6900. Supporting LGBTQ+ Identified Children and Youth

Approval: Connie Lambert-Eckel, Acting Assistant Secretary

Original Date: July 1, 2018

Revised Date:

Policy Review: July 1, 2023


Purpose

To address the specific needs of children and youth under the age of 21 receiving Children’s Administration (CA) services who are developing, discovering, or identifying themselves as lesbian, gay, bisexual, transgender and questioning (LGBTQ+). This policy will provide guidance to assist CA staff in identifying and referring LGBTQ+ children and youth to appropriate and culturally responsive services.

Scope

This policy applies to CA staff.

Definitions

SOGIE means an acronym for addressing Sexual Orientation, Gender Identity and Expression which are distinctions everyone has; LGBTQ+ is a sub-distinction within SOGIE self-identifiers. SOGIE includes LGBTQ+ as well as heterosexual, cisgender, and non-questioning individuals.

Bisexual means a person who has an emotional and physical attraction to persons of the same and different genders.

Cisgender describes a person whose gender identity and gender expression matches the gender typically associated with their biological sex. Often abbreviated to “Cis”.

Gay means a sexual orientation to describe a person who is emotionally and physically attracted to someone of the same gender. It is more commonly associated with males or men.

Gender Affirming means medical procedures that changes a person’s body to conform to their gender identity.

Gender or Gender Identity means a person’s inner sense of being a male or man