Creating Safety Above 14th Street: Therapeutic Spaces in Service of Our LGBTQ Youth

Shilpa R. Taufique, PhD Assistant Clinical Director, CARES The Child and Family Institute St. Lukes-Roosevelt Hospital Center Tel: 212-523-3153 E-mail: staufique@chpnet.org Shelby J. Semino, PhD Child Psychology Fellow The Child and Family Institute St. Lukes-Roosevelt Hospital Center Tel: 212-523-6637 E-mail: ssemino@chpnet.org

Competency
Awareness
Increase your awareness of LGBTQ youth in need of services

Knowledge
Increase your knowledge of recent research, data, and current resources available

Skills
Enhance your clinical skills in relation to working with LGBTQ youth

Awareness

 Ever treated LGBTQ youth? What % of population in treatment at CFI would benefit from LGB-specific treatment/services?
What resources are available above 14th Street?

Map of LGBTQ Resources for Youth in NYC

http://maps.google.com/maps?f=q&source= s_q&hl=en&geocode=&q=gay+and+lesbia n+organizations&mrt=all&sll=40.805234,73.961484&sspn=0.009031,0.019312&g= 411+West+114th+Street,+NY,+NY&ie=UT F8&ll=40.768842,73.918419&spn=0.144569,0.30899&z=12

Knowledge

Question #1
What does In the Life mean?

Answer #1
What does In the Life mean?
Slang, a Harlem-Renaissance euphemism for a prostitute or homosexual

Question #2
What does AG mean?

Answer #2
What does AG mean?
Aggressive Lesbian- Women who present, in their style and demeanor, like thugs or gangstas. They have a swagga and attitude of toughness and dominance, and often seek out femmes as their romantic partners (aka: shorties, wifeys)

Question #3
What does on the low mean?

Answer #3
What does on the low mean?
Identity of discretion, privacy, and secrecy for straight men who have sex with other men.

National Statistics (N = 6209): School Climate and Homophobia** 1. Nearly 75% of students had heard homophobic remarks often or frequently at school 2. Roughly 86% of students had reported being verbally harassed at school in past year 3. About 44% of students had been physically harassed at school in past year
** Data gathered from the 2007 National School Climate Survey (GLSEN, 2008); www.glsen.org

The Climate In New York Schools

(N = 113)

**

93% of students reported hearing homophobic remarks at school (faggot, dyke, thats so gay); 84% heard negative remarks about gender expressions at school; 19% heard TEACHERS or SCHOOL STAFF make homophobic remarks; Majority of LGBT students (68%) did NOT feel safe in their schools; 60% of LGBT students had been verbally harassed in school because of sexual orientation; 35% of LGBT students were physically harassed; 13% of LGBT students were physically assaulted.
** Data gathered from the 2005 National School Climate Survey, GLSEN.

Substance Abuse & Mental Health Issues in the LGB Population

Meta-analytic review of 18 studies conducted between 1994 and 2006 found that LGB youth are significantly more likely to report substance use (tobacco, alcohol, & other drugs) than their heterosexual peers (Marshal,
Friedman, Stall, King, Miles, Gold, Bukstein, & Morse, 2008)

Rates of poor mental health have been shown to be consistently more prevalent amongst adolescents and young adults who identify as LGB or are questioning their sexuality and experience effects of stigma (DAugelli,
2002)

Local Stats for NYC

Similar findings have been reported with NYC youth. Data from the 2005 YRBS (N = 7744), revealed significant differences between groups (LGB vs. Heterosexual) in reported substance use, where LGB youth were more likely to report ever using substances and increased alcohol use (Egan, Botsko,
Netherland, Pathela, Yeung, Sell, 2007).

Types of Resources
GSA P-FLAG Websites Hotlines The Door The Center Hetrick-Martin FIERCE, NYC

Map of LGBTQ Resources for Youth in NYC

http://maps.google.com/maps?f=q&source= s_q&hl=en&geocode=&q=gay+and+lesbia n+organizations&mrt=all&sll=40.805234,73.961484&sspn=0.009031,0.019312&g= 411+West+114th+Street,+NY,+NY&ie=UT F8&ll=40.768842,73.918419&spn=0.144569,0.30899&z=12

Skills

Rate yourself on each of the 5 scales:

Adolescent Development: Me or We? Interpersonal Relations: are you more emotional, more logical, or balanced? GAF: should need no explanation! (below 50, proceed to the nearest ER) Substance Abuse: be honest, were not looking at your answers Sexuality / Orientation: are you a manly man? are you a girly girl? in between?

