 3. Some 4. None The Moss Group, Inc. 53

Staff in this agency believe that LGBTQI residents sexualize an environment, making abuse and harassment in a facility more likely. 1. All 2. Most 3. Some 4. None The Moss Group, Inc. 54

Staff in this agency believe that LGBTQI residents are more vulnerable to assaults and harassment than straight and gender-conforming residents. 1. All 2. Most 3. Some 4. None The Moss Group, Inc. 55

Staff in this agency believe they have an obligation to actively work to prevent the abuse and harassment of LGBTQI residents. 1. All 2. Most 3. Some 4. None The Moss Group, Inc. 56

Group Discussion What Do We Bring to the Workplace? Why are you here? What gets you up every day to work with these kids? The Moss Group, Inc. 57

Themes from Oregon Detention Facilities’ Mission Statements o. Public Safety o. Security o. Resident & Staff Safety o. Courts have Immediate Access to Youth The Moss Group, Inc. 58

Questions The Moss Group, Inc. 59

Module 3: Medical & Mental Health Care The Moss Group, Inc. 60

The Moss Group, Inc. Objectives o Outline medical and mental health Issues to be aware of for all LGBTQI residents o Outline medical and mental health issues to be aware of for transgender residents o Outline agency policy in these areas The Moss Group, Inc. 61

The Moss Group, Inc. LGBTQI Medical and Mental Health Concerns Research shows that certain medical and mental health problems may occur more frequently in LGBTQI populations The Moss Group, Inc. 62

The Moss Group, Inc. LGBTQI Medical and Mental Health Concerns According to the Substance Abuse and Mental Health Services Administration, lesbians o May be more likely to suffer from major depression, phobia, and posttraumatic stress disorder o Experienced more emotional stress as teenagers, and were 2 to 2. 5 times more likely to have experienced suicidal ideation in the past 12 months o May be at higher risk for heart disease, breast cancer, and intimate partner violence o May be more likely to smoke and drink heavily The Moss Group, Inc. Substance Abuse and Mental Health Services Administration. Top Health Issues for LGBTQI Populations Information & Resource Kit. HHS Publication No. (SMA) 12 -4684. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2012. 63

The Moss Group, Inc. LGBTQI Medical and Mental Health Concerns According to the Substance Abuse and Mental Health Services Administration, gay men and youth o. May be at higher risk of: ◦Heart disease; prostate, testicular, colon and anal cancer ◦Victimization from criminal violence and intimate partner violence o. May be more likely to suffer from eating disorders, depression, and anxiety. Gay men and youth have higher rates of suicidal attempts o. Use alcohol and illicit drugs at a higher rate than the general population, and 50% more likely to smoke o. Are at higher risk of HIV and other STDs The Moss Group, Inc. Substance Abuse and Mental Health Services Administration. Top Health Issues for LGBTQI Populations Information & Resource Kit. HHS Publication No. (SMA) 12 -4684. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2012. 64

The Moss Group, Inc. LGBTQI Medical and Mental Health Concerns According to the Substance Abuse and Mental Health Services Administration, transgender youth Are significantly more likely to: ◦Have suffered from physical or sexual assault or abuse and may be less likely to report due to social stigmatization ◦To experience suicidal ideation (38 -65%); research shows suicide attempts may range from 16 -32% ◦May use marijuana, crack cocaine and alcohol, as well as methamphetamine and injection drugs; more likely to smoke The Moss Group, Inc. Substance Abuse and Mental Health Services Administration. Top Health Issues for LGBTQI Populations Information & Resource Kit. HHS Publication No. (SMA) 12 -4684. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2012. 65

The Moss Group, Inc. LGBTQI Medical and Mental Health Concerns Barriers to treatment services for transgender youth often include discrimination, provider hostility and insensitivity, strict binary gender (male/female) segregation within programs, and lack of acceptance in gender-appropriate recovery groups. The Moss Group, Inc. 66

The Moss Group, Inc. LGBTQI Medical and Mental Health Concerns There is a lack of available research related to physical health issues among transgender people. However, some research shows: o. Hormone therapy may lead to an elevated risk of certain diseases o. HIV/AIDS rates may be significantly higher than the general population, particularly among transgender women of color o. Other STD and infectious disease rates may also be higher o. One study found a tuberculosis rate of up to 13% among transgender women in San Francisco The Moss Group, Inc. Substance Abuse and Mental Health Services Administration. Top Health Issues for LGBTQI Populations Information & Resource Kit. HHS Publication No. (SMA) 12 -4684. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2012. 67

