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Cultural Competence With Lesbian, Bisexual, Gay, Transgender, and Questioning Individuals

Cultural Competence With Lesbian, Bisexual, Gay, Transgender, and Questioning Individuals
Sara Pullen, DPT, MPH
February 18, 2020

Editor’s note: This text-based course is an edited transcript of the webinar, Cultural Competence With Lesbian, Bisexual, Gay, Transgender, and Questioning Individuals, presented by Sara Pullen, DPT, MPH.

Learning Outcomes

After this course, participants will be able to:

  • Identify key aspects to be included in LGBTQ non-discrimination policies.
  • Identify specific strategies to welcome and include LGBTQ families at your organization/school.
  • Identify specific strategies to provide an affirming, safe environment for LGBTQ employees and co-workers.

Introduction and Definitions

  • LGBTQ – Lesbian, Gay, Bisexual, Transgender, and Questioning/Queer
  • Sexual orientation – A person’s emotional connection and attraction to another person.
  • Lesbian - A woman who is emotionally, romantically, or sexually attracted to other women.
  • Gay - A person who is emotionally, romantically, or sexually attracted to members of the same gender.
  • Bisexual- A person emotionally, romantically or sexually attracted to more than one sex, gender, or gender identity though not necessarily simultaneously, in the same way, or to the same degree.
  • Transgender - An umbrella term for people whose gender identity and/or expression is different from cultural expectations based on the sex they were assigned at birth. Being transgender does not imply any specific sexual orientation. Therefore, transgender people may identify as straight, gay, lesbian, bisexual, etc.
  • Cisgender - A term used to describe a person whose gender identity aligns with those typically associated with the sex assigned to them at birth.
  • Queer - A term people often use to express fluid identities and orientations. Often used interchangeably with "LGBTQ."
  • Questioning - A term used to describe people who are in the process of exploring their sexual orientation or gender identity.

I always like to start with definitions for clarification. These definitions are from the Human Rights Campaign, which is a national organization that does a great deal of work with advocacy and education for everything from schools to medical programs. Let's start with some general definitions of LGBTQ issues.

LGBTQ stands for Lesbian, Gay, Bisexual, Transgender, and the Q can be either Questioning, which is someone who may be questioning their sexuality or not really sure where they stand, or Queer. Queer is a word that used to be used in a discriminatory way but now has been taken back by the LGBTQ community. It's now more of an umbrella term for LGBTQ where someone might refer to themselves as queer.

Sexual orientation is a person's emotional connection and attraction to another person. A lesbian is a woman who is emotionally, romantically, or sexually attracted to other women. Gay is again, kind of an umbrella term for a person who is emotionally, romantically, or sexually attracted to members of the same gender, male or female. Bisexual is a person who's attracted in all those ways to more than one sex, gender, or gender identity, although not necessarily simultaneously, in the same way, or to the same degree. 

Transgender is an umbrella term for people whose gender identity or gender expressions with how they present themselves outwardly is different from cultural expectations, based on the sex they were assigned at birth. We all know either from our own experiences as parents or TV or movies, a baby is born and the first thing they say is, it's a girl or it's a boy. That's the sex you're assigned at birth. Just that moment of the doctor or midwife saying, it's a girl or a boy based on secondary sex traits like genitals. Being transgender does not imply any specific sexual orientation. Therefore, transgender people may identify as straight, gay, lesbian, bisexual, et cetera.

Cisgender is a term used to describe a person whose gender identity aligns with that typically associated with the sex assigned at birth. Transgender is where someone is born and assigned the sex of a boy based on the male genitals, but that person feels that's not quite the right gender for them. They feel that they are not male inside and may change physically once they get to be an adult through having surgery or taking hormones. 

Again, queer is a term that people use to express fluid identities and orientations. Often it's used interchangeably with LGBTQ. Again, that's a term that was used and unfortunately is sometimes still used, in a derogatory, discriminatory, or offensive way or trying to insult people. It's a term that the LGBTQ community has taken back and said, we're going to use this term ourselves and not let it be a discrimination tool. The Q can also stand for questioning, which is a term used to describe people who are in the process of exploring their sexual orientation or gender identity.

Another term that you may hear frequently is coming out. The term "came out" means sharing their gay or transgender identity. Historically, because we're talking about children and adolescents here, very few adolescents came out or told their families or others that they were LGBTQ for fear of discrimination, abuse, or rejection. In the era of greater access to resources and more social acceptance, more LGBTQ individuals are "coming out" during adolescence.

The Internet has been a huge boon for people of all identities, whether they are LGBTQ, have been adopted, or are going through medical issues. For all of the negative things we can say about the Internet, it definitely has been a great source of information for people who don't have access to people to talk to or libraries to go to.

To best support and nurture LGBTQ youth, family members, educators, and providers need accurate information about sexual orientation and gender identity. As educators or perhaps school administrators, it's important to have accurate information and also an understanding of how to best provide a safe and affirming environment for LGBTQ youth and their families.

Sexual Orientation

Research on adolescents in the past 20 years shows that sexual orientation develops early. Studies show that both LGBTQ and non-LGBTQ children have their first crush or attraction to another person at around age 10. Homosexuality and bisexuality are part of normal sexual identity. No one knows why some people are gay or bisexual and others are heterosexual. We do know that no one including parents, friends, or role models (coaches or teachers) can make someone gay. It's something that people are or they're not.

