Vianey Pelaez and Kaitlin Zylich
In 1950, gay rights activists founded the Mattachine Society, one of the earliest homophile organizations in the United States (Bronski, 2009). Shortly thereafter came the creation of other gay rights organizations, which empowered and furthered the gay rights movement. For nearly two decades before the Stonewall Riots, which occurred in 1969, these organizations brought homosexuality into the public eye. Historically speaking, the 1960s were marked by many political and social movements, from the Vietnam War protests to the fight for civil rights, the women¡¯s liberation movement, and the Black Power movement. The gay liberation movement thus found itself in the mix of multiple fights for social change (Bronski, 2009). Activists disagree about who was at the forefront of the gay rights movement, and whether lesbians or gay men played a more pioneering role. Most agree, however, that the group that was an integral force in the Stonewall Riots included transgender men and women. Despite the important role that transgender people played in the Stonewall Riots, transgender people are still marginalized and left out of the LGBT (lesbian, gay, bisexual, and transgender) discussion (Allison, 2011).
In New York City alone, an estimated 20,000 to 30,000 youth are homeless, and around one in five transgender individuals are at risk of needing homeless services (Christian & Mukarji-Connolly, 2011; Mokonogho, Mittal, & Quitangon, 2010; Mottet & Ohle, 2006; Yu, 2010). While only 3% to 5% of the U.S. population identify as LGBT, LGBT youth represent up to a staggering 40% of the homeless population nationwide (Cochran, Stewart, & Ginzler, 2002; Gattis, 2009; National Gay and Lesbian Task Force, 2010). More specifically, approximately .25% to 1% of the U.S. population identifies as transgender (Mokonogho et al., 2010). Precise statistics regarding homeless transgender youth are unavailable, as this population is often studied under the LGBT umbrella rather than individually. This paper examines current literature addressing homeless transgender youth as an invisible population and the lack of programs and services available to meet their needs.
Transgender youths experience an increased risk for victimization and discrimination across the board (Cochran et al., 2002; Gattis, 2009; Hunter, 2008; Spicer, 2010; Spicer, Schwartz, & Barber, 2010; Walls, Hancock, & Wisneski, 2007). It is important for social service providers to stay up-to-date with current transgender concerns, allowing for open and ongoing discussions regarding transgender youth needs. Providers can work to better meet the healthcare needs of transgender youth by facilitating access to accurate, unbiased, and supportive information (Grossman & D¡¯Augelli, 2006; Kreiss & Patterson, 1997; Mokonogho et al., 2010; Spicer, 2010). Social workers, advocates, and community leaders need to cultivate a nondiscriminatory environment and may do so by creating policies to this effect.
Language and Definitions
As used throughout this paper, the term transgender denotes a person whose self-identity does not unambiguously conform to conventional notions of either male or female gender. The term gender identity refers to one¡¯s ¡°internal view of their gender¡± and one¡¯s ¡°own innermost sense¡± of oneself (Anti-Violence Project, 2007). The term sexual orientation refers to individuals to whom one is physically, spiritually, and emotionally attracted in relation to one¡¯s own gender identity. Much of the current literature utilizes the term sexual minority, which refers to both individuals who do not identify as heterosexual, as well as those with gender identities that are inconsistent with the gender assigned at birth (Walls et al., 2007). The term youth, as used in this paper, refers to individuals ranging from 14 to 23 years old. A person experiencing homelessness is an individual ¡°without permanent housing who may live on the streets, stay in a shelter, mission, single-room occupancy facilities, abandoned building or vehicle, or in any other unstable or non-permanent situation¡± (NHCHC, 2014). Finally, the recurring phrase, mental health, while lacking a given definition in the reviewed literature, refers to a person¡¯s psychological, emotional, and behavioral wellbeing.
Review of Relevant Literature
Homelessness poses a significant problem in the United States and in New York City in particular. It is consistent within the literature addressing both youth studies and homelessness that youth identifying as lesbian, gay, bisexual, or transgender are disproportionately represented in the homeless youth population (Christian & Mukarji-Connolly, 2011; Cochran et al., 2002; Gattis, 2009; Gattis, 2013; Walls et al., 2007). This disparity is especially important to recognize, given that homeless and sexual minority youth are both viewed as being particularly vulnerable and stigmatized populations (Gattis, 2013).
