Affirming services

LGBT2SQ-affirming and inclusive services, placements, and organizations create conditions where children and youth may feel comfortable expressing themselves without fear of rejection, ridicule, disrespect, or invisibility. Inclusive environments in the child welfare system can help LGBT2SQ children and youth feel safe and respected, and reduce the potential that they may experience the risks and challenges outlined in the previous section. LGBT2SQ-affirming and inclusive services can help children and youth develop a positive sense of self, build their resilience, and make trusted connections that will be important throughout their life.

Every individual has an important role to play in creating inclusive and affirming services in the child welfare system, and supporting LGBT2SQ children and youth to be safe, and reach their full potential:

• Everyone involved in the child welfare system can become an ally. Allies are youth, families, caregivers, child protection workers, and child welfare leaders who do not identify as LGBT2SQ, but who are committed to take action to promote fairness, acceptance, mutual respect, and equity for LGBT2SQ children, youth, and families.
• Families and caregivers can make conscious choices to provide supportive, inclusive and affirming care for LGBT2SQ children and youth. Families who accept their child or youth's sexual orientation and gender identity and expression provide a critical protective factor that greatly reduces risks that LGBT2SQ children and youth face, and strongly influences health, well-being, and positive outcomes for their children^{footnote 65[65]}.
• Child welfare professionals can support families and caregivers struggling to accept their LGBT2SQ child or youth's identity by delivering services within their mandate that are supportive, accessible, and affirming. Professionals can also support LGBT2SQ children and youth in accessing affirming healthcare, education, services, positive spaces, peers, and communities that are culturally relevant.
• Child welfare leaders can be committed to organizational cultures that are safe, inclusive, and affirming, so that all services are inclusive, equitable, and demonstrate respect for LGBT2SQ children, youth, and families.

Affirming and inclusive services promote resiliency in children and youth, which research indicates improves future outcomes^{footnote 66[66]}. Resiliency refers to a child or youth's ability to bounce back from tough situations and thrive^{footnote 67[67]}. Promoting resiliency can decrease the likelihood of a child or youth feeling isolated and help build skills to recover from difficulties they encounter. Introducing even a few positive elements into a child or youth's life (e.g., family supports, supportive social environments) can help them bounce back, flourish, and reach their full potential^{footnote 68[68]}

To be resilient, LGBT2SQ children and youth need adults in their lives who respect their sexual orientation, gender identity, and gender expression. The single most common factor for children and youth who are resilient is having at least one stable and committed relationship with a supportive parent, caregiver, or other adult^{footnote 69[69]}.

It is important to understand that resiliency in Two-Spirit and Indigenous LGBTQ children and youth will look different than in non-Indigenous children and youth. Building resiliency within Two-Spirit and Indigenous LGBTQ children and youth is dependent on access to culture and ceremony, as well as the opportunity for them to build a sense of belonging with their community. To increase resiliency in Two- Spirit and Indigenous LGBTQ children and youth, it is crucial to ensure they have access to holistic supports that affirm their overlapping and intersecting identities. The importance of holistic, community-based supports to building resiliency also applies to other populations of LGBTQ children and youth (e.g., Black and racialized children and youth).

This part of the guide provides tips and resources that may be considered by families, caregivers, and child protection and residential services workers to develop, promote, and create LGBT2SQ affirming and inclusive practices. Part III covers the following topics:

• The importance of allies
• Demonstrating respect in conversations with LGBT2SQ children and youth
• Supporting families who are struggling with their child’s identity
• Intake, assessment and service planning for LGBT2SQ children and youth
• Inclusive language in forms and tools
• Affirming placements
• Affirming and inclusive placements for transgender children and youth
• Supporting transgender and gender diverse children and youth
• Affirming programs and activities for LGBT2SQ children and youth
• Supporting LGBT2SQ youth in care to transition to adulthood.

The importance of allies

As noted previously, allies play an important role in the child welfare system by promoting and contributing to organizational and system cultures in which LGBT2SQ people are valued and respected. They model behaviours and practices that affirm the identities, worth, and equality of children and youth^{footnote 70[70]}. Allies stand-up to homophobia, transphobia, biphobia, and all forms of oppression through their ongoing actions.