Adolescents are much more likely to be open about their LGBTQ identity and be mentally and emotionally healthier when they are not afraid of rejection, ridicule, abuse, or negative reactions from family and friends. I would add educators there as well.

That's all research that's come out over the past 20 years. I'm in the medical field myself and there's nowhere in the medical research that says anything about LGBTQ identity being a pathology or a phase people go through. It's a part of healthy sexuality and healthy development.

Gender Identity

In the past decade, we've had a lot of interesting and positive progress in terms of gender identity and understanding what makes someone transgender or what that even means. Gender identity refers to a deep sense of being male or female. I'll never forget one of my patients who's transgender was talking to me about coming out. I asked him about coming out and how that had been, and he said to me, "How did you know you were female?" I just paused and I said, "I never thought about it. I just am." He said, "Right. That's how I felt." He was born female but never felt female. He always felt male and he said, "I never felt that way that you feel."

It really made me think when he asked me that question because no one had ever asked me that. How did you know you were female? For me, I said, "It's like how do I know I have brown hair? I just do, that's just who I am." I think that was an important conversation for me to keep in mind as I work with and support my transgender patients and friends.

Transgender individuals often feel that their inner sense of being male or female does not match their physical body. Research on supporting children's gender identity and transgender adolescents is extremely important but very limited. Most teachers, caregivers, and providers have had little training or guidance or no training on how to support children who are transgender.

Gender identity occurs at an early age, even as early as two or three years old. Children will express clear gender choices for clothes, toys, and personal items. Gender variant or gender non-conforming may also be used to describe children and adolescents who do not look or behave the way that girls and boys are expected to behave. It is really important for parents and educators to know that it is typical for young children to experiment with different clothing and toys. It does not mean that the child is transgender. Parents and educators/caregivers, should see this as part of normal development and encourage children to pursue their interests, whatever the interests are in play.

I remember when my kids started using toothbrushes once they started getting teeth. At the dentist, the choices were a little blue, toothbrush with an airplane or a bright pink, sparkly Barbie toothbrush. If you have a choice and you're a two year old and you see a plain, kind of boring blue one with the little airplane or a bright pink, glittery, sparkly one, what are you going to choose? I'd choose the glittery one. He wanted the glittery one, but his twin sister got the glittery Barbie one and he cried because he wanted it. The dentist said, "This is a boy one." I said, "Can you just give them both a pink one? I mean, who cares, right?" He got his Barbie toothbrush. I just think that that's an example of how kids are going to want what they want. It doesn't mean that he's transgender. It doesn't mean anything. It just means that he likes things that look sparkly and are more interesting. Again, it's very typical for girls and boys to want to explore different things that are typically made for "girls" or "boys."It's important as educators, for us to really encourage them to play with whatever they are interested in and to explore their natural development.

LGBTQ Discrimination in Schools

A 2011 national survey of 8,584 LGBTQ students ages 13 to 20 from 3,224 unique school districts, which is an older group than most of you work with, found the following:

  • 85% of them reported frequently or often hearing "gay" used in a negative way 
  • 57% heard homophobic remarks from teachers or other school staff
  • 82% had been verbally harassed because of their sexual orientation in the past year
  • Almost 64% felt unsafe because of their sexual orientation
  • 38% were physically harassed because of their sexual orientation
  • 18% were physically assaulted because of their sexual orientation 

Those statistics are pretty sobering and upsetting. Again, the more we can encourage not just LGBTQ students and families but all students and families to be respectful and affirming to everyone, the less we'll have to manage this kind of abuse and harassment in schools.

Transgender-Specific Discrimination

Transgender youth experience even higher rates of harassment. One study that focused on transgender youth found that 2/3 of the transgender students felt unsafe in school because of their orientation and how they express their gender. Another study found that those who expressed their transgender identity or gender variance while in grades K through 12, starting at age four or five, reported having experienced high rates of harassment (78%), physical assault (35%) and sexual violence (12%). That makes my blood run cold when I think about kids this young feeling these things. As teachers and as educators, it is our responsibility to nip that in the bud.

LGBTQ Discrimination

LGBTQ youth are more likely to experience stress and fear than our non-LGBTQ youth due to verbal harassment, physical harassment, and physical assault because of their sexual identity and gender identity/expression. This makes LGBTQ youth more likely to drop out of school, have higher absenteeism, have lower post-secondary education aspirations, have higher levels of depression and anxiety. and have lower self-esteem. 

How Can We Improve School Experiences for LGBTQ Children and Families?

That's the depressing statistics. Now let's talk about how we as educators can improve school experiences for LGBTQ children and families. Regardless of their sexual orientation and gender identity or expression, all students have the right to a safe, supportive learning environment. Think about your own children. You may have children of your own, nieces or nephews or any child in your life, or maybe your students themselves. Of course, they have the right to a safe, supportive learning environment.

Students who are harassed, assaulted, bullied, or just anxious because they are LGBTQ or are perceived to be, can benefit from speaking with caring, supportive teachers or other adults in their schools. I think we probably can all remember as kids how other kids can be mean. Unfortunately, being gay is often used as an insult. I certainly remember in elementary school kids teasing other kids and saying, "Oh, you're gay." Now it's much more accepted in our society than it was the 80s when I was in elementary school. It's important that we think about our role as teachers and know that we actually can put a stop to this.