Reasons of Homelessness
One factor contributing to LGBT youth homelessness is the refusal of the young person¡¯s family to accept the nonconformity of the youth¡¯s gender or sexual orientation (Christian & Mukarji-Connolly, 2011). When youth are cut off from their families, they face additional personal, cultural, financial, and legal barriers to accessing support. Financial and legal supports are especially vital for transgender youth who are at high risk for victimization and discrimination. Personal support is critical, as transgender youth are more likely to engage in sexually risky behavior, substance abuse, illegal, or dangerous activity and are additionally susceptible to mental health issues. Insufficient support structures are caused in part by a lack of knowledge about transgender issues within social services and the general population. This enables continued stigmatization and oppression of an already marginalized group. Marginalization often leads to internalized oppression, which further influences whether or not transgender youth look for and find support (Spicer, 2010).
In addition, Walls et al. (2007) seek to identify factors that contribute to sexual minority youth homelessness by making comparisons to a sexual minority non-homeless control population. Specifically, this study examines the ways in which victimization and harassment occurs in the lives of sexual minority youth. While this contributes to a better understanding of the lived experience of sexual minority youth, it does not comprehensively discuss their explicit mental healthcare needs. Instead, Walls et al. (2007) confirm that ¡°homeless sexual minority youth are at increased risk of negative life experiences over the already heightened risk that all sexual minority youths face¡± and indicate a need for culturally responsive homeless prevention services for sexual minority youth (p. 195). Furthermore, while these empirical studies include transgender youth as part of a sexual minority youth population, they do not recognize the unique circumstances affecting each individual identity group within that population (Cochran et al., 2002; Gattis, 2013; Walls et al., 2007).
Experiences of LGBT Homeless Youth
The empirical research conducted by Cochran et al. (2002) and Gattis (2013) contrasts the different experiences of LGBT youth to their heterosexual homeless youth counterparts. Cochran et al. (2002) specifically identify differences in the physical and mental health challenges these populations face. This comparison leads Cochran et al. (2002) to posit that homeless youth who are also sexual minorities are at an increased risk for negative experiences and outcomes. Spicer (2010) describes these outcomes as increased risk for homelessness, depression, anxiety, suicidal ideation, HIV and other sexually transmitted diseases, violence, gender-related psychosocial and physical abuse, and posttraumatic stress disorder.
Similarly, Gattis (2013) examines the differences between homeless sexual minority youth and their heterosexual counterparts by looking broadly at various micro psychosocial problems, as well as meso and macro level factors. These include a youth¡¯s family context, peer behaviors, school environment, mental health status, substance use, sexual risk behaviors, and experiences of stigma and discrimination. Gattis (2013) confirms that, ¡°sexually minority youth are more likely than their heterosexual homeless peers to report a range of negative outcomes¡± (p. 45). These factors relate to the mental health care needs of sexual minority youth experiencing homelessness.
These empirical studies illustrate the quantity of current literature addressing LGBT youth as a unified group. In reality, this group is actually quite diverse. For example, according to Grossman and D¡¯Augelli (2006) and Ryan and Futterman (1997), transgender people are generally more stigmatized than lesbian, gay, or bisexual individuals and require more support and services. An empirical study by Grossman and D¡¯Augelli (2006) explored factors affecting the experience of youth identifying as transgender, although they did not explicitly consider the issue of homelessness within this population. These authors did, however, note that each individual experiences their identity in a unique way. Combining the experiences of LGBT individuals together may not properly recognize the unique differences that exist within each population. Further, when it is assumed that individuals identifying as lesbian, gay, bisexual, and transgender share experiences, and should only be researched together, the unique experiences of people are invalidated, leading to further marginalization. For this reason, it is important to recognize the differences and unique experiences of transgender youth.
Service Needs of Transgender Homeless Youth
The literature agrees that LGBT homeless youth have unique safety and mental health service needs (Grossman & D¡¯Augelli, 2006; Hunter, 2008; Mokonogho et al., 2010; Mottet & Ohle, 2006; Yu, 2010). Two of these needs are the necessity to create safer spaces and increase access to culturally competent mental health services (Mokonogho et al., 2010).
