Trauma Informed Approaches to Working with LGBTQ Youth

Trauma Informed Approaches to Working with LGBTQ Youth in Housing and Treatment Services Emily Etzkorn, LCSW Transition Services Manager, Outside In Amanda Antenucci, LCSW, MAC Clinical Services Manager, Outside In

LGBTQ Youth LESBIAN / GAY / BISEXUAL Women who love women / Men who love men / People who love both men & women TRANSGENDER Folks whose gender identity does not align with the biological sex they were assigned at birth. QUEER or QUESTIONING Identity that falls outside of societal norms of gender identity &/or sexual orientation. YOUTH or YOUNG PEOPLE Folks between the ages of 14 & 26. Specifically, unaccompanied

USA General Population 5 to Youth Experiencing Homelessness 40% 10% Identify as LGBTQ

Youth Department Participant Survey Winter 2016 other 10% Straight 29% other 11% LGBQA 60% Sexual Orientation Trans spectrum 19% Cisgender 70% Gender Identity

To be Trauma Informed Realize the widespread impact of trauma and understand the potential paths for recovery; Recognize the signs and symptoms of trauma in clients, families, staff and others involved with the system; and Respond by fully integrating knowledge about trauma into policies, procedures, and practices, and seek to actively resist re-traumatization SAMHSA’s concept of Trauma and Guidance to Trauma Informed Approach, 2014

Contributors to mental health and substance use issues Discrimination Sexual violence Racism Criminal Justice Depression Peer Suicidality Substance Abuse Foster care Family Conflict Sexual solicitation PTSD Symptoms

Needs of LGBTQ Youth Experiencing Homelessness PRIORITY OF NEEDS Cited by LGBQ Youth PRIORITY OF NEEDS Cited by Transgender Youth Education 7% Education, 7% Other ; 13% Housing ; 26% Other 8% Housing 28% Health Care 13% Health Care; 18% Acceptance/E motional Support; 19% Employment; 18% Employment 19% Transition Related Support 26%

Case Study Jane is 23 year old Latina trans woman who moved to Portland four months ago. She was receiving hormone replacement therapy in California but has not accessed hormones since arriving in Portland. Jane lived in foster homes from ages 13 to 18 and has been homeless since. Jane’s name and gender do not match what is on her birth certificate. Jane reports she was in mandated counseling as a minor. She says she was diagnosed with ADHD, and bipolar. Jane reports trauma symptoms and struggles to be in enclosed spaces. She reports disassociating and auditory hallucinations. Since being in Portland she has been hospitalized twice for suicidal ideation. Jane reports using heroin most days with occasional amphetamine and alcohol use. Jane is currently sleeping at youth shelters and outside. She does not have a phone and struggles to make appointments. Jane says she wants help but that she is worried about getting “locked up”. If this youth approached your place of work for services, how do you think they would be received? What barriers might they encounter? How could you make your workplace more accessible to Jane?

Screen for LGBTQ Competency at hire All agency spaces are queer informed. Clinic and Youth Department have trans and LGB specific services Staff are down to earth Prioritize competent services for LGBTQ youth Agency has a history of taking radical stances on political issues Staff call each other out- in a supportive way Serving queer youth is part of our mission When I see someone who is queer, I feel safe. Staff gets to know people They ask my pronoun preference and remember it You know, we use drugs. It’s a safe place to be real about what’s going on

Housing & Shelter Values • Every youth is capable of learning to set their own goals and determining which services meet their needs • All youth have the right to be housed • Housing first is our goal, through a range of developmentallyappropriate housing options and supports • Funding follows the youth to promote individual choice and action • Housing options are culturally responsive, culturally competent, and affirmatively further opportunity for people who have traditionally been underserved • Youth need to have room to take risks and fail as part of their development • The Continuum operates as an integrated network sharing investment, risk, outcomes, opportunity, and accountability

CONTINUUM of HOUSING OPTIONS Short-Term – Emergency Shelter – Short-Term Shelter – Annex – Medical Housing Transitional Housing/Shared Living – Site-based options; 6 locations • Two options, Unity House – specific to LGBT Short-term and Limited-Term Community Housing Assistance – Scattered site options; 6 different funders/eligibility criteria Permanent Supportive Housing – Site-based options; 2 locations – Scattered site options; 3 different HUD projects

Coordinated Referrals to Housing Drop In Program Staff & Case Managers • Complete Housing Interest Form with Youth • Educate youth about options • Help youth apply for preferred housing options Housing Orientation provides further detail about options • Facility-based Transitional Housing programs • Community apartment options Permanent Supportive Housing • New Chronically Homeless Criteria • Most units accessed through TAY Co-Occurring Treatment Program

The transition into being housed can be difficult • Symptoms may increase initially when a client is housed • Struggles with being in a quiet home • Peer considerations • Increase in substance use • Housed further out, increased isolation

Street. RISE Street RISE Participant Experiences Team Members Services Provided Program Goals Transition Age Youth 6 Masters-Level MH Counselors Community Based Treatment ER Visits Homelessness 6 Certified Substance Use Counselors Therapeutic and Recreation Groups Involvement with Criminal Justice Severe Mental Health Issues 1 Peer Specialist Drop-In Space Homelessness Complex Trauma 1 Registered Nurse Support with Social Security Enrollment Health Substance Use 1 Psychiatrist 24 - hour crisis line Social Support Involvement with legal system 1 Housing Specialist Support with Medical & Legal Issues Employment Frequent ER Visits 1 Employment & Education Specialist Permanent Supportive Housing Education

Approaches used by Street. RISE • Meet people where they are—literally • Harm Reduction • Assume trauma • Long term relationships • Flexibility • Team approach • Housing first in Permanent Supportive Housing

Emily Etzkorn emilye@outsidein. org Amanda Antenucci amandaa@outsidein. org www. outsidein. org