The Moss Group, Inc. LGBTQI Medical and Mental Health Concerns There is also a lack of research around the medical and mental health problems faced by intersex youth, beyond any specific to the intersex condition. Be aware of the following: o. Diagnosis will most likely have occurred previous to incarceration o. At birth, parents may have chosen a gender for the child; others may have not ◦Opinions in the medical field are evolving o. Intersex people may face the same social stigmatization as transgender people, depending on their physical appearance and gender identity The Moss Group, Inc. Allen L. Disorders of sexual development. Obstet Gynecol Clin North Am. 2009; 36: 25 -45. ; Donohoue PA. Disorders of sex development (intersex). In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19 th ed. Philadelphia, Pa: Saunders Elsevier; 2011: chap 582. [Retrieved from ] 68

The Moss Group, Inc. Consider… “The longstanding consensus of the behavioral and social sciences and the health and mental health professions is that homosexuality… is a normal and positive variation of human sexual orientation and/or gender identity” -American Psychological Association See the American Psychological Association Resolution on Appropriate Affirmative Responses to sexual orientation and/or gender identity Distress and Change Efforts [Retrieved from ] The Moss Group, Inc. 69

The Moss Group, Inc. What does this mean? Sexual orientation and/or gender identity Change Efforts on the part of a counselor or psychologist o. Are unlikely to be successful o. May cause harm Even in instances where a person may request sexual orientation and/or gender identity change efforts, the American Psychological Association recommends the facilitation of identity exploration and development without imposing a specific sexual orientation and/or gender identity outcome. See the Report of the American Psychological Association Task Force on Appropriate Therapeutic Responses to sexual orientation and/or gender identity [Retrieved from The Moss Group, Inc. 70

The Moss Group, Inc. What Does This Mean? LGBTQI youth should not be classified into sex offender or other treatment based on their sexual orientation and/or gender identity, and sex offender treatment should not discriminate against LGBTQI residents. See the American Psychological Association Resolution on Appropriate Affirmative Responses to sexual orientation and/or gender identity Distress and Change Efforts [Retrieved from ] The Moss Group, Inc. 71

The Moss Group, Inc. What is Gender Dysphoria? To fit the diagnosis of GD, a transgender individual must experience “intense, persistent gender dysphoria, ” or find their transgender feelings to be so “incongruent with their birth sex or with the gender role associated with that sex” that it is distressing or disabling GD is classified as a medical disorder by the American Psychiatric Association in the Diagnostic and Statistical Manual of Medical Disorders V (DSM V) Not all transgender youth fit this diagnosis American Psychological Association. (2011). Answers to Your Questions about Transgender People, Gender Identity, and Gender Expression. Washington, DC: Author, [Retrieved from ] The Moss Group, Inc. 72

The Moss Group, Inc. Significance of Dysphoria Will the agency require a GD diagnosis for all operational considerations, to include: ◦Housing ◦Clothing ◦Grooming The Moss Group, Inc. 73

The Moss Group, Inc. Purpose of Treatment o The purpose of treating gender dysphoria is not for the person to end up physically as the other sex o The purpose is to relieve, and eventually remedy, the dysphoria The Moss Group, Inc. 74

The Moss Group, Inc. Treatment for Dysphoria According to the World Professional Association for Transgender Health (WPATH), there are four treatments for GD: 1. Gender Expression 2. Hormone Therapy 3. Surgical Procedures 4. Psychotherapy World Professional Association for Transgender Health. Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People, Seventh Version , 2001. pg. 22, 13 The Moss Group, Inc. 75

The Moss Group, Inc. Gender Expression is: o The use of clothing, grooming, or living full- or part-time in the gender identity with which the individual identifies World Professional Association for Transgender Health. Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People, Seventh Version , 2001. pg. 22, 13 The Moss Group, Inc. 76

The Moss Group, Inc. Hormone Therapy Hormone therapy creates or enhances feminine or masculine physical characteristics through the administration of certain hormones Requires: 1. Demonstration of a long-lasting and intense pattern of gender nonconformity or gender dysphoria (suppressed or expressed) 2. Gender dysphoria emerged or worsened with the onset of puberty 3. Any co-existing psychological, medical, or social problems that could interfere with treatment have been addressed World Professional Association for Transgender Health. Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People, Seventh Version , 2001. pg. 22, 13 The Moss Group, Inc. 77