One way we can improve experiences for LGBTQ children and families is to make sure that all of the staff has inclusion training on LGBTQ issues. This includes everyone from the principal to teachers to custodians and cafeteria workers and everybody in between. The principal should make sure that everyone is in compliance. The custodian often sees kids go to bathrooms and can make sure that everyone is on the same page and if there's a transgender student or students to make sure that we're all supporting them.

Have LGBTQ people and families represented in classroom materials such as books. In the resources slide at the end of our presentation, we'll go through a web link with a list of LGBTQ books that is updated frequently. Think about how a kindergarten student with two moms might feel if he or she saw that in every single book in the classroom there were only books about a mom and a dad. That would be a little isolating. The more we can normalize it and respect and reflect students, the better for them and for all of us.

Profile LGBTQ role models in all fields such as medicine, science, arts, and sports.  Look at who you're profiling in terms of your art class. I know in my kids' school, they had a whole art section on Keith Haring who is an artist who did something similar to graffiti with figures dancing or babies crawling. He was a gay man and unfortunately, he died of AIDS when he was in his 30s, back in the 80s or early 90s. My kids' school did a whole section on him and they learned how to do line drawings similar to Keith Haring. I thought that was a great idea because that was representing him as a gay man and they didn't have to talk about it in school. I loved the fact that my kids brought home these great drawings that they had done based on his artwork.  I thought it was really neat that he's well known as an artist and as a gay man who died of AIDS but he's still very current and really revered and respected for his art contributions.

Where Do We Start?

So where do we start? I know this is a lot to think about but where do we start? Does your school or organization have a nondiscrimination policy? By organization, I mean a daycare or child care center or wherever you work. Are LGBTQ people included in this policy? Some people will say, "I don't know if we have one" and some people will say, "Yup, we have it right here. It's printed out and posted on every bulletin board in every classroom." It really varies. 

Implementing and/or publicizing a nondiscrimination policy inclusive of the LGBTQ community is a first step to welcoming and affirming LGBTQ students and families. The policies should ideally include the terms "sexual orientation," "gender identity," and "gender expression." The policies should be written and recorded as official policies that are distributed to all staff and easily accessible.

Non-Discrimination Policy Examples

I was in Target yesterday and saw a dish towel that said, "All are welcome here." I thought that is such a great dish towel. You could hang it up in your classroom and even if your organization might say, no we can't change the non-discrimination policy or that's corporate level or whatever, you could still share it in your classroom. I wasn't even looking for dish towels, who knows what was looking for in Target. I just thought that was really neat, all are welcome here. It just sends a message really loud and clear to families and kids that everyone is welcome. 

I'd like to share two examples of non-discrimination policies. I'm not looking at this through rose-colored glasses. I do understand that different organizations have different theories about non-discrimination and your organization might not have one. Both of these examples have been highlighted as really good examples of non-discrimination policies that include LGBTQ.

Bright Horizons, as most of you probably know, is a well-known early education and preschool-age center for young children. Here is their non-discrimination policy.

Bright Horizons provides full-day and part-day care (where available) to children between the ages of infancy and six years (school-age programs may be available in some centers) without regard to race, religion, color, creed, gender, cultural heritage, parent/guardian marital status, parent/guardian political beliefs, parent/guardian sexual orientation, disability or special needs, child's toileting ability, medical condition, HIV status. or any other consideration made unlawful by federal, state, or local laws.

I thought this was an excellent example because it's succinct and doesn't have all this extra stuff in it. It's very clear that this is what we do. We do not discriminate on any of these grounds. 

I live in Atlanta myself and was very proud to see the Atlanta Public School (APS) System's non-discrimination policy was highlighted as something that's a good example. So APS includes Pre-K to 12th-grade students and employees.

The Atlanta Public School System does not discriminate on the basis of race, color, religion, sex, citizenship, ethnic or national origin, age, disability, medical status, military status, veteran status, marital status, sexual orientation, gender identity or expression, genetic information, ancestry, or any legally protected status in any of its employment practices, educational programs, services or activities.

I'm really proud of this and I think that this is an excellent way of wording this because it talks about gender identity and gender expression. In other words, you can't say that a male can't wear a skirt to school. You're protected here.

These are two great examples of good non-discrimination policies. 

Staff Training

Staff training specific to LGBTQ individuals and families is a key component of an organization's efforts to create a culture that's inclusive and affirming of all students and families. Staff training alone is not sufficient to achieve longstanding change in a school or organization culture. Continued diligence and vigilance are key for maintaining an inclusive environment. What does that mean? Staff trainings are great. We've all been to them and some have been really good and some have been really boring. It's important to have these staff trainings and have everyone come together to learn, but it may only be an hour-long or over a lunch break. If you've had a whole lifetime of being surrounded by discriminatory attitudes from your family or your friends or your spouse that one hour might not quite be enough to shake that.

Again, what do I mean by diligence and vigilance? If you're out of the training and at the water cooler or in the break room and somebody says something negative you might say, "Hey, remember that staff training? We should probably not talk like that." You can keep it calm and say, "That's not cool. Let's change the subject." 