Allies can feel confident that while their support may seem small, these acts can make a significant difference in the lives of LGBT2SQ children and youth, and promote positive system and organizational change.

How you can be an ally

• Assume in every conversation that there are LGBT2SQ people or people with LGBT2SQ loved ones in the room. Allies consider how others might be affected by the tone and direction of the conversation.
• Do not make assumptions about how people identify. Listen for, or politely ask at the appropriate moments, how someone identifies (e.g., gay, lesbian, cisgender, transgender, gender-fluid, genderqueer), and what name and gender pronoun (e.g., he, she, they) they prefer.
• Recognize how being cisgender and/or heterosexual is privileged in society, and identify ways to use that privilege to support LGBT2SQ people and communities.
• Use inclusive language in both individual and group conversations so that everyone feels welcome (e.g., use partner instead of only “boyfriend” or only “girlfriend”; “hi everyone” instead of “boys and girls” or “ladies and gentlemen”).
• Listen respectfully to the experiences and perspectives of LGBT2SQ children and youth, validate what is shared and acknowledge that homophobia, biphobia, and transphobia exist, and that it takes courage to share personal stories and ideas.
• Speak up when witnessing offensive language or bullying behaviour. Addressing homophobia, transphobia, and biphobia is a shared responsibility, not just that of LGBT2SQ people alone.
• Promote inclusive practices, policies, and procedures that address barriers for LGBT2SQ children and youth (e.g., lack of LGBT2SQ positive messaging, spaces, programs, non-inclusive forms) within an organization.
• Recognize and address the intersecting identities and possible multiple oppressions that a child or youth may experience, and the unique situations and barriers that they may face (e.g., LGBT2SQ children and youth who are Indigenous, Black, racialized, live with a disability).
• Let all children and youth know that you are open to talking about and affirming LGBT2SQ identities and experiences.

Demonstrating respect in conversations with LGBT2SQ children and youth

When children and youth are able to talk openly about their identities, service providers are better equipped to meet their needs. At all stages of involvement with the child welfare system (e.g., initial contact and assessment, ongoing service, and transitioning out of care), children and youth need to feel respected and engaged in issues that affect their care and well-being.

A child or youth may, with any person and at any time, disclose or discuss their identity/orientation and/or their experiences. As a result, all child protection workers, other staff and board members in child welfare agencies, caregivers, families, and volunteers should be well trained and ready to have these conversations in an informed and supportive manner.

It is important to remember that you may not know if a child or youth is LGBT2SQ, so all conversations should be respectful and encourage children and youth to feel safe and comfortable voluntarily sharing information about their identity.

When the opportunity arises to have a one-to-one conversation with a child or youth about their sexual orientation and/or gender identity:

• Listen for and create space for self-disclosure. Children and youth will disclose their sexual orientation and/or gender identity when, and if, they feel ready, and if it has been demonstrated that it is safe to do so.
• Do not “out” a child or youth without their permission. Allow them to set the pace of “coming out” if that is what they want. Be proactive in opening conversations related to gender and sexual diversity (e.g., ask: “Do you know what the rainbow sticker on my datebook means?”).
• Ask for a child or youth’s consent to record, share, or use their chosen name(s), pronouns, or other information related to their sexual orientation and/or gender identity.
• Ask respectful questions and be clear that you want to understand their perspectives, wishes and experiences, and that you will accept and support them in the identity that feels most comfortable for them.
• Children and youth have a right to confidentiality. You should not disclose information regarding a child or youth’s sexual orientation or gender identity without good reason (e.g., a safety concern) and only with their permission. This includes disclosure to the child or youth’s family or caregiver.
• Never make assumptions about a child or youth’s gender identity or sexual orientation based on their dress, behaviour, or other forms of gender expression, although sometimes these can give clues to their identity.
• Do not assume that LGBT2SQ children and youth are suffering or have regrets about their sexual orientation or gender identity, and want to be heterosexual or cisgender. Likewise, if an LGBT2SQ child or youth is having problems, don’t assume that sexual orientation or gender identity is the cause.
• Recognize that many children and youth have never heard anything positive about being LGBT2SQ. They may have internalized negative social messages and stereotypes about LGBT2SQ people. Provide them with a positive response that affirms who they are and their experiences as an LGBT2SQ-identified person.
• Create a safe environment by letting them lead the conversation as much as possible.
• Be a connector. Children and youth need information and access to other LGBT2SQ people of all ages, including peers and role models— when they are ready. In smaller areas it may be necessary to reach out to the broader community or other communities across the province. LGBT2SQ children and youth living in regions where these supports are not readily available can be connected with supports that are available online (see Part 5: B of this guide—Relevant provincial and national organizations, service directories, regional and community agencies and support networks, LGBT2SQ-specific health centres, and LGBT2SQ social events (i.e. , LGBT2SQ-specific film festivals, Pride organizations)—p. 68).
• LGBT2SQ children and youth have different experiences and have specialized needs. Make sure you are informed about appropriate LGBT2SQ services and supports (e.g., health care, mental health, and education) to promote healthy development and self-esteem.
• For youth transitioning out of care, a successful transition to adulthood can be facilitated by relationships with caring adults who provide youth with emotional support, guidance, and assistance in this time of change. Connect LGBT2SQ children and youth transitioning out of care with appropriate organizations, resources, and services, and help them build community that includes other LGBT2SQ peers and mentors.