The Moss Group, Inc. Hormone Therapy Results Female-to-male: o Deepened voice o Clitoral enlargement (variable) o Growth in facial and body hair o Cessation of menses o Trophy of breast tissue o Decreased percentage of body fat compared to muscle mass World Professional Association for Transgender Health. Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People, Seventh Version , 2001. pg. 22, 13 The Moss Group, Inc. 78

The Moss Group, Inc. Hormone Therapy Results Male-to-female: o Breast growth (variable) o Decreased erectile function o Decreased testicular size o Increased percentage of body fat compared to muscle mass The Moss Group, Inc. 79

The Moss Group, Inc. Hormone Therapy Hormone therapy is accepted in the medical community as a medically necessary intervention for many transgender youth who have been diagnosed with Dysphoria Case law has supported the right of detained youth to receive this medical treatment for Dysphoria World Professional Association for Transgender Health. Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People, Seventh Version , 2001. pg. 22, 13 The Moss Group, Inc. 80

The Moss Group, Inc. Surgical Procedures o. Secondary sex characteristic modification may include breast implantation or removal, facial surgery, etc. o. Primary sex characteristic modification changes genitalia o. For a certain sub-section of youth diagnosed with Dysphoria, "relief from gender dysphoria cannot be achieved without modification of their primary and/or secondary sex characteristics to establish greater congruence with their gender identity". World Professional Association for Transgender Health. Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People, Seventh Version , 2012 The Moss Group, Inc. 81

The Moss Group, Inc. in cooperative agreement with NIC TA No. 12 C 1024 Surgical Procedures Genital surgery should not take place until an individual has reached the legal age of majority to give consent; and patients have lived for at least one continuous year in the gender role congruent with their gender identity World Professional Association for Transgender Health. Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People, Seventh Version , 2012 The Moss Group, Inc. 82

The Moss Group, Inc. Psychotherapy can be defined as the process of treating psychological disorders and mental distress by an appropriately trained and licensed professional. Psychotherapy provides support to the transgender individual before, during, and after other treatments. World Professional Association for Transgender Health. Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People, Seventh Version , 2001. pg. 22, 13 The Moss Group, Inc. 83

The Moss Group, Inc. Practitioner Qualifications The World Professional Association for Transgender Health (WPATH) recommends the following minimum credentials for mental health professionals who assess, refer, and offer therapy to children and adolescents with gender dysphoria: o. A master’s degree or its equivalent in a clinical behavioral science field. o. Competence in using the Diagnostic Statistical Manual of Mental Disorders and/or the International Classification of Diseases for diagnostic purposes. World Professional Association for Transgender Health. Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People, Seventh Version , 2001. pg. 22, 13 The Moss Group, Inc. 84

The Moss Group, Inc. Practitioner Qualifications ◦Ability to recognize and diagnose co-existing mental health concerns and to distinguish these from gender dysphoria. ◦Documented supervised training and competence in psychotherapy or counseling. ◦Knowledgeable about gender non-conforming identities and expressions, and the assessment and treatment of gender dysphoria. ◦Continuing education in the assessment and treatment of gender dysphoria. This may include attending relevant professional meetings, workshops, or seminars; obtaining supervision from a mental health professional with relevant experience; or participating in research related to gender nonconformity and gender dysphoria. The Moss Group, Inc. 85

Activity: Agency Policy – Clinical Interaction The Moss Group, Inc. 86

Questions The Moss Group, Inc. 87

Module 4: Communication The Moss Group, Inc. 88

Objectives o Provide guidance to staff on how to address LGBTQI residents in a culturally competent manner. o Provide guidance to staff around managing LGBTQI residents o Provide guidance to staff around information management regarding LGBTQI residents The Moss Group, Inc. 89

Why “good” Communication? o Good communication with all residents is an important skill that will help you do your job, as well as manage and keep staff and residents safe. o Effective communication combines a set of skills including: o. Nonverbal communication o. Attentive listening o. The ability to manage stress in the moment o. The capacity to recognize and understand your own emotions and those of the person you are communicating with The Moss Group, Inc. 90

Ideas for Good Communication The Moss Group, Inc. 91

What Do We Mean By a “Culture of Respect? ” Respect is a positive feeling of esteem or deference for a person, and includes specific actions and conduct that reflects back that esteem. Respect can be a specific feeling of regard for the actual qualities of the person being respected (e. g. , "I have great respect for her judgment"). The Moss Group, Inc. 92