"Roll Out the Welcome Mat!"

Someone said to me one time as I was working with my patients who were LGBT, "Roll out the welcome mat." I want people to roll out the welcome mat. As schools and organizations, it's everyone's responsibility to provide a welcoming, affirming environment for all students and families. This ranges from official policies, such as non-discrimination policies we just talked about, to shutting down offensive or discriminatory break room talk. You can just shut it down. You might say, "Hey guys, we really shouldn't talk like that" or, "Hey guys, you know what? I've actually got a gay cousin and it really hurts my feelings or it makes me feel pretty uncomfortable." Just say whatever you're comfortable with.

Take a moment now to think about what this looks like in your organization? What do you see in your organization? If you think about your break room or a non-discrimination policy or you think about your boss or your coworkers, what might this look like if you heard something like this and what might it look like in terms of your best approach to shut it down?

What do you see as your responsibility? I think that this is a broader thing, culturally and societally that we all know that where we get into trouble is when people say, "That's not my problem and that's not my responsibility." However, it really is all of our responsibility, especially all of us who are dedicated to working with children. It's our responsibility to make sure all kids feel safe. If you're in the break room and someone's saying something discriminatory or offensive and you step in, maybe the person talking will think about what they're saying. Don't let something slip in front of a kid. Think about what you do and say on a personal level of hurting someone's feelings or insulting someone. Think about what you see as your responsibility in this. 

How can you personally and/or your organization roll out the welcome mat?

Find out about your non-discrimination policy and see if LGBTQ included. If not, what is the process for adding this? Find out if staff ever had training regarding LGBTQ competence. If so, has it been a while and Is it time for a refresher.

What's the general culture surrounding LGBTQ families/students in general? Is it respectful? If so, keep it going. A positive example of this is that Johnny's two moms came to pick him up, but one of them is going to be picking him up from now and no one says anything negative about it. The next day, one of Johnny's moms called and was wondering if he ate his breakfast. It's should just be normal that he has two moms instead of a mom and a dad.

Is it disrespectful? Don't be afraid to notify a supervisor or address water cooler talk or break room talk if it's discriminatory. Everyone has a personal connection to an LGBTQ person. I guarantee that wherever you live, everyone knows someone who is LGBTQ. I will say that you never know who's there. What if it's someone who's just questioning their own identity and there's break room talk and people are being offensive and this person is sitting there miserable, thinking, gosh, I have nobody here. I have no one to support me. Maybe that could be you. You never know who's there or who has an LGBTQ child or family member or a best friend. We always say don't assume anything. Don't assume someone is gay and don't assume someone is not.

We talked a little bit about the Human Rights Campaign. That's our definitions came from and they're kind of a gold standard of LGBT inclusivity, education, and health.  The Human Rights Campaign (HRC) has identified these steps for using LGBTQ inclusive language.

a) Agency forms use gender-neutral language (e.g., "Parent 1" and "Parent 2" rather than "Mother" and "Father") where applicable.

b) Agency forms provide the opportunity to indicate a gender other than "Male" or "Female."

c) Agency forms provide the opportunity to indicate a preferred/chosen name that is different than a person's legal name.

d) Agency forms provide the opportunity to indicate the pronouns (e.g., she/her, he/him, they/them) by which a person would like to be addressed.

e) Agency demonstrates other innovations in LGBTQ inclusion in forms and paperwork.

One step is that the agency forms use gender-neutral language. An example of that would be using parent one and parent two rather than mother and father where applicable.

Another step is that agency forms provide the opportunity to indicate a gender other than male or female. This was the first year for the medical school where I teach to use an online application. I noticed this is the first year the application gave the options of male, female, and transgender. I thought, wow, times are changing. The opportunity to indicate a gender other than male or female is a very welcoming thing to do.

A third step is that agency forms provide the opportunity to indicate a preferred or chosen name that's different than a person's legal name. For example, maybe someone's legal name is Jane Doe and that person is transgender. Even though legally that's their name, maybe they prefer to be called Jamie or John.

The fourth step listed is that the agency forms provide the opportunity to indicate the pronouns a person would like to be addressed with, such as she, her, he, him, they, or them. Even though "they" and "them" are plural, some people who are transgender or gender questioning do prefer those pronouns. An example would be, "How old are they?" instead of, "How old is he or how old is she?"

The final step listed is that the agency demonstrates other innovations in LGBTQ inclusion in forms and paperwork. This includes things to make your organization or school unique in this area.  Things to ask include what specifically do we need to do given our either constraints or our resources to be inclusive?

  • Agency displays visual cues throughout common areas to communicate support and inclusion of LGBTQ clients and their families.
  • Agency's external communications (website, printed materials, etc.) explicitly and consistently reflect its commitment to working with and welcoming LGBTQ clients and their families.
  • Agency uses social media to communicate its commitment to working with and welcoming LGBTQ clients and their families.
  • Agency demonstrates other innovations in its LGBTQ-inclusive external communications.

Some examples of this include an agency displaying visual cues throughout the common areas to communicate support and inclusion of LGBTQ clients and their families. This could include books on a bookshelf about different kinds of families or pictures on the wall of LGBTQ families to help say that all are welcome here.