Supporting families who are struggling with their child’s identity

Research indicates that family acceptance or rejection plays a critical role in influencing the health, mental health, and wellbeing of all children and youth^{footnote 71[71]}. Some research suggests that LGBT2SQ children and youth may be over-represented in the child welfare system because they have been rejected or abused by their families due to their LGBT2SQ identity^{footnote 72[72]}. The objective for societies in all child protection cases is to continually work with the child’s family and extended family or community towards establishing a stable, safe, and permanent home for the child.

Families who are struggling to accept their child or youth’s sexual and/or gender identity may need support from child welfare professionals to change their behaviours if those behaviours have resulted in the child or youth suffering harm or being exposed to a risk of harm within the meaning of child welfare legislation. In some cases, it may be necessary to bring a child or youth to a place of safety while parents or caregivers learn how to better support their LGBT2SQ children and youth. Research demonstrates that rejecting families can become much more accepting if they receive support and accurate information to understand, accept, and connect with their child^{footnote 73[73]}.

Child protection workers can support families and caregivers who struggle with their child or youth’s identity by doing the following:^{footnote 74[74]}

• providing a setting where parents and caregivers may privately raise concerns, feelings and questions about their child’s identity;
• providing information to correct misunderstandings and address myths about sexual and gender diversity;
• educating families and caregivers about the impacts of family rejection on LGBT2SQ children and youth;
• giving families respectful language to talk about sexual orientation and/or gender identity and expression with their child or youth;
• educating families and caregivers on how supportive and accepting behaviours will positively affect LGBT2SQ children and youth and what these behaviours look like (e.g., using a child or youth’s chosen name(s) and pronouns, allowing age-appropriate relationships, providing LGBT2SQ positive information, including on community resources); and
• referring families to peer supports that help build connections with LGBT2SQ-positive families and allies (e.g., peer support networks such as PFLAG^{footnote 75[75]}), and when possible, trying to connect them with other families and caregivers with similar cultures, faiths, and places of origin, who support their LGBT2SQ children and youth.

Many families struggle in isolation to understand their child or youth's identity, unaware of community resources that can help. Providing appropriate support and resources can repair or strengthen a family's relationship with their child or youth and help them gain understanding, shift perspectives, change behaviours, and become allies.

Intake, assessment and service planning for LGBT2SQ children and youth

There are specific requirements outlined in legislation, regulation, and standards that must be followed by societies and child protection workers in determining if a child or youth is in need of protection and in providing child protection services, when appropriate. This section outlines key stages of this process and discusses how child protection workers can become more informed about the experiences and needs of LGBT2SQ children, youth, and families, and use their clinical assessment skills to explore issues of safety and wellbeing that are related to identity at each stage of a child protection case.

Intake: Receiving a referral and determining the appropriate response

When a society receives a report or information that a child or youth is or may be in need of protection, they assess the referral in accordance with the requirements in the Ontario Child Protection Standards (the Standards) and apply the Ontario Child Welfare Eligibility Spectrum (the Spectrum) to support decision making about eligibility for child protection services. The child protection worker uses the Spectrum in combination with other available information about protective factors, safety threats and risks, and patterns of previous child welfare involvement, to determine the most appropriate response to the referral that meets the unique needs of children and youth (for safety) and their families (for support).

