LGBT youth at risk of poor outcomes in foster care and unstable housing


By Marilynn Larkin

NEW YORK (Reuters Health) - Lesbian, gay, bisexual, transgender, and questioning (LGBTQ) young people are "overrepresented" in foster care and unstable housing, and face "disproportionate risks" related to school performance, substance use and mental health, researchers say.

"People have been concerned for some time that LGBTQ youth are overrepresented in child welfare, but there has been little evidence," Dr. Stephen Russell of the University of Texas at Austin told Reuters Health. "Our statewide study showed that while less than 1% of all youth lived in foster care, 30% of foster care youth reported an LGBTQ identity."

"California is one of only 13 states that has laws that protect youth in the foster care system from discrimination based on sexual orientation and gender identity," he noted. "Yet youth still aren't faring well, so disparities might be even greater in states without such protections."

Dr. Russell and colleagues studied close to 900,000 students ages 10 to 18 who completed the California Healthy Kids Survey from 2013-2015.

As reported online February 11 in Pediatrics, more young people who self-identified as LGBTQ were living in foster care (30.4%) and unstable housing (25.3%) than those in a nationally representative sample (11.2%).

In addition, "the proportion of LGBTQ youth in foster care and unstable housing is 2.3 to 2.7 times larger than would be expected from estimates of LGBTQ youth in nationally representative adolescent samples."

Compared with heterosexual youth and LGBTQ young people in stable housing, LGBTQ youth in unstable housing reported poorer school functioning (e.g., absenteeism, victimization), higher substance use, and poorer mental health (odds ratios, 0.73-0.80).

Further, LGBTQ young people in foster care had more fights in school, victimization, and mental health problems (ORs, 0.82-0.73) compared with LGBTQ youth in stable housing and heterosexual youth in foster care.

Exploratory analyses revealed a disadvantaged position for LGBTQ African American young people in unstable housing with respect to substance use, mental health problems and school functioning. Findings were similar for American Indian youth, but did not reach significance, likely because of small sample sizes.

The authors conclude, "Disparities for LGBTQ youth are exacerbated when they live in foster care or unstable housing."

"Our results show that it is crucial that the child welfare system continue and extend efforts that focus on supporting the unique needs of LGBTQ youth," Dr. Russell said. "We also need more alternatives for safe and affirming placements for LGBTQ youth who aren't able to live with their families of origin. LGBTQ organizations in many communities are able to help identify resources to support youth."

"More programs are needed that link child welfare, housing, and schools to provide support to vulnerable youth, and these programs need to incorporate attention to LGBTQ youth and their needs," he added.

"Local and regional LGBTQ centers or LGBTQ youth programs are an important resource for education and health professionals who interact with youth they might be concerned about, and for child welfare professionals who are seeking expertise in working with and supporting LGBTQ youth," he noted.

"It would be ideal if a branch of the US Department of Health and Human Services - the Children's Bureau, for example - had the capacity and authority to reach out nationwide and provide professional development and support like the Recognize Intervene Support Empower (RISE) initiative in Los Angeles," he concluded.

Darrel Cummings, Chief of Staff at the Los Angeles LGBT Center, which runs the RISE program, said in an email to Reuters Health that this study and related RISE research ( "confirm what we have known anecdotally for decades: LGBTQ+ youth in systems of care not only are overrepresented but also are further harmed by these systems."

"For too long, this population has been largely underserved - or ignored entirely - by service providers despite repeated calls for action and policy changes," said Cummings, who was not involved in the study. "We will continue to pioneer these efforts, and we implore allies of youth everywhere to follow suit."


Pediatrics 2019.

Related Articles

U.S. Medicare plans to track CAR-T cancer therapy outcomes

By Deena Beasley (Reuters) - The U.S. Centers for Medicare & Medicaid Services (CMS) on Friday proposed coverage of expensive CAR-T cell therapies at cancer centers that meet criteria including a Read More »

Smartphone app promising for postop care after pediatric tonsillectomy

By Marilynn Larkin NEW YORK (Reuters Health) - Families and caregivers found a smartphone app helpful for communicating with a physician after their child's tonsillectomy, in a pilot study. Dr. S. Read More »

Neoadjuvant anti-PD-1 immunotherapy may improve glioblastoma outcomes

By Will Boggs MD NEW YORK (Reuters Health) - Neoadjuvant immunotherapy with anti-PD-1 agents may improve outcomes in patients with resectable or recurrent glioblastoma, researchers report. "The Read More »