Agency's external communications (website, printed materials, etc.) explicitly and consistently reflect its commitment to working with and welcoming LGBTQ clients and their families. A non-discrimination policy is excellent to include but again make sure you use stock art or actual families to make sure LGBTQ families are represented there and not just the nuclear family with the mom, the dad, and the baby. Make sure that anything in your organization or even your individual classroom is inclusive. If there's an LGBTQ individual or family that comes in, you want them to see that and think, oh wow, we're included already here.

Social media is an excellent way of communicating a commitment to working with and welcoming LGBTQ clients and their families. This would include not just a website but a Facebook page or any other social media platform. Those can be used to let people know that LGBTQ pride is coming to your city and hope to see you there or something like that.

The agency demonstrates other innovations in its LGBTQ-inclusive external communications. I'm not an HR or communications person, but I know that there are so many good ideas there of how to be inclusive that might just need a little more exploration.

How Can We Welcome and Include LBGTQ Parents and Families?

  • Do promotional materials and ads feature same-sex couples or trans parents?
  • Does the organization take care to ensure LGBTQ parents feel included in parent trainings & meetings?
  • Does the organization provide information on creating a safe and affirming environment for LGBTQ families?
  • Are the parents aware that staff has inclusion (including LGBTQ) trainings?

How can we welcome and include LGBTQ parents and families? Again, do promotional materials and ads feature same-sex couples or trans parents? Does your organization take care to ensure that LGBTQ parents feel included in parent trainings and meetings? If there are parent trainings and meetings, instead of saying, "Moms and dads" when you address the parents, make sure you acknowledge that there are a lot of different family structures.

When my kids were in Pre-K, I volunteered at their school one day reading books to the class.  One of the books I read was called Love Makes a Family. The story talks about a child who was with her mom and dad and they love to give their dog a bath. Another child in the story was with her dad and his partner and they like to cook dinner together. It also talked about two sisters who live with their grandma and she's great at helping them with their math homework. This book is an example of normalizing LGBTQ families and all different kinds of families, whether they are single parents or children living with grandparents.

Are the parents aware that the staff has had inclusion trainings including LGBTQ? We have some friends who are lesbians and they have an adopted daughter. It really made a difference to them knowing that the staff at their child's school goes through diversity training and inclusion training, including LGBTQ. They felt that because it was in the promotional materials and on the website they really knew they were going to a place where their family is valued.

How Can We Provide an Affirming, Safe Environment for LBGTQ Children, Parents and Employees?

Organizations should provide students and families with an LGBTQ inclusive nondiscrimination policy. Again, it's sort of a broken record, talking about this nondiscrimination policy, but having that in writing really speaks volumes. It says to families and parents and students, "We value your family. We value you. We value your child. This is a safe, inclusive environment, for everyone involved - for your child, for our employees, for everyone."

Provide staff with guidance on assessing a parent's capacity to provide safe and supportive homes for LGBTQ families, employees, and coworkers. Working with younger aged children in early childhood you're less likely to experience this, but if you happen to work with older children and have a student who is LGBTQ, make sure things are okay at home.  

If your student is saying, "I think I'm going to get thrown out because I came out and I'm gay," make sure you have resources for the child.  This includes providing staff with guidance on creating LGBTQ inclusive safety plans for youth, including local LGBT organizations, trans-affirming policies and resources, and a list of LGBTQ competent referrals for outside services for LGBTQ families.

What Can Schools, Teachers, and Providers Do?

Establish safer, more supportive environments by developing and implementing policies that protect LGBTQ people from discrimination, violence, and bullying. Again, those non-discrimination policies from Bright Horizons and Atlanta Public Schools were very clear that those people were protected under that policy.

Assess school climate to improve non-discriminatory culture. A great tool to use is the Gay, Lesbian, & Straight Education Network (GLSEN) school climate survey. It's a great survey for everyone at your school or your organization to take and see how you feel and how you measure up. You can just take the survey yourself with your particular school in mind. This tool has been validated and taken and written about a lot. 

Again, provide trainings for teachers and other staff on supporting LGBTQ families, employees, and coworkers. This is really important. We're not just talking about student support, we're talking about LGBTQ coworker support. Do your LGBTQ coworkers feel supported and safe? If someone is LGBTQ and feels like every time they go into the break room people are talking or making gay jokes, they likely won't feel supported and safe. Your staff needs to be educated about supporting their coworkers.

Establish organizations and clubs that expand school-based supports for LGBTQ. Again, this is for older students, but you could start a gay-straight alliance. Identify community and online resources for LGBTQ children and families. For example, if a family with two dads just moved to town and you already know of organizations that they can be a part of, let them know about them. If your students are older, ask them how their family reacts to their identity. Ask them if everything is going okay at home or have one of your counselors available if the student wants to talk.

Fortunately, there is so much more acceptance now than in the past. When my students talk about coming out, they often say, "Oh no, it was not a big deal" or, "No, my parents and my teachers were cool with it." I think if you grow up in a larger city such as New York City or San Francisco, coming out might have been different than if you grew up in rural Georgia for example. I live and work in Georgia, so nothing against Georgia of course.

Provide or refer to supportive and safe counseling as needed. Connect LGBTQ families, employees, and coworkers with community resources and programs if they wish. Again, some people may be totally fine and it would not be appropriate to say, "Oh, I know this great organization for LGBTQ families." Only provide the information if they ask or want it. Again, encourage your school to start a gay-straight alliance or start it yourself.

