NASW Social Work Talks - EP87: Supporting LGBTQIA2S+ Youth in 2022

Episode Date: June 29, 2022

Social worker Caitlin Ryan, is founder and executive director of the Family Acceptance Project. She talks with us about how her organization has worked for 20 years to help families support their children who are LGBTQIA2S+ and how social workers can also do this work.

This episode is sponsored by Connect to End COVID-19. Welcome to Social Work Talks. My name is Greg Wright, and it's my honor and it's also a pleasure to have Caitlin Ryan here. She is Executive Director of the Family Acceptance Project. Caitlin, hi, how are you? Greg, it's great to be with you. I'm good. Hope you're well, too. Thank you. Thank you. So I want you to tell this audience exactly what is the Family Acceptance Project and what is its mission?

The Family Acceptance Project is the first research, education, intervention, and policy project to help diverse families learn to support their LGBTQ children. All of our work is carried out in the context of the family's cultural and faith-based traditions, in the context of their cultural worlds. The roots of the Family Acceptance Project go way back to my early days. This is actually my 45th year, going into my 46th year, working in LGBTQ health and mental health. I had a calling for this work. When I was a teenager, I started working in the anti-poverty movement in the 1960s in impoverished communities, and I saw the impact of lack of health care and discrimination on people's lives, and I realized this was the most important work that I could do. And when I came out as a young lesbian in the 1970s, I immediately became involved as an organizer in the early LGBTQ health movement, as we would call that today, developing the 1979 national, then we called it Lesbian and Gay Health Conference, and a national network of LGBTQ providers. and in carrying out the conference and developing that network, I saw multiple unmet needs in our

community that predated AIDS. I did the first lesbian healthcare survey. I was accepted into social work school after having to fight to become a social worker as an out lesbian in the 70s. And I was sent to Atlanta to do my first field placement where the CDC had identified AIDS in 1980 at the same time as I arrived. And I started immediately doing early work there as an organizer in LGBTQ health. I started as a volunteer to help develop the first AIDS organization in the South. And I don't know that people realize that from the very beginning of the epidemic, a high proportion of people with AIDS were gay and bisexual men of color, black gay and bisexual men. And part of my work as I, as soon as I graduated with my MSW,

I became the first director of Aid Atlanta. And part of my work involved meeting families who came from across the South to the bedsides of their dying children. At that time, there was a huge LGBTQ community in Atlanta. Hardly anybody was out and people moved to the big cities to try to integrate their lives without shaming their families. And so these parents and caregivers came from small cities and towns across the South. They were devastated to learn at the same time that their son was gay and bisexual and was dying of AIDS. They didn't understand why maybe they only came home once a year, why they didn't know anything about their lives or anything about who they were. And the media at the time was focused on family rejection, on how all families were

rejecting, on how they swooped in when a young person died and took everything that was accumulated by a couple and left the surviving member of that couple with nothing. I mean, the imagery about gay and bisexual men was horrific. And the imagery about families was all about rejecting behaviors but I saw this incredible response from so many parents and caregivers that would have done anything to change the future if only they knew what that was but it was at the portal of death it was at the last moment and so I realized that we needed to have a way to provide accurate information for families and caregivers about LGBTQ people way to help them learn to support LGBTQ family members. And that started me on

a many decade course of really beginning to plan for how I could develop a family support program, do research, get the resources that I needed. And it wasn't really until 20 years later when I was recruited to move to California in 1999, I started talking with San Francisco State University about moving there to set up an institute on LGBTQ health, equity, and social justice. And as part of that work, when I moved to California, the California Endowment invited me to present a proposal on LGBTQ health because they wanted to add LGBTQ health to their portfolio. And with Rafael Diaz, I developed the Family Acceptance Project. It conducted the first research on LGBTQ young people and families. The intent was indeed to develop that family