When determining eligibility for services for LGBT2SQ children and youth, based on the information available, child protection workers should also consider to what extent, if any, sexual orientation, gender identity, and/or gender expression are contributing factors associated with the referral for child welfare services and the child or youth’s level of safety and risk. In doing so, child protection workers can more adequately evaluate the unique needs of the child or youth and their family, and determine the most appropriate response.

Conducting a safety assessment and risk assessment

If a child protection worker determines that an investigation is required, the Standards guide the child protection worker in making decisions about the child’s needs and care—through the investigative phase of service, to planning for ongoing case management, and throughout the life of the case.

In accordance with the Standards, a child protection worker first conducts a safety assessment to determine the level of immediate danger to a child or youth. The child protection worker considers the immediate threat of harm and the seriousness of the harm or danger given the current information and circumstances. The child protection worker also conducts a risk assessment to determine the likelihood of future risk of child maltreatment due to family characteristics, behaviours, and functioning. The results of the risk assessment are intended to inform case decision making and service provision.

It is important to note that a determination for ongoing intervention must be based on the existing grounds for determining whether a child is in need of protection in accordance with the Standards and the Spectrum. The determination that the child is in need of protection is independent of a family’s response to a child’s LGBT2SQ identity, unless there is harm or risk of harm that is sufficient to ground the determination that the child or youth is in need of protection. The existence of strife within the family over the child or youth’s LGBT2SQ identity, even if that strife includes a degree of poor treatment, does not, in and of itself, create a ground for a child welfare intervention.

Family rejection is an important factor to identify and assess when determining whether a child or youth is in need of protection, as family rejection of the child or youth’s sexual and/or gender identity can increase a child or youth’s risk of harm, self-harm, and suicidal thoughts and behaviours.

When conducting the safety and risk assessments for children and youth who identify as, or may be, LGBT2SQ, child protection workers can include consideration of whether the parents’ or caregivers’ attitudes and/or response towards the child or youth’s sexual orientation, gender identity, and/or gender expression are putting the child or youth at risk of emotional, physical, or sexual harm^{footnote 76[76]}. The child protection worker can assess the effects of family rejection or acceptance on the wellbeing of LGBT2SQ children and youth^{footnote 77[77]}.

When conducting the safety and risk assessment, a child protection worker may wish to consider whether the LGBT2SQ child or youth is experiencing, or is at risk of, maltreatment and rejecting behaviours. Some examples include:

• physical punishment because of the child or youth’s sexual orientation, gender identity, and/or gender expression;
• verbal harassment or name-calling related to the child or youth’s LGBT2SQ identity;
• sexual assault or aggression related to the child or youth’s LGBT2SQ identity;
• being forbidden from dressing, grooming, or expressing their gender in a way that is consistent with their gender identity;
• being prevented from accessing healthy LGBT2SQ supports and community, such as peers or mentors;
• being prevented from accessing gender-affirming health care and transition support;
• refusing to acknowledge a transgender or gender diverse child or youth’s choice of name and gender pronouns; and/or
• subjecting the child or youth to reparative therapy, religious conversions, or other treatment designed to attempt to change sexual orientation and/or gender identity^{footnote 78[78]}.

After an investigation has concluded, if there is a determination that the child or youth is in need of protection and the case is transferred to ongoing services, the focus of ongoing services is on protecting the child(ren) and engaging families in services and other community supports in order to reduce the likelihood of future harm to the child(ren). At this stage in the child protection case, it is critical that child protection workers assist the child or youth determined to be in need of protection, and their families, with identifying and accessing community services that are affirming and support acceptance of diverse sexual and gender identities.

Ongoing service case management

Once a decision is made that the child/youth and family will receive ongoing child protection services from a society, the child protection worker will develop a service plan (for both in/out of care services). The service plan is the link between assessment and intervention and guides the family, child protection worker, other service providers, and all casework activities toward well-defined goals and outcomes against which progress can be measured over time. The service plan utilizes family strengths and targets areas of need and is intended to reduce and/or eliminate risk, and increase the safety and wellbeing of the child or youth and family.