Teacher - Parent Communication

Teacher-parent communication, as we all know, is extremely important. As educators, we're also advocates for our students, whether that's in terms of helping them figure out how to do their homework at home, making sure they feel safe at home, and educating parents. It can be general education that negative reactions to children's identity can have a serious impact on that child's physical and mental health. Everyone wants their kid to be healthy. Just make sure everyone knows this is important to know that all of us are in this together.

Encourage parents and caregivers to decrease stigmatizing and rejecting behaviors and direct parents to community and online resources if they ask. Parents and Friends of Lesbians and Gays (PFLAG) is an excellent national organization you can let parents know about. 

What Can Parents Do to Support LGBTQ Children and Youth? 

  • Talk with your child openly and non-judgementally about LGBTQ identity.
  • Express unconditional love and support when your child tells you or when you learn that your child is LGBTQ.
  • Support your child’s LGBTQ identity even though you may feel uncomfortable.
  • Advocate for your child when he or she is mistreated/bullied/discriminated against because of their LGBTQ identity.
  • Insist that other family members respect your LGBTQ child – this may require difficult conversations with family members, but remember: you are the adult!
  • Bring your child to LGBTQ organizations or events.
  • Connect your child with an LGBTQ adult role model to show them positive, successful options for the future.

This information is adapted from an article by Ryan (2009) that was really eye-opening to me. I read every word of it because I thought it was so interesting and had a lot of things I had never thought about.

Talk to your child openly and non-judgmentally about LGBTQ identity. This might include when they have friends with different family structures. My daughter has Barbies and she has a part of her little Barbie villages that has two moms. I thought that was really cool that she just said, "Oh, look. Those are two moms and they have a daughter and they are taking her to ballet class." It was just normalized. I thought that was really cool.

Support your child's LGBTQ identity even though you may feel uncomfortable. I think a key here in medicine and education is that you may not agree with it but you have to be respectful. As an educator or in my situation as a medical provider, even if you don't agree with someone or something someone's doing, you have to be supportive of it because that's your job. It's your job to support your students and your patients.

Advocate for your child if he or she is mistreated, bullied, or discriminated against because of their LGBTQ identity. Insist that other family members respect your LGBTQ child. This may require a difficult conversation with family members, but remember you're the adult. I read an article where a mom was talking about how her daughter had come out in high school as being a lesbian. She said that they always had Christmas at their house and she said, "I wanted everyone to know so and so has come out as a lesbian. We're so proud of her for being so strong and we really support her. If you cannot be supportive of her, then it's best for you not to come to our house for Christmas this year." She stated the family rules and that they support her and are proud of her. She wasn't banging them over the head telling them they had to support her, but she was saying, "If you don't feel like you can, please stay away for now." I thought that was a great message to send to the family.

Bring the child to LGBTQ organizations or events. Connect the child with an LGBTQ adult role model to show them positive, successful options for the future.

What Can Parents Do to Support LGBTQ People?

Welcome your families, coworkers, employees, LGBTQ friends and partners to your home and to family work events and activities. If your aunt has a female partner make sure she feels welcome.  If your daughter is getting married and Uncle John has a partner, make sure they're both listed on the invitation. Encourage coworker's partners to come to work social events. If you're having a happy hour or a holiday party, instead of saying, "Bring your husband or wife," say, "Bring your partners." All it takes is one word.

Support your child's gender expression. Work to make your congregation supportive of LGBTQ members or find a supportive faith community that welcomes your family. Believe that your child can have a happy future as an LGBTQ adult. Especially in this day and age, it is so important to remind our students and our children that they are supported than they are loved, no matter who they are, no matter what they look like, and no matter who they love.

Enlist the village.

I love the expression "It takes a village to raise a child" and it sure does. We all have our own villages. Maybe it's a combination of work friends and home friends or it could be parents of friends of your kids at school. Maybe it's your actual family, but we all have our village. Our village is the actual street that we live on.

If you work with children ages zero to eight, you will likely not have students identifying with sexual orientation. I'm not saying never, but that young is young for students to really be orienting sexually in any direction. Kids should be not pushed in that direction and kids should be allowed to be kids as long as they can. It's our collective responsibility to provide supportive environments for all coworkers, students, and their families.

I want to share a story about a family in our own neighborhood. There is a family that lives on our street and they have a child that I first knew as a little little girl who I'll call "Jane" who was in kindergarten and always had a sour look on her face. I always thought to myself, I wonder why she's in such a cranky mood and always has a grouchy, miserable look on her face? I just thought she's five and maybe she's tired or just a grouchy kid. We know the family pretty well and her sister was really sweet and seemed to be pretty happy all the time.

A couple of months passed and I remember on Halloween, her mom and dad said, "We actually are bringing her to counseling because she just is in such a bad mood all the time." Our village gets together a lot for little block parties and holiday gatherings and all the parents talk during these get-togethers. They told us that during counseling and talking to them, Jane said that she has always felt like a boy and she feels nervous and sad all the time. She said she feels angry because people call her a girl and she doesn't want to wear dresses and she wants to have short hair. Her parents said, "Of course we want her to be happy."  By the time she was seven years old, "Jane" said she wanted to cut her hair and her parents let her. She now goes by a boy's name which I'll call "John."  She wears boys' clothing, identifies as a boy, has her hair cut short, and is an adorable little boy. His village, which in this case was our neighborhood, was supportive. His mom and dad explained what they were dealing with and asked everyone to please support their child.