Respect LGBTQI people often encounter biases and negativity when they are honest about their self-identification or status as LGBTQI, or when they present themselves in a gender non-conforming manner. The way you treat LGBTQI residents: ◦Should reflect agency mission and values ◦Can impact the emotional well-being of staff, residents and other stakeholders The Moss Group, Inc. 93

Respect Be aware that not all LGBTQI residents or staff are “out” Your conversations with other residents or staff who you do not perceive as LGBTQI will impact: ◦The culture of the facility ◦The attitudes and emotional well-being of the conversation participants The Moss Group, Inc. 94

Respect Be aware of your own biases and assumptions ◦Your upbringing may impact how you perceive LGBTQI people ◦Your religion & spiritual beliefs may impact how you think about LGBTQI people This module will hopefully impact how you treat LGBTQI youth in your role as an employee. The Moss Group, Inc. 95

The Moss Group, Inc. in cooperative agreement with NIC TA No. 12 C 1024 Respectful Language What is respectful language? Don’t make heteronormative assumptions Don’t use slang or slurs to refer to LGBTQI people Be aware that LGBTQI youth may be sensitive due to past experiences What could a staff person say unintentionally that may harm an LGBTQI youth or another staff? The Moss Group, Inc. 96

The Moss Group, Inc. Terms to avoid in a correctional setting o Sexual Preference o Homosexual lifestyle o Slang terminology such as: • He/she • Flamer • Butch • Gay for the stay • Sissy • It • Shemale The Moss Group, Inc. 97

The Moss Group, Inc. Respectful Language: Policy Considerations Consider providing directives: o. Using language of “choice” when referring to gender identity or sexual orientation and/or gender identity o. Discussing religious ideology of this issue with staff and residents; if they initiate a conversation, consider directing staff to the facility Chaplain The Moss Group, Inc. 98

Youth Management: Policy Considerations Consider providing directions to staff around managing youth conversations and interactions to minimize youth harassment of other youth If staff overhear a conversation between youth around LGBTQI issues that is disrespectful to LGBTQI people or misinformed, should they refer the youth to someone in particular? The Moss Group, Inc. 99

Avoid Unintentional Discrimination o. Be aware that you may interpret the actions of LGBTQI youth differently than heterosexual. o. If you see an LGBTQI youth hug another youth, do you interpret or think differently than if two heterosexual youths were hugging? o. Try to avoid unintentionally discriminating against LGBTQI by treating them differently. The Moss Group, Inc. 100

Addressing Transgender People o. Transgender girls (biological males) should be addressed as “she” and referred to as “her” o. Transgender boys (biological females) should be addressed as “he” and referred to as “him” o. Transgender people should be addressed using the name they select, which will likely be appropriate to their gender identity Policy Consideration: o. Refer to transgender and/or gender non-conforming youth according to their Preferred Gender Pronoun (PGP) The Moss Group, Inc. 101

Group Discussion 1. What could a staff person say unintentionally that could harm an LGBTQI inmate or another staff member? 2. What would you say and then do if an LGBTQI inmate came up to you and indicated that other residents were using derogatory words and bullying/harassing them because of his/her perceived sexual orientation and/or gender identity? The Moss Group, Inc. 102

Privacy and Confidentiality Rights and Responsibilities o Be careful with personal information you may have about someone else, such as their sexual orientation and/or gender identity and or gender identity o Consider how and why you may share that information o. Perceptions and assumptions can be harmful, and unnecessarily sharing information can get someone hurt, whether inmate or co-worker. o Honor confidentiality - be respectful and discrete. Share information only on a “need to know” basis - for your own safety and the safety of others. The Moss Group, Inc. 103

What do we mean by a “culture of safety? ” o. Physical Safety o. Emotional Safety o. Sexual Safety The Moss Group, Inc. 104

“Staff attitudes and actions influence inmate behavior and their perceptions of how safe the facility is, and as a result, are also very important components of staff safety. Staff should always behave in a professional, consistent and respectful manner when interacting with residents. ” (Corrections Today, Ernie Moore, 2004) The Moss Group, Inc. 105

Group Discussion Discuss what you would do as a staff member if an inmate “comes out” to you (reveals his or her sexual orientation and/or gender identity) The Moss Group, Inc. 106

Questions The Moss Group, Inc. 107

Module 5: Intake The Moss Group, Inc. 108

Objectives o Provide guidance to staff on their responsibilities during intake o. Provide information on best practices related to intake screening and risk assessment of LGBTQI o Provide staff with information on agency policy in this area The Moss Group, Inc. 109