The child-focused and family-centred approach to service delivery is both a philosophy and a practice that supports active and meaningful participation of families and their support system in case planning and when service decisions are being made. Together, a child protection worker and the family identify intervention strategies and services that would assist in the reduction and/or elimination of risk for the LGBT2SQ child or youth, to increase their safety and wellbeing and, if the service plan involves an out-of-home placement, identify the path to family reunification.

The goal of the service plan, developed through collaboration and engagement with the family and child or youth, is to address the behaviours that have created the need for protection, and should consider:

• developing an understanding of the caregiver’s perspective, including assumptions and values that may be associated with the behaviours that have created the need for protection;
• identifying available supports or services (e.g., peer-support groups for families of LGBT2SQ children and youth) that could help address the protection concerns by promoting positive change and improve child and youth safety and wellbeing;
• strengthening the child or youth’s connections to supportive adults;
• identifying individuals within the family’s and child or youth’s networks, including cultural and faith communities, who can model and reinforce acceptance of the LGBT2SQ child or youth, and provide direct support to them and/or their family; and
• using a child and youth-centred approach that encourages and considers the child or youth’s voice.

In situations where a parent-child separation is required, the chosen placement should be one that affirms the child or youth’s LGBT2SQ identity^{footnote 79[79]}. Additionally, the service plan can consider individuals, organizations, and professionals from whom the child or youth may wish to receive more support related to their LGBT2SQ identity.

The following chart identifies considerations for child protection workers when using mandated tools with LGBT2SQ children and youth, and/or their families. While these tools are required and there is structure to them, workers can apply them in ways that support LGBT2SQ children, youth, and families, and affirm their identities. The considerations are not exclusive or limited to any one of the tools and can be used at all stages of case management.

Family strengths and needs assessment

Description: Assists child protection workers to identify the presence of family and child/youth strengths and resources by identifying the needs of family members and utilizing family strengths while targeting areas of need.

Consideration when using the tools:

• Does the child/youth have supports in place where they can openly express their sexual orientation, gender identity or expression?
• Does the family or caregiver have supports in place to assist with understanding and accepting their child/youth’s sexual orientation, gender identity or expression, including those that are connected to their cultural or faith communities?
• Does the child have people in their life who can act as advocates for their needs, in spaces such as schools, if needed?
• Has the child/youth been utilizing drugs or alcohol, engaging in self-harm, considering or attempting suicide or running away, potentially as a way to cope with any internalized homophobia, biphobia or transphobia which may or may not relate to the situation in their home?
• Has the child experienced bullying in school or elsewhere because of their sexual orientation, gender identity or expression?
• What is the child or youth’s perception of themselves?
• Does the child or youth have a peer group or friends who are part of LGBT2SQ communities?

Plan of care

Description: Specifies the plan for a child/youth when receiving services from a society, including desired outcomes linked to the child/youth's needs and strengths.

Consideration when using the tools:

• How have the child/youth's sexual orientation and gender identity or expression been considered in the development of the plan of care (e.g., possible peer supports, affirming placement and caregiver, identifying affirming service providers), and access to transition supports and gender-affirming health care, if desired?

Assessment and Action Record (AAR)

Description: Tracks the progress of a child/youth in care in seven life dimensions: health, education, identity, family and social relationships, social presentation, emotional and behavioural development, and self-care skills. The AAR helps child welfare professionals, families, and caregivers assess a child/youth's needs, develop high-quality plans of care, and monitor the child/youth's progress from year to year.

Consideration when using the tools:

• Has the child/youth expressed interest in further exploring their sexual orientation and gender identity?
• Does the child/youth have a relationship with individuals who are supportive of the child/youth's sexual orientation or gender identity or gender expression? If so, who?
• Does the child/youth feel comfortable talking to their primary physician about their sexual orientation, gender identity or expression?
• How have others responded to their identities or perceptions about their identity? Have they experienced negative responses (e.g., bullying, blame, ostracism)?
• How well supported are they for their identity in their family or placement? At school? In the community?

Inclusive language in forms and tools

By using inclusive language, staff and caregivers can communicate that it is safe to be open with them about gender identity and sexual orientation. Inclusive language is a powerful way to demonstrate that no assumptions and/or value judgements will be made about a child or youth's identity or the ways they prefer to express their gender.

When staff adopt inclusive language in using child welfare tools, services are likely to be even more responsive to the needs of a child or youth.