It took a little bit to get the name right, but now everyone knows him as "John" and he's absolutely adorable with a wonderful smile and dimples.  I said to his mom, "I never knew that he had dimples because I never saw them because he didn't smile." This child now smiles all the time.

His parents went and talked to his principal and the principal was very accommodating and said, "Of course we support him as John." He was in second grade and the teacher introduced him as John to his classmates. Because the children were all young and there was support from the teacher, the parents, and the school administration, there was never any trouble with it. What made this easier was that it was normalized and respected by the parents and the teachers and the village and the pediatrician. If it's not respected by the pediatrician, then maybe it's time for a new doctor. It really does take a village. That's an example again from my own street in Atlanta about an adorable little boy who is happy all the time and had a happy ending.

5 Tips for Supporting LGBTQ Students in Your Classroom

(adapted from S. Green, 2017)

We want to support students in our classroom as well. We want to create a welcoming atmosphere. You'll see a lot of repeats here with this information because supporting students and supporting families and coworkers are a lot of the same things. These tips can apply to supporting students, families, and co-workers.

1. Create a welcoming atmosphere.

Posting fliers and signs in your classroom about your school’s LGBTQ student association or gay-straight alliance is an easy and unobtrusive method for supporting LGBTQ students. Set a rule in your classroom that students must be accepting and respectful of students from different backgrounds, and enforce that rule when it’s broken.

This is really important. Whether it's race, whether it's sexual orientation, whether it's weight (being overweight or underweight), whether it's gender, that's the rule. The rule is no cheating on your test. The rule is no running around the classroom. The rule is that you have to be accepting and respectful of students from different backgrounds. It's just one of the rules in our classroom. Enforce the rule when it's broken. There must be consequences.

2. Respond to insensitive comments about gender and orientation.

I think we all know of experiences where people were just bystanders. There are upstanders and bystanders. An upstander reacts and responds when they hear something discriminatory or bullying. A bystander just stands by and lets it happen. As educators and adults, we all need to be upstanders. 
Think about some tools for supporting LGBTQ students before you’re confronted with the issue. Have clear consequences for these words, and rely on more reflective practices like journaling in order to give students pause to think about that kind of language, why they use it, and what they can do differently. Ask them how they think this may have affected the targeted student. Ask them to reflect on their own differences/times they’ve been discriminated against.
It's not wagging your finger at them and saying, "No, that's against the rules." As a parent and as an educator, I can tell you that it is extremely effective to ask kids how that might have affected the targeted student. Don't make it a public shaming. It could be done one-on-one or with the student and the person who called the name or bullied.  You can ask them to think about how that might have affected that student or have the student themself say, "When you did this, I felt this way." It makes a huge impact to have someone who's done something insensitive to sit in front of the person that was targeted. It makes a huge impact to ask them to reflect on their own differences or times they've been discriminated against. Not one of us has sailed through life without ever experiencing something discriminatory. Kids might not be able to reflect on that specifically but, what's a time that somebody wasn't nice to you? They all have an example.

3. Take bullying complaints seriously.

If a student comes to you and says they’re being bullied due to their own or their families’ LGBTQ status, listen to them and don’t dismiss it as “just teasing.” There is a massive increase in LGBT teenage suicides nationally. If a student comes to you and says they're being bullied, believe them. Don't say, "Oh, they're just teasing" or "They're just being silly." You don’t need to know why they’re being bullied and the student may be uncomfortable/embarrassed telling you if they’re being bullied on the basis of their sexual orientation or gender identity. Supporting LGBTQ students means taking their concerns seriously and reporting the bullying to your principal….and then keep taking it up the chain of command! 

 If a student is being bullied, address it with the students. Tell your principal. If the principal doesn't react, go to the superintendent. You'd be surprised how taking things up the chain of command, can get things done.

4. Start or support a gay-straight alliance (GSA).

If your school district is in a more liberal area, you can support LGBTQ students by creating or supporting your school’s GSA. If you live in a state or district that is not as supportive or willing or open, try starting an anti-bullying club where students learn to advocate for and support anyone who’s being bullied – in many contexts. None of us are living under a rock. We've all seen in the news and read about bullying and how it has very severe consequences, including suicide, depression, and anxiety. No one is going to disagree with an anti-bullying club. Within that club, LGBTQ is one of the ways people are bullied. That's an option if your school is a little more hesitant to have something called a gay-straight alliance.

5. Be a role model!

I think this is huge. I know in my own life, professionally and personally speaking, I have had really great role models.  Your role model might be your grandma or your tennis coach. It might be your fifth-grade teacher that told you you were smart and she was the first person that told you you were smart. Set a good example by modeling acceptance in words and actions. Be aware of your own biases around gender norms and stereotypes, and do your best to help students understand where their own biases lie. Reflective journaling and including LGBTQ voices in your curriculum can go a long way to helping students see that “different” is not scary. It also provides a tool for supporting LGBTQ students by showing them positive role models, and by showing other students that LGBTQ people have always been around and that they’ve made invaluable contributions to society.