support model that could help, you know, racially, ethnically, religiously diverse families learn to support their LGBTQ children to reduce the serious health risks, you know, that had been identified over many years and help promote well-being. So that's what I did. And that research included identifying over a hundred specific behaviors that parents and caregivers engage in to respond to their LGBTQ children. About half of those behaviors were rejecting, half were accepting. It included behaviors like making your child pray or attend religious services to change their identity, not letting them have an LGBTQ friend or participate in LGBTQ support groups. And we showed how those rejecting behaviors contributed to serious health risks. Lots of those rejecting

behaviors we correlated with a more than eight times greater likelihood of attempted suicide or a nearly six times greater likelihood of high levels of clinical depression or more than three times as likely to use illegal drugs and put oneself at high risk for HIV and sexually transmitted infections. And we also identified over 50, I was just going to say we also identified over 50 family supportive behaviors that help protect against risk and promote well-being. And those were behaviors like standing up for your child when other people mistreated them because of who they were, or finding a positive role model to give them positive options for the future. And so based on those behaviors and together in a participatory

framework with LGBTQ young people and families, we developed not only the first family support model that could help, you know, reduce these risks and promote well-being and do so in the context of the family's cultural world, but a whole range of family guidance and educational and assessment materials based on these behaviors that would help families learn to support their LGBTQ children. And so that's what we've been doing over the past 20 years. And this is actually the 20th anniversary of the Family Acceptance Project. Wow. I was wondering if you have any estimates on how many families that you've worked with at this point, Caitlin? I'm sure it's been probably like hundreds of them at this point. It has been hundreds. And I would say that I've

worked with over a thousand LGBTQ youth. It's even more than that. If I think about going back, you know, to the early days of doing this work, because I did another project in faith-based communities before I started the Family Acceptance Project. But the other thing I think that's really been so inspiring for me is that I've worked with families across cultural and racial and religious backgrounds. And what I found is, you know, based on our work, that when information and guidance is presented to them in culturally relevant ways, they can learn to support their LGBTQ children and become more supportive and decrease those rejecting behaviors. And in doing so strengthen the family. And what's also been so moving is that once they learn to support their

LGBTQ children and learn about the disinformation that's really so widespread about sexual orientation and gender identity, not only do they learn how to advocate for their own children, but many of them across diverse racial backgrounds also become advocates for other people's children and are helping build civil society and change communities and really change and build healthy futures. I was also wondering, it's a playbook, changes for you based on the family. So in other words, is there a different strategy when you are working with a Black family or an Asian or a Mormon one, or are there a lot of commonalities going on? Ironically, there are a lot of commonalities in those three groups that you just mentioned,

and the family is at the core of all of them. And if we start to think in particular of families of color, families are their first buffer against racism and discrimination. It's the way that parents transmit knowledge about their racial identity and building communities and living in the world. The Family Acceptance Project's basic model is the same regardless of the background of the families, but we do an in-depth cultural assessment up front to learn about the cultural and religious values, to learn about what the parents and caregivers know and don't know about sexual orientation and gender identity, to learn about their hopes and dreams for their child. And we do separate assessments with the child and adolescent and the family members

to really understand where each of them is coming from. And so our psychoeducation plan, our approach is grounded in their cultural world. So there may be some differences in how the family perceives sexual orientation and gender identity, differences in stereotypes, differences in how they communicate with their child. But we base all of that in their cultural world. So it's very uniquely culture-based. And I think that's one of the reasons why we've been so successful, because we hear a lot, Greg, about queering this or queering that. And that's one of the things that's very troubling for families from traditional backgrounds. They don't want to queer anything. They want to have this child as they had expected them to be. There are really

many are troubled by a queer identity that they don't understand at all, because I think largely because of the misinformation and disinformation. So we're approaching them, working with them in the context of their cultural world, which is very different than trying to queer anything. And that includes their underlying cultural and religious values, their family values. Almost every parent wants their child to be happy, healthy, to have a good life, to keep their family together. And that's how we work with them. There may be some specific values related to gender roles or religious values that may be different with some of these families. But what we found is that most families want their child to be safe and healthy. And part of the, I think,