Creating Safer Spaces
The literature reviewed herein agrees that, currently, many of the safety needs for transgender youth in homeless shelters remain unaddressed. According to Hunter (2008), Mottet and Ohle (2006), and Whitbeck, Chen, Hoyt, Tyler, and Johnson (2004), many homeless LGBT youth choose to live on the streets rather than endure pervasive physical abuse, intimidation, and denigration in homeless youth programs. Providing services that take into account the discrimination and victimization transgender youth face in society may create a safer environment for transgender youth. In doing so, providers may curtail further discrimination and emotional injury that poorly informed services and insensitive environments can have on transgender youth (Mottet & Ohle, 2006). Changing the way services are provided and tailoring the environment to the needs of transgender youth may help address some of the reasons that motivate transgender youth to resist traditional services.
In order for social services to better address the needs of homeless transgender youth, shelters must make changes to ensure the physical safety and emotional well-being of transgender youth. This should include a zero-tolerance harassment policy amongst shelter residents, and explicit acceptance of and support for transgender people (Gattis, 2009; Hunter, 2008; Mottet & Ohle, 2006; Yu, 2010). Some authorities recommend that clear signs should be placed in shelter lobbies, designating the facility as a safe space for transgender people (Mottet & Ohle, 2006). Reinforcing acceptance of transgender people can also be accomplished by respecting the client¡¯s self-identified gender and by not structuring shelter entrances around male or female gender divisions (Mottet & Ohle, 2006; Yu, 2010). Further, shelter rules should not reinforce gender divisions, such as through gender-specific dress codes. These, unfortunately, are common policies in youth shelters, despite the fact that they are dehumanizing for transgender people (Mottet & Ohle, 2006; Spicer, 2010; Yu, 2010).
Shelters must also do away with communal bathrooms and shower areas, as these expose transgender youth to opportunities for harassment and physical abuse (Hunter, 2008; Mottet & Ohle, 2006; Spicer, 2010; Yu, 2010). Yu (2010) proposes a slight modification, which enables an individual to decide on which gendered bathroom to use, while still providing male or female designated facilities. This solution is seen as problematic because it fails to recognize that there are periods of transition for some transgender individuals, and forcing one to select a gendered bathroom may effectively ¡°out¡± that person (Mottet & Ohle, 2006). Mottet and Ohle (2006) suggest abandoning gendered bathrooms altogether, creating a safer environment and one that respects the privacy and dignity of each individual. It is imperative to have doors, preferably with a lock, on all bathroom and shower stalls to ensure individuals have privacy (Hunter, 2008; Mottet & Ohle, 2006; Yu, 2010).
There are currently two distinctly different views regarding whether the social costs and benefits of maintaining safe and integrated shelters outweigh those of segregating transgender youth in separate shelters. According to Hunter (2008), ¡°the most effective way to curb violence against homeless LGBT youth is to provide them with separate housing facilities¡± (p. 551). Others have stated that this approach risks further ostracizing and marginalizing transgender youth. According to Gattis (2013), Mottet and Ohle (2006), and Walls et al. (2013) shelters must implement safety precautions to protect transgender youth while they are living in integrated shelters. Gattis (2013) and Hunter (2008) take a novel approach to educating shelter residents and staff by providing comprehensive sensitivity trainings that draw on the common feelings of disrespect and stigmatization shared by many shelter residents. Inclusive trainings help reduce the effects of the stigma faced by transgender shelter residents. It should be noted that these conflicting approaches could be explained in part by the disciplines of those who espouse them. For example, Hunter (2008) takes a legalistic approach, whereas other authors referenced practice in the fields of social work or psychology.
Addressing Mental Health Needs
In order to alleviate the invisibility and effects of vulnerability, traumatization, and stigmatization experienced by transgender youth who are homeless, it is imperative to better understand the specific concerns and psychosocial challenges of transgender youth. According to Kreiss and Patterson (1997) and Mottet and Ohle (2006), the process of self-acceptance and identity formation for sexual minority youth is difficult, and presents risk for emotional, mental, and social health problems. It is important to take this process into account when seeking to understand the needs of transgender youth. However, the process must also be examined in a broader context, as sexual minority youth who are homeless experience a lack of community support and face discrimination and stigmatization across multiple levels.