We talked about GLSEN, Gay, Lesbian, Straight Education Network, which is an excellent resource specifically for educators. If you're thinking about starting a gay-straight alliance in your school, the Gay-Straight Alliance Network has everything from pamphlets to wording for how to talk to your principal. The Welcoming Schools Project is from the Human Rights Campaign which we talked about before and specifically talks about how to make your schools welcome. Parents and Friends of Lesbians and Gays is specifically for parents who have an LGBT student and how to support them. Classroom books are a wonderful resource and we'll talk about that in a second.

This LGBT Bias Tool is something out of Harvard. In my faculty department, we've taken the race bias questionnaire from this same site to help us in terms of implicit bias, which is the bias you don't really even know you have. It is a really interesting test. Make sure you're in a quiet place when you take it because It does take some focus and concentration to complete and takes about 15 minutes to complete. It's interesting to learn where your own biases lie. What I recommend for staff training is to have everyone take it. Have everyone take this and see where their bias is. You don't have to turn your laptop around and show everyone your score. In fact, I recommend not showing people the scores, just letting it be something for everyone to understand their own bias and work on that in their own life.

Classroom Books

A great website for finding classroom books on this or any other topic is This is the website I mentioned before that gets updated regularly. Here are some inclusive books that I really like on the topic of LGBTQ that I found on this website.

  • And Tango Makes Three, by Justin Richardson
    • This book is a sweet book that is a great discussion piece. It's actually a true story about two penguins at the Central Park Zoo in New York City. Usually, penguins pair off male and female and lay eggs and hatch their chicks and that's their family. This story is about two male penguins who paired off and built a nest and they kept putting rocks in their nest and sat on the rocks and they would get up and look at the rocks and turn their head side to side and sit back on the rocks. Of course, the rocks didn't hatch because they were rocks. A zookeeper noticed that one penguin had laid two eggs. Penguins can only care for one egg at a time, so the zookeeper put the extra egg in the two male penguins' nest and they sat on it and hatched it and that was their family. The two dads and the baby penguin was their family for life. It's a great story because it's penguins and kids love animals and it's a true story.
  • Heather Has Two Mommies, by Leslea Newman
  • Red: A Crayon's Story, by Michael Hall
  • 10,000 Dresses, by Marcus Ewert
    • This book is about a transgender little boy who really loves wearing dresses and how he has a great experience with a girl next door who loans him her dresses. T
  • It's Okay To Be Different, by Todd Parr
    • I really like this book and it's one we read as a bedtime story to our children. It's a great book that says it's okay to have green hair, it's okay to eat macaroni and cheese in the bathtub, it's okay to be in a wheelchair, and it's okay to have two moms.  It weaves in things that are really silly and it'll make kids laugh and then it talks about real things. 
  • The Family Book, by Todd Parr
    • This book talks about different animal families and different human families.
  • King & King by Linda de Haan
    • This book is a classic fairy tale where two kings get married to each other and it's told in a very much like castles and the fairy tales and kings and queens and is great for kids who really love fairy tales.

These are just a few books from this great list. Hopefully, you can look and see some really great ones for your classroom.


  • In summary, individuals are “coming out” as LGBTQ at earlier ages.
  • LGBTQ sexual orientation/gender identity is normal and should be supported and respected.
  • Despite this, LGBTQ youth face discrimination and even abuse in schools. LGBTQ adults still face discrimination in the workplace.
  • ALL of us: parents, educators, providers, caregivers, and schools have a key role in supporting LGBTQ youth to ensure that they look forward to a bright, successful future.
  • We ALSO have a key role in supporting LGBTQ co-workers and employees to ensure a safe, welcoming workplace.

I hope that you all were able to get some positive information out of this course and I wish you all the best of luck in supporting and affirming all of our students and our families to make sure that everyone has a bright and happy future ahead of them.


Ryan, C. (2009). Helping Families Support Their Lesbian, Gay, Bisexual, and Transgender (LGBT) Children. Washington, DC: National Center for Cultural Competence, Georgetown University Center for Child and Human Development.

Green S (2017). 5 Tips for Supporting LGBT Students in your classroom.


Pullen, S. (2019). Cultural competence with lesbian, bisexual, gay, transgender, and questioning individuals. - Early Childhood Education, Article 23364. Retrieved from

sara pullen

Sara Pullen, DPT, MPH

Dr. Pullen is an Associate Professor at Emory University School of Medicine, where she coordinates the service learning program and the pro bono physical therapy clinic. Dr. Pullen’s clinical practice and research focuses on the intersection of HIV, chronic pain and opioid use, especially in underserved areas. Dr. Pullen started the first physical therapy clinic within a freestanding, multi-service AIDS clinic in the southeastern U.S. where she holds weekly clinics and conducts clinical research.  She has wide experience in the provision of health services to underserved communities both in the U.S. and internationally. She has published several peer-reviewed journals on the topic of HIV and physical therapy, and provided the HIV content of the two major study guides for the physical therapy national board licensure exam. In 2015, she received the IPT-HOPE Award from the World Congress of Physical Therapy for her work in the field of HIV and physiotherapy. In 2018, she received the Emory University School of Medicine’s prestigious Hidden Gem Award for her groundbreaking work with HIV and chronic pain in vulnerable communities. 

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