Additionally, inclusive language in child welfare forms demonstrates an organization's commitment to inclusion and diversity, communicates to children and youth that they are recognized, and can help make services more responsive to the unique needs of each LGBT2SQ child or youth. For example, wherever gender information is requested, forms should include multiple options, and not only "male" or "female." Forms should also provide an opportunity for individuals to indicate whether the name they go by is different from their legal name. For example, if a legal name is needed, a form can ask for "Legal name" as well as "Chosen name(s)." Language can also be made more inclusive by replacing narrow options such as "mother" and "father" with "parent 1," "parent 2," and "parent 3."

Conducting a review of all forms and tools is an important step to making language inclusive of LGBT2SQ children, youth, and families.

Placing a blank for a person's gender designation allows an individual to identify their gender identity. The "Other" box can feel like an after-thought and people are made to feel like a freak for not "fitting in" to the other boxes.

Youth

Affirming placements

Caregiver recruitment and placement selection

Finding appropriate and affirming placements for LGBT2SQ children and youth (e.g., foster, customary, kin, and group care placements) is critical for their safety and wellbeing. When LGBT2SQ children and youth are placed in settings that are not affirming, they are at greater risk of bullying and potential violence from their peers, and may face rejection or denial of their identity by their caregivers. Affirming placements, on the other hand, can help build a child or youth’s self-esteem, confidence, and self-advocacy, which all can assist with long-term positive outcomes. For Two-Spirit and LGBTQ Indigenous, Black, and racialized children and youth, culturally appropriate placements and facilitating connections with community members, mentors and cultural spaces that affirm and support their sexual and gender identities is critical to providing good care.

Our agency needs to change its policies on gay/lesbian foster and adoptive homes. How are youth supposed to feel welcome when who they are isn't accepted?

Foster Parent

With the goal of finding affirming placements, child welfare professionals may consider the following questions, whether they know the child or youth’s identity or not:

• Has the caregiver or family received adequate information and training on LGBT2SQ-inclusiveness?
• Is the caregiver willing to educate themselves about gender and sexual diversity, and examine their own biases?
• Does the caregiver or members of the family openly identify as LGBT2SQ?
• Does the caregiver have knowledge and awareness of LGBT2SQ communities and issues that may uniquely affect LGBT2SQ children and youth?
• Does the caregiver have any experience providing a positive home for LGBT2SQ children and youth?
• Are there currently any other LGBT2SQ children, youth or adults in the placement?
• Does the caregiver model LGBT2SQ-affirming and inclusive behaviour (e.g., referring to children and youth by their chosen name(s) and pronouns, encouraging children and youth to utilize the washroom that best aligns with their gender identity)?
• Is the caregiver open and willing to affirm the child or youth’s choice of name, pronouns, clothes, hairstyle, and/or other indicators of identity?
• Is the caregiver willing to support and promote LGBT2SQ cultural inclusion in the home (e.g., posting LGBT2SQ-positive symbols and posters, making LGBT2SQ-positive resources, books, and films available)?
• Will the caregiver support a child or youth to access LGBT2SQ social functions or support groups specifically for LGBT2SQ people, as well as any health appointments related to their identity?

Families and caregivers can create and maintain open, safe, and inclusive homes through various strategies, such as:

• Creating an environment where it feels safe and comfortable to speak openly and honestly about sexual orientation and/or gender identity (e.g., through modelling positive behaviour for other family members and peers, not tolerating incidents or expressions of homophobia, transphobia, or biphobia, having day-to-day conversations that affirm the child or youth).
• Inviting the child or youth’s friends and/or partner home and to family events and activities.
• When the child or youth is ready, reaching out for peer supports (e.g., family to family, parent to parent, caregiver to caregiver) and supportive community groups that welcome LGBT2SQ children, youth, and families^{footnote 80[80]}.
• Not tolerating any homophobic, biphobic, or transphobic language, messaging, or media in their home, from family members, visitors, or anyone who may have contact with the children or youth in their care.

