As transgender youth move out of the Castro Youth Housing Initiative (CYHI), a transitional living program for homeless lesbian, gay, bisexual, and transgender youth in San Francisco, Calif., Kate Calimquim does all she can to help them get through rough times.
“I’ve had quite a few youth say, ‘If it wasn’t for this program, I don’t think I would be alive,’” said Calimquim, the Larkin Street initiative’s program manager.
Young people who identify as transgender experience high rates of family and community rejection. That, compounded with growing up in a world that often sees people as male or female, means that transgender youth arrive at her agency with substantial trauma histories.
Calimquim sees firsthand how CYHI’s culturally-competent services save lives and boost transgender young people’s mental health and overall well-being. As transgender youth navigate their gender identity and their transition process, CYHI’s gender-affirming environment provides a safe space for young people to figure things out, she says.
Johanna Olson-Kennedy, MD, the medical director of the Center for Transyouth Health and Development at Children’s Hospital Los Angeles, says the transgender youth she works with arrive with many of the same diagnoses that children who have experienced chronic trauma receive, such as oppositional defiant disorder, anxiety, impulse control problems, and suicidality.
Gender is such an integral part of who we are, Olson-Kennedy adds, and transgender youth can’t escape the body they were born in, or the onslaught of subtle and overt aggressions from people who judge and discriminate against them.
"Choose, choose, choose. The world around you is always saying, ‘Choose,’ as if it's a choice, first of all, and as if it's that important when it really is not,” Olson-Kennedy said of society’s insistence that everyone identify as male or female. “And so you can imagine what that must feel like.”
Calimquim and Olson-Kennedy agree that organizations can support the mental health of transgender homeless youth by providing gender-affirming services that honor each young person’s gender identity, and a welcoming, safe space that is transgender-inclusive.
Create an Inclusive Environment
Asking youth for their chosen name and gender pronoun during intake is a way to bolster transgender young people’s self-esteem and personal growth, Colimquim says. It’s important for staff to acknowledge there are alternative pronouns beyond ‘he’ and ‘she,’ like ‘they’ and ‘ze,’ an alternative, gender-free pronoun some people use when referring to another person.
Olson-Kennedy recommends that youth workers try not to use the phrase, “preferred pronoun,” because it implies that transgender youth have a choice in their gender and pronoun, and it also gives others permission to disregard it since it is “preferred.” Olson-Kennedy suggests staff ask, “Which pronoun most accurately reflects your gender?”
The physical environment of an agency also has the potential to communicate welcoming messages to youth. Olson-Kennedy recommends staff hang posters and other visuals in waiting areas and offices that say things like, “We welcome all genders here,” or “Tell us about your gender.” Transgender youth feel more comfortable when they see posters that affirm the fluidity of gender and the spectrum of gender identities, Calimquim says.
Olson-Kennedy and Calimquim offer several other ways to put transgender youth at ease, including providing gender-neutral bathrooms and hiring transgender adults to work at your agency.
Provide Transgender-Specific Services
In addition to providing a welcoming and safe environment, it’s important that staff understand the experiences of transgender youth and their unique service needs.
Transgender youth experience something called “gender dysphoria,” Olson-Kennedy explains, which is an ongoing state of distress caused by the awareness that one’s gender identity doesn’t match the sex assigned at birth. Medical care such as hormone blockers for younger children, and cross-sex hormone therapy for adolescents and young adults, helps resolve young people’s gender dysphoria and improves their mental health.
It’s important for staff to receive training so they know how to discuss sensitive topics like transgender health care and the gender transition process with youth, Calimquim says. Building rapport with young people is important so they feel safe discussing it, so it’s best to wait until they bring it up themselves, or until you know them better. When youth approach you seeking transition-related health care, culturally-affirming mental health care, or help changing legal documents, be ready with a list of referrals, she says.
Experiencing homelessness, gender dysphoria, discrimination, and family rejection is very painful, Olson-Kennedy says, and it’s essential that staff understand where transgender youth are coming from and why they may use drugs and alcohol to self-soothe. Recently one of her patients demonstrated this point when they said, “When I’m high, I don’t actually have to think about my body.”
One of the most powerful ways agencies can support the overall well-being of transgender youth is to address family rejection. If staff can help family members move from a place of rejection to a place of understanding and acceptance, transgender youth have the possibility of reuniting with their families.
“When you increase people’s awareness and capacity for celebration of their trans child, you change the world,” Olson-Kennedy said. “If you just keep taking trans kids and confining them into the system, without trying to change families, we don't move the world as fast.”