Harris County TX Example The Moss Group, Inc. 110

Intake is the first point at which your agency will interact with LGBTQI youth. The intake process should: 1. Collect information on which residents self-identify or can be perceived as LGBTQI 2. Start the processes to ensure the inmate’s safety and to ensure all needs are met 3. Start building a relationship with the individual where the LGBTQI inmate understands that the agency respects them and their sexual orientation and/or gender identity The Moss Group, Inc. 111

Importance of Intake It is important for staff to know what occurs during intake so as to be able to effectively follow-up with the inmate and make most effective use of the information gathered. The Moss Group, Inc. 112

Identification PREA Standard 115. 341, states that intake screening must consider, at a minimum, Whether the resident is or is perceived to be gay, lesbian, bisexual, transgender, intersex, and/or gender non-conforming When possible, give the inmate a straightforward explanation of your purpose in asking them questions, or of what you are trying to accomplish. This will help reduce anxiety and promote trust. Explanations should be general, positive, and in commonly recognized terms rather than in technical jargon. The Moss Group, Inc. 113

Group Discussion How many of you have asked residents about their sexual orientation and/or gender identity? Does anyone want to share how that has gone for them and any thoughts on words to use/not use? Reactions from residents? Reactions from staff – what have you heard your co-workers say? The Moss Group, Inc. 114

Video Clips The Moss Group, Inc. 115

Identification: Who? Consider specifying in policy who should ask this question o Other intake personnel o Personnel conducting mental health screening The “who” may impact the “when” The Moss Group, Inc. 116

When? Consider specifying in policy when the question should be asked: o Day 1 o Week 1 Note that the “when” may impact the “who” The Moss Group, Inc. 117

Where? Consider specifying in policy a location that is private, or in which the conversation cannot be overheard These questions may lead to emotionally difficult disclosures, and privacy will ultimately lead to greater comfort and honesty on the part of the youth. The Moss Group, Inc. 118

How? Consider specifying in policy how this question should be asked: o Actual language, with context provided to residents o General recommendations The Moss Group, Inc. 119

Identification Records o Where this information will be recorded and who will have access? o Should staff record information concerning residents who may be perceived as LGBTQI, but who do not self-identify as such? Consider specifying in policy what procedures should be followed in the event that an inmate’s genitalia is ambiguous The Moss Group, Inc. 120

Strip Searches/Genitalia In the event that a youth’s genitalia is ambiguous staff will? During intake if you suspect a youth’s genitalia does not match their stated gender identity what do you do? PREA Standard 1115. 315 (e): Prohibits an agency from conducting a strip search of a youth for the sole purpose of determining their genitalia. The Moss Group, Inc. 121

Follow-up Consider specifying in policy whether intake personnel will: 1)Ask whether the inmate has previously experienced sexual victimization, which is also required by PREA Standard 115. 341 2)Ask whether the inmate feels that they will be vulnerable in a confinement setting, which is also required by PREA Standard 115. 341 Consider specifying in policy whether intake personnel will inquire whether the LGBTQI inmate has a family who is supportive of their status as LGBTQI. The Moss Group, Inc. 122

Medical Referrals o. If the inmate is intersex, they will most likely have been diagnosed as such previous to incarceration. o. Consider specifying in policy if all intersex residents will be referred to medical to ensure they are provided appropriate treatment. The Moss Group, Inc. 123

Medical Referrals If individual is transgender, they will fall into one of the following categories: 1. Diagnosed with Gender Dysphoria previously; 2. Have received hormonal or other treatments related to that diagnosis through a medical practitioner. 3. Have not been diagnosed with GD by a medical practitioner, but have self-administered hormonal treatments acquired through non-medical channels 4. Have not been diagnosed with GD; have not received medical treatment, through a practitioner or otherwise The Moss Group, Inc. 124

Mental Health Screening Consider specifying in policy how current mental health screening procedures will interact with intake on this issue. The Moss Group, Inc. 125

Intake Housing Consider specifying in policy where LGBTQI youth will be housed during intake o In a single room o In a housing unit consistent with their physical sex o In a housing unit consistent with their gender identity o When do you consider “special housing” or “segregation? ” The Moss Group, Inc. 126

Information Dissemination Consider specifying in policy how appropriate information will reach facility staff The Moss Group, Inc. 127

Risk Assessment Consider specifying in policy how the facility’s risk assessment tools may be integrated with an LGBTQI policy. The Moss Group, Inc. 128