Affirming placements for transgender and gender diverse children and youth

Transgender children and youth have distinct needs and often face multiple barriers and placement changes^{footnote 81[81]}.  Child welfare practitioners may wish to consider the following when recruiting caregivers and selecting placements for transgender children and youth:

• Transgender children and youth should be consulted about their preferred type of placement. In general, they should be provided with placements according to the gender with which they identify, or mixed gender placements, and should not be placed according to their legal sex/sex at birth. Exceptions may be made in some circumstances in consultation with the child or youth (e.g., if they are in a stable placement when they come out and prefer to stay; if they are just beginning to transition and would be uncomfortable or unsafe in a placement based on their gender identity).
• Transgender children and youth should have access to appropriate washroom facilities (e.g., all-gender, single-stall washrooms) and private spaces. If washrooms are segregated by gender, transgender children and youth should be permitted to use the washroom that feels most comfortable, based on their lived gender identity and safety.
• Placements should be supportive of the transition of transgender children and youth.
• Transgender children and youth should be asked their preference regarding sharing a room with another child or youth of the same birth assigned sex.

Sharing rooms is a common thing in the foster care system, which may be much more complicated for trans folks.

Youth

Supporting transgender and gender diverse children and youth

Providing affirming homes and services for transgender and gender diverse children and youth involved with the child welfare system means allowing them to freely and openly express their identity. This includes supporting a child or youth’s choice of clothing or hairstyle, which can be important aspects of self-expression. It may also include supporting access to tools (e.g., chest binders, packers, standto- pee devices), gender-confirming health care and/ or interventions (e.g., hormone treatments, hair removal) that for some children and youth may help them to feel their body better aligns with their gender identity.

It is critically important that transgender youth interested in hormone blockers, hormone treatments, and other gender-confirming health care interventions receive competent and affirming medical advice and care. Youth who don’t have access to the health services they need, for example, may resort to using hormones without a doctor’s supervision, which could lead to negative health consequences. Lack of access to trans-affirming health care can also lead to mental health concerns (depression, anxiety), self-harm, substance use, and suicide.

It is also important to avoid assumptions that youth interested in considering hormone blockers or therapies, or other medical interventions should wait until they are older to make decisions. Forcing youth to wait to access gender-confirming health care greatly increases risks, including suicidal thoughts and behaviours. Referrals to medical professionals who are competent in working with transgender and gender diverse youth should be sought, so that they can receive appropriate advice and care^{footnote 82[82]}.  Where qualified medical professionals cannot be easily accessed, especially in rural or northern communities, mentoring by experienced practitioners and collaborative care by local and distance practitioners may be possible^{footnote 83[83]}.

Finding gender-affirming supplies

It is important to look for stores or agencies, both online and in your community that sell or rent gender-affirming supplies such as binders, packers, stand-to-pee devices, and hair removal devices.

Read QMUNITY’s resource on chest health for trans, gender diverse, and Two-Spirit communities to learn more about safe binding practices and where to purchase binding supplies online. This resource can be accessed at: http://qmunity.ca/wp-content/uploads/2015/03/I_Heart_My_Chest_-_English_version.pdf

Community spotlight: The dress code project

The DressCode Project is an initiative to create safer spaces in salons for people in LGBT2SQ communities. The initiative highlights the importance of being able to look the way you feel and how going to a salon and asking for a haircut that is not traditional to your gender is sometimes a scary and difficult experience, particularly for people who are transgender.

The Dresscode Project has the objective of ending gender discrimination in the hair industry by ensuring an affirming, supportive and non-judgemental salon experience. All dress code salons undertake to use appropriate pronouns, have gender neutral washrooms and to complete sensitivity training provided by the Dresscode Project. The Dresscode Project also hosts "The Gender free Haircut Club," a free haircut event for LGBT2SQ youth once every two months in Toronto. For more information and the online directory of salons participating in the Dresscode Project, visit: http://dresscodeproject.com/

Instagram : @thedresscodeproject
Facebook : Dress Code Project

Additionally, child welfare professionals and caregivers can support self-expression of transgender and gender diverse youth by:^{footnote 84[84]}.

• Promoting organizational cultures or policies that support a youth's self-expression;
• Modelling trans-positive behaviours in the workplace, home, and the community;
• Participating in and promoting trans-positive community activities; and
• Assuming that transgender youth are NOT "acting out" when they express their gender identity.

Not being able to make my own decisions means to me that my voice and opinion isn't being heard. Not being able to make my own decisions can make a person feel small and invisible. This could make people feel insecure because no one listens to their opinions, ideas, and decisions.