According to Mottet and Ohle (2006) and Walls et al. (2007), transgender youth experience an overwhelming feeling of hopelessness primarily due to their marginalized status within society. In particular, Mottet and Ohle (2006) specify that the rejection from family, coupled with discrimination in school, increase vulnerability of transgender people. Such discrimination in educational institutions works to perpetuate poverty for transgender people and thus affects their access to necessary health and mental health care (Grossman & D¡¯Augelli, 2006). Moreover, the absence of any connection to a primary safety net, and the lack of access to housing is pivotal in the experiences of transgender youth.
The tumultuous internal process of self-acceptance, in combination with the trauma that often accompanies a marginalized social status, contribute to higher incidences of depression, anxiety, suicidal ideation, physical abuse, posttraumatic stress disorder, and substance abuse amongst transgender youth (Kreiss & Patterson, 1997; Spicer, 2010; Walls et al., 2007). Further, as addressed by Cochran et al. (2002), Moskowitz et al. (2013), and Yu (2010), homeless transgender youth experience higher rates of sexual and physical victimization, survival sex, sexually transmitted illnesses, substance abuse, suicide attempts, and psychiatric and emotional disorders. It is imperative that in order to address these health and mental health concerns, practitioners have expertise in trauma and substance abuse.
According to Moskowitz et al. (2013), self-harming and suicidal behaviors in homeless youth occur due to a combination of behavioral, emotional, and familial problems. Through this study, Moskowitz et al. (2013) attempted to explain the connection between an individual¡¯s background and self-harming behavior. However, the study looks at the larger population of homeless and runaway youth, of which transgender youth are only a part. Further distinctions must be made, as this study focuses primarily on stress and psychosocial factors connected to self-harming behaviors and does not address other mental health concerns of homeless and runaway youth. However, it does recognize the role of stress in the lives of homeless and runaway youth and the connection between stress, self-harming, and suicidal behaviors. From here, Moskowitz et al. (2013) recommend that service providers focus on mechanisms to help reduce stress, as stress is a predictor of self-harm and suicide attempts.
Reducing stress and increasing family support may be an important step towards decreasing incidences of homelessness amongst transgender youth. Gattis (2013), Grossman and D¡¯Augelli (2006), Moskowitz et al. (2013), and Walls et al. (2007) all agree that family interventions to strengthen communication and support benefit both transgender youth and their families. According to Walls et al. (2007), families are often one of the greatest sources of stress and are difficult to mobilize to support transgender youth. However, through family therapy and improving communication, families can better understand the issues confronting transgender youth (Gattis, 2013; Moskowitz et al., 2013). Therapy can help families create a culturally safe environment for transgender youth to develop an identity. Health and mental healthcare providers must have knowledge of resources that promote family support or have practices that recognize that family support may not be present in the lives of transgender youth experiencing homelessness.
Transgender individuals experience great prejudice, discrimination, and a marked lack of understanding when accessing services. These cultural, social, and structural barriers are understandably far greater for homeless transgender youth. The families and communities of transgender individuals are often not supportive of their gender identities. The trauma, stigma, and discrimination faced by this population may lead to unhealthy behaviors, further ostracizing transgender individuals from mainstream society. Isolation continues when service providers neglect to specifically recognize and address the needs of homeless transgender youth. The limited amount of literature that focuses on this population highlights the need for further research on the unique and specific needs of transgender homeless youth.
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About the Authors
Vianey Pelaez is a graduate student at the Silberman School of SocialWork at Hunter College in New York City. Her specialization isClinical Practice with Individuals, Families, and Groups. Her passionfor advocating on behalf of those disempowered has led her to workwith the LGBTQ community and Latino immigrants. Priorto pursuing her Master¡¯s degree in Social Work, Vianey worked as anarts administrator in the non-profit sector, cultivating herprofessionalism and leadership. Vianey can be reached firstname.lastname@example.org.
Kaitlin Zylich is a graduate student at the Silberman School of SocialWork at Hunter College, where she studies Community Organizing,Planning, and Development with a Health and Mental Health practicespecialization. Kaitlin is interested in combining her passion forsocial justice and community organizing while providing services tohomeless New Yorkers. Prior to pursuing her Master’s degree in SocialWork, Kaitlin earned a BA in Asian Studies and Government from St.Lawrence University. She can be reached at email@example.com.