CARES
Comprehensive Adolescent Rehabilitation & Educational Services Program Who do we serve? What do we treat? How do we do it?

Adolescent Development
Many demands during the years of adolescence and early adulthood; Adjust to changes in their physical and emotional selves; Develop and maintain mutually effective interpersonal relationships; Establish independence; Develop secure identity and positive sense of self.

Factors that Complicate this Process?

Mental illness Substance abuse problems Unsupportive family dynamics Academic and social difficulties Sexual/Orientation Identity Development

Sexuality at CARES
5- Year Retrospective Assessment: Homophobia, Sexuality, Students, and Staff. About 25-30% of our students identify as LGB or questioning. The majority of these students are addressing issues of substance abuse and mental illness at CARES.

Sexuality at CARES (cont.)

Many students identifying as LGBQ within the CARES program.
Students strongly felt the need to openly express themselves re: sexuality without being ostracized, ridiculed, discriminated against. Need to use institution to begin to create a culture of safety and security for exploration of sexual orientation identity.

Our goal:
Build tolerance Build acceptance

How do we do this, given existing resources?

Map of LGBTQ Resources for Youth in NYC

http://maps.google.com/maps?f=q&source= s_q&hl=en&geocode=&q=gay+and+lesbia n+organizations&mrt=all&sll=40.805234,73.961484&sspn=0.009031,0.019312&g= 411+West+114th+Street,+NY,+NY&ie=UT F8&ll=40.768842,73.918419&spn=0.144569,0.30899&z=12

Why GSA?
Made way into public schools in general Way to normalize questioning Want to build tolerance, so not just gay group or straight group

GSA/Healthy Living & Sexuality

Explanation of the name. How were group leaders chosen? How were/are group members chosen? What is the mission of the group?

Our goal:
Build tolerance Build acceptance

How?
Our population is always in flux wrt:
Adolescent development Interpersonal relations Mental health issues Substance use/abuse issues Sexuality / sexual orientation

Stages of Change (or, Phases of Flux)

[adapted from: Velasquez, Maurer, Crouch, and DiClemente (2001).] Precontemplation:
Not thinking of changing Feel that things are fine Do not see a problem Contemplation: Thinking of changing Wondering how I affect others Maybe trying small changes

Maintenance: Still engaging in new behaviors Accepting self and identity

Preparation: Have a plan to change May have made small changes Can see some benefits of changing

Action: Have made several big and small changes Asking others for support

5 Clinical Dimensions to Consider

1) Adolescent Development
Self/Other: -Me
-Family

--

--

--

--

--

-We
-Self

In/Dependence:

--

--

--

--

--

2) Interpersonal Relations
State of Mind: -Emotion Mind ---Wise Mind ---Reasonable Mind

3) GAF- social, occupational, psychological functioning

0--------------------------------50-----------------------------100

5 Clinical Dimensions to Consider

4)Substance Abuse Treatment
Frequency of Use: 0 None
0 No Desire

7 Daily
6 7 Depen dence

Quality:

1 Experi mental

5) Sexuality & Sexual Orientation

Gender:

1 100% Masculine
1 Males Only

4 50/50

7 100% Feminine
7 Females Only

Attraction:

4 M&F

Initial group member profiles

JD- 18 y.o., lesbian female, founder of GSA @ CARES CG- 16 y.o self-identified Homophobe, wanted to learn GS- 17 y.o straight/bisexual female, joined group, just cuz MP- 17 y.o, straight female, lots of gay friends, wanted to be a support/ally. SP- 15 y.o, gay male, uber-PROUD of gay identity.

Creating Safety Above 14th Street

Taking this into your office

Remain informed of current trends in LGB development Work with the family Dont assume Ask questions Use their Language Explore connection between behaviors and underlying feelings/thoughts Listen to what is not being said Be curious about how they present Normalize Remain neutral and flexible Use unisex pronouns Get supervision and consultation Examine your own cultural biases, assumptions, impasses