Youth (From The Ultimate Health Rights Survival Guide, Provincial Advocate for Children and Youth)

Government-issued identification and gender identity

Birth registration and certificates record the sex/assigned sex of all children and youth. Personal information listed on birth registration and certificates is used to develop other forms of government-issued identification. For transgender and genderqueer children and youth, this means that their government-issued identification aligns with their sex/assigned sex and not their gender identity (Rainbow Health Ontario, 2015).

It is important that transgender and genderqueer children and youth have the option of changing government-issued identification to align with their gender identity. Lack of access to affirming identification can significantly impact access to job opportunities, housing, appropriate health care and social services, and can decrease safety (particularly if what is on a child or youth’s identification doesn’t match their gender expression).

With the support of parents, guardians, and caregivers, sex designation can be changed on the following government-issued identification:

• Ontario Birth Registration and Certificate
• Ontario Driver’s Licence
• Federal Passports

Note: Ontario Health Cards issued as of June 13, 2016, no longer list sex designation (although this information is still within the Ministry of Health and Long-Term Care’s database). Take a look at the following websites for more information on how to change sex designations on government issued identification:

• Changing sex designation on an Ontario birth registration and certificate
• Changing sex designation on an Ontario driver’s licence
• Changing the sex designation on a passport

Affirming programs and activities for LGBT2SQ children and youth

Tailored programs for LGBT2SQ children and youth promote peer and community connections, build identity and positive self-regard, and provide an opportunity for fun social events. Programs that are not specific to LGBT2SQ children and youth, but that support their presence and actively affirm their rights and dignity, can also help LGBT2SQ children and youth feel they do not have to keep their identity a secret^{footnote 85[85]}. In northern, remote, and rural communities, child welfare workers can be creative and collaborate with other community organizations and agencies to ensure children and youth have access to affirming programs and activities.

Some agencies have established LGBT2SQ peer support or social/recreational groups. These groups may include allies, be offered in partnership with other community organizations, and include LGBT2SQ children and youth who are not in the child welfare system. Sponsoring or participating in Pride events (e.g., LGBT2SQ Pride, Trans Pride) are also important ways to affirm LGBT2SQ children and youth. If peer support and social groups for LGBT2SQ children and youth are not available, child welfare workers, as allies, may wish to assist in developing them.

It is important that child welfare organizations collaborate with other identity-based organizations, for example, Indigenous organizations that provide culture-based and holistic services. Two-Spirit or LGBTQ Indigenous children and youth can be referred to a local Indigenous Friendship Centre^{footnote 86[86]} to access culturally-based services and programming, or be provided with information about the Native Youth Sexual Health Network, which is an organization led by and for Indigenous youth that works across issues of sexual and reproductive health, rights, and justice^{footnote 87[87]}.

Supporting LGBT2SQ Youth in Care to Transition to Adulthood

All youth leaving care need access to supports to help them transition successfully to adulthood, including fostering connections with community, building social networks, developing life skills, obtaining stable housing, and securing further education, training and employment. When supporting LGBT2SQ youth in these transitions, consideration should be given to helping youth build their self-advocacy and skills to help them address potential discrimination and bias they may face in adult service systems and the community at large (e.g., in securing housing). Connecting these youth with LGBT2SQ programs, mentors, peer supports, networks, and LGBT2SQ-affirming social opportunities is essential. This should also include helping youth connect with culturally-based and faith-based services and supports that they may be seeking. Appendix B includes information on some organizations, service directories, community agencies, and support networks.

Youth in Transition Worker Program

The Ministry of Children and Youth Services funds the Youth-in-Transition Worker (YITW) program in community agencies across Ontario. YITWs are working with youth formerly in the care of a society to connect them with educational, employment, housing, life skills, mental health, and other supports in their communities, and support them to navigate the transition from care to adulthood.

Through the YITW program, funding is provided to the Sherbourne Health Centre’s Supporting Our Youth (SOY) program, a mentoring program for LGBT2SQ children and youth in Ontario. SOY has one YITW who focuses on supporting LGBT2SQ children and youth who are leaving care to identify, access, and navigate the services and supports in their communities to make a smooth transition into adulthood.