Questions The Moss Group, Inc. 129

Module 6: Classification and Housing Placement The Moss Group, Inc. 130

Objectives o Provide guidance to staff on the agency classification process for LGBTQI residents o Provide staff with best practices in this area The Moss Group, Inc. 131

Placement The housing placement of LGBTQI residents can impact: o Their physical safety o Their sexual safety o Their emotional well-being The Moss Group, Inc. 132

Placement Considerations include: o Appropriate facility, o Appropriate unit within that facility, and o Appropriate room (e. g. , single vs. double) o If applicable, the appropriate roommate The Moss Group, Inc. 133

Placement Standard PREA Standard 115. 342(g) requires that lesbian, gay, bisexual, transgender, or intersex residents not be placed in particular housing, bed, or other assignments solely on the basis of such identification or status, unless such placement is in a dedicated facility, wing established in connection with a consent degree, legal settlement, or legal judgment for the purpose of protecting such residents. The Moss Group, Inc. 134

Placement: Transgender and Intersex PREA Standard 115. 342: In deciding whether to assign a transgender or intersex resident to a facility for male or female residents, and in making other housing and programming assignments, the agency shall consider on a case-by-case basis whether a placement would ensure the resident’s health and safety, and whether the placement would present management or security problems. The Moss Group, Inc. 135

Placement: Intersex Youth Intersex youth: o. May or may not self-identify with the gender associated with their genitalia. o. May present themselves as “gender-conforming” (i. e. their genderidentity matches their anatomy) or as gender non-conforming or genderless. o. Intersex youth may present varying challenges to the system with regards to housing placement and classification. The Moss Group, Inc. 136

Placement: Transgender Youth Best practice with this population encourages agencies to: o Respect the gender-identity of residents to the extent possible within security guidelines o Make decisions based on the inmate in question rather than based on blanket policies. The Moss Group, Inc. 137

Use of Isolation Isolating LGBTQI residents from the general population may keep them physically safe, but isolating residents for lengthy periods can be a liability for your agency and harmful to the residents. PREA Standard 115. 343 Protective Custody (excerpt): (a) residents at high risk for sexual victimization shall not be placed in involuntary segregated housing unless an assessment of all available alternatives has been made, and a determination has been made that there is no available alternative means of separation from likely abusers. If a facility cannot conduct such an assessment immediately, the facility may hold the inmate in involuntary segregated housing for less than 24 hours while completing the assessment. The Moss Group, Inc. 138

Use of Isolation PREA Standard 115. 342 Residents may be isolated from others only as a last resort when less restrictive measures are inadequate to keep them and other residents safe, and then only until an alternative means of keeping all residents safe can be arranged. During any period of isolation, agencies shall not deny residents daily largemuscle exercise and any legally required educational programming or special education services. Residents in isolation shall receive daily visits from a medical or mental health care clinician. Residents shall also have access to other programs and work opportunities to the extent possible. The Moss Group, Inc. 139

Use of Isolation PREA Standard 115. 432 (continued) If a resident is isolated pursuant to paragraph (b) of this section, the facility shall clearly document: 1. The basis for the facility’s concern for the resident’s safety; and 2. The reason why no alternative means of separation can be arranged. Every 30 days, the facility shall afford each resident a review to determine whethere is a continuing need for separation from the general population. The Moss Group, Inc. 140

Group Discussion Who should be involved in the placement decisions for transgender residents. What processes should the unit team follow? The Moss Group, Inc. 141

Re-Assessment PREA Standard 115. 342(d) requires that placement and programming assignments for each transgender or intersex inmate shall be reassessed at least twice each year to review any threats to safety experienced by the resident. o. Best practice dictates that housing placement be reassessed upon request and in the event of an incident of physical or sexual abuse. The Moss Group, Inc. 142

Questions The Moss Group, Inc. 143

Now It’s Your Turn! The Moss Group, Inc. 144

Module Review Guiding Questions In your small group please review each of the modules you were assigned. For each module have a discussion using the following questions as a guide: o. What did you like that was included in the module; what was the most important information? o. What was hard to follow or understand? Describe this and also some suggestions for improvement. o. What would you want more of? Was there additional content or practice you would like to see included? o. What else? The Moss Group, Inc. 145

Wrap up • Review of Training Objectives • Parking Lot • Evaluations The Moss Group, Inc. 146

Thank You! The Moss Group, Inc. 1312 Pennsylvania Avenue SE Washington, D. C. 20003 202 -546 -4747 www. mossgroup. us The Moss Group, Inc. 147