the power of our work is that because we've identified and measured behaviors, we can show them that it's not their beliefs that are harmful, it's not their values that are harmful, it's these behaviors that so many are engaging in because they think they're going to help their LGBTQ child to make sure that people will treat them with respect, to keep their family together, to help them fit in. And once they realize that the beliefs that are grounded in certain kinds of misinformation and disinformation about LGBTQ people are then leading to behaviors that are putting their child at risk. We help them change and modify those behaviors, and we can show them, especially in the early stages of working with them, families that believe that this is wrong,

we can show them that there are behaviors that they can engage in to support that LGBTQ child without having to accept an LGBTQ identity that to them may be very wrong. And those are simple behaviors that we can show them how we've measured them and what that looks like. Behaviors like simply talking with your LGBTQ child and listening respectfully without ridiculing them or punishing them. Requiring that other family members treat their child with respect like all of the other children in the family because they're a member of the family, because they're child of God, if it's a religious family, standing up for your child when other people mistreat them because of who they are, because of their LGBTQ identity or gender diversity. These are things

that parents and caregivers can do that we can show how they reduce risk and help promote well-being, but they can do that without having to agree that this is what they want, this is acceptable, that this is an appropriate behavior. And it's a way to begin to open the door once they learn that they can increase connectedness with their child and help decrease those high-risk behaviors they're in. Join NASW's National Connect to End COVID-19 effort. It's a CDC-funded initiative to support social workers and their clients in informed vaccine decision-making. NASW is collaborating with its partner, the University of Texas at Austin, Steve Hicks School of Social Work,

to provide national webinars, chapter trainings, tools, and information that promote vaccine confidence among social workers and equip social workers to support clients in informed vaccine decision-making. Visit NASW's website to learn more. Yeah, so what if a parent is of a faith that actually believes that a child who is queer is automatically going to go to hell? Are you trying to like alter that belief or like just have them not express that in a harmful way, Caitlin? I think it's more of the latter, but we don't attack their beliefs. And that's something that is really important for them to understand that we are there to help them learn to support their LGBTQ child and strengthen their family. So our approach really is to understand what are their

underlying values and beliefs in terms of their family culture, in terms of their religion. We've worked with families from many rejecting religious backgrounds, but when we ask them about their beliefs and then about their religious values, it's very clear that the values are different than the beliefs. And I'll give you an example. Many of the world's major religions condemn homosexuality, and increasingly many are anti-gender diversity. But when you look at the underlying values of the world's major religions, they're not values of hate or victimization, they're values of mercy, compassion, love. And so we're helping families and their pastors very often whom we've worked with and religious leaders understand those underlying values,

show them how LGBTQ young people, because of the way people treat them, are at extremely high risk for suicidality, for ending up out of home, for ending up in the foster care system, for example, which really impacts life chances across the course of their lives, helping them understand their high risk. And most people don't want that to happen. So we can show them how to modify those rejecting behaviors and how that actually helps decrease their child's risk and pulls their family together. And part of this is it's a process. Young people have been thinking about their identities typically for a while by the time families find out. And families find out very quickly and maybe carry a lot of misinformation and also beliefs that this is wrong. And so what

we're actually doing is helping them reconcile values and beliefs. Some people can do that very quickly. Some it takes longer. And part of our process includes peer support with families from their cultural and religious backgrounds who have LGBTQ children who've been on that journey and who can help them understand what this really means for them and for their family and how they can, in fact, reconcile what seems like discordant beliefs. So how does the Family Acceptance Project find the families that it's working with? I mean, is it a referral? Are like faith-based organizations reaching out to you? How are you like finding that connection out there, Caitlin? Well, we provide a number of different kinds of services. One is we actually do a great deal of

training across the U.S. and in other countries on helping diverse families learn to support their LGBTQ children, and that training could be for families themselves, for foster parents in the child welfare system, for providers, for youth and religious leaders. We also, early on in the work, when we developed our family support model, we had the funding here on the West Coast to provide those services directly. And when that funding ended, I started working with agencies across the U.S. where we've been helping them implement FAP's family support model. So my role is really as a coach in training and providing guidance and case consultation to help them build those programs and to increase family support. And because we've developed a whole

range of different kinds of materials, everything from a family support model to intervention strategies, to multilingual, multicultural family education materials like our Healthy Futures posters that are in 11 languages and cultural versions, we can show many people how to use these tools in simple ways to start to modify these rejecting behaviors and increase support. So we work in a range of ways, including building the field, you know, by writing about this work and publishing on our strategies and intervention framework. How many other nations other than the U.S. are you working in now, Caitlin? I think in like China at some point, correct? I worked in China. I worked in Korea. I've been working in the

Spanish-speaking countries for about 15 years. And actually about a week ago, I did the opening session for an international conference. It's an organization of families with LGBTQ children from 23 Spanish-speaking countries. So I've been working with them in those countries and have presented in a number of different countries over the years, and some of them actually went across the country and did education and training. So we've been working with them to provide guidance to policymakers, to use our research to change repressive laws, and to disseminate our Spanish-speaking materials in those different countries. And I've worked with Canada as well, and I'm hoping to work with them increasingly in the future, and with some of the European countries.

So we're in a political environment now where there was a lot of progress on LGBTQ rights, But now there are several states that have either enacted or are thinking about enacting anti-LGBTQ laws. So how has this affected the work that you're out there doing, Caitlin? I think the situation now is extremely serious. And in fact, in all the years that I've worked in LGBTQ health and mental health, I have not seen it as dire as it is now. There's been a dramatic increase in distorted, violent rhetoric and public violence. There's been significant stress on LGBTQ children, youth and families, especially for transgender and gender diverse children and youth. And it's affected my work a lot. I mean, it's increased my level of stress because for me, part of the tragedy is that we don't have systems in place to provide accurate information, guidance, and support for these diverse families with LGBTQ children. And these services are especially lacking in our public systems for low-income, racially diverse young people and families, for those that are involved with child welfare, juvenile justice, and mental health systems.

We don't, I think, really understand that we need to be providing the same kind of support across systems of care that we routinely provide for other children with special needs for our LGBTQ children and their families. I think historically, sexual orientation and gender identity, especially sexual orientation, is seen as a private behavior and not something that our public systems should be addressing. And because of the information age and the dramatic changes really over the last 30 years, we now see many, many young people increasingly coming out in childhood, not just as transgender, not just observing gender diverse expression, but also young children coming out as gay, lesbian, bi, whatever language they use. largely because they can see positive images of themselves that they could never see before and because this these identities are much more in the public domain than they ever were before we talked about them in schools in our congregations over the dinner table in our families so young people are identifying at very early ages families are having to grapple with this but our public systems still i think carry those perceptions that these are private behaviors

This is something that is an issue of adulthood or older teens. It's not part of childhood. And what we're seeing now, Greg, is the stripping away of those information barriers that prevented us from seeing what normative development of child and adolescent identities looked like. And we're seeing that now. Those are a function of childhood, just like other identity development that starts in childhood. It's not something that all of a sudden pops up at age 21. But our systems aren't acclimated to that. They're not used to seeing it. They're now seeing this as something that's deviant. And unfortunately, the violent, divisive rhetoric that's just so widespread now and spread through the media is fanning that. And it's telling parents and caregivers when they see these issues in their children that there's something really wrong with this, that they have to fix it, that they have to try to change them at home with, you know, the more than 50 rejecting behaviors that we've identified and measured, and then maybe send them to some kind of a provider or religious leader to try to change them outside the home.

And it's a dire situation because I think our systems of care have neglected these families, especially families that are disadvantaged because of so many historic gaps in who they are and what's happened to them and how they're treated, how information is disseminated, access to resources. They don't have the same level of access to resources and care as families with resources. And this is a very serious problem right now. And I think also in religiously conservative communities, those young people and families lack access to accurate information and support. And I think that we're going to see increased levels of risk over the considerable future.

Wow. So my final question for you is, I was wondering if you could give social workers advice on how they can help members of the LGBTQ community, especially our youth and children. I think social workers are in a unique place to make a difference. One of the things they could start doing is using our Healthy Futures posters in their agencies. These are 11 different cultural and language versions that on a single page tell the story of family acceptance and rejection. And there are three versions of these posters in these different languages, plus a guidance, a poster guidance that explains the research underlying them. It gives more than 20 plus rejecting or accepting behaviors that we've shown contribute to health risks and help

promote well-being on a single page. You don't need a social worker or any other kind of provider to interpret the poster. It's there by putting it in public spaces where everyone can see it and learn about these behaviors. We're immediately telling people how important families are. families are the most important resource for their LGBTQ children, and that could be a mentor, a foster parent, auntie, grandma. It's all different kinds of caregivers. We've shown with our research how important they are, but one of the things I think that people don't understand is you don't have to have a whole intervention program or special staffing to be able to make a difference. Just by helping everyone understand that behaviors matter,

the behaviors impact their child's risk and well-being. That's something that we can do right now. And one of the things we did recently was we created a new web... I'll start again. One of the things we did recently was we created a new online resource for LGBTQ youth and families, diverse young people and families, that is a place where youth can go on their own, where parents and caregivers can go on their own, and where they can go together as a family. And that website includes a national searchable website with resources to increase social support, to decrease mental health risks around the U.S. and some outside the U.S. It includes what we think is the largest list of affirming culture-based resources where parents and young people can find resources to help them affirm those intersectional identities across their diverse identities, organizations that may be local but have online activities and where they can talk with someone and get more information about integrating those identities. It includes a really large list of diverse affirming faith-based resources, and some of them, like Unity Fellowship, which is an African American congregation that's LGBTQ affirming, have online worship services where if it isn't in your community, you can go online and worship together as a family.

It includes our evidence-based resources from the Family Acceptance Project and national resources. And this is something that really should be on every list of resources that all providers should be aware of. And I hope you put the link to it up next to how you're going to disseminate this interview. But the website is LG. We will. We will. Should I tell you what the website is? Should I tell you what the website is?

Yes. Yes, please. And we'll also post that up in our show notes up under this episode as well. Fantastic. So the website is lgbtqfamilyacceptance.org. And we developed this website with the Institute for Innovation and Implementation at the University of Maryland that has a very large network of LGBTQ affirming services and supports and a deep reach into social work practice. So this is something that everybody can do right now. And also they can become familiar with our work at the Family Acceptance Project. They can come to the Family Acceptance Project's website, familyproject.sfsu.edu, learn more about some of the materials that we've developed, including a publication for supporting LGBTQ young people in child welfare, a publication for SAMHSA in how to create more affirming agencies, and our first best practice

resources for suicide prevention for LGBTQ young people that was listed in the National Best Practices Registry for Suicide Prevention. There are a lot of resources to open eyes. They're written at a more simple literacy level to engage and involve families and in different languages. And I think self-education is one of the most important things we can do as social workers. The beauty of being a social worker is you can practice for many, many years, and it's something that we can even do as volunteers in retirement. And self-educating about what transgender identity means, what gender diversity means, what sexual orientation is like in childhood and adolescence, what family support means. These are things that we can learn about, and we can teach everyone

about, because the beauty of the work of the Family Acceptance Project, it's not just for work, it's information for life that we can use in every parts of our lives, including in our communities and congregations, and certainly in our cultural worlds, because families really matter, and that's, I think, the most powerful outcome of this work that really is the culmination of my work in LGBTQ health over almost five decades. Thank you. So this is Caitlin Ryan from the Family Acceptance Project. They are celebrating a 20th anniversary, and I hope that you have far more than 20 years more because there's a lot of work and we're so happy that you're on the forefront out there doing it. Thank you. You have been listening to NASW Social Work Talks, a production of the National

Association of Social Workers. We encourage you to visit NASW's website for more information about our efforts to enhance the professional growth and development of our members to create and maintain professional standards and to advance sound social policies. You can learn more at www.socialworkers.org. Don't forget to subscribe to NASW Social Work Talks wherever you get your podcasts. Thanks again for joining us. We look forward to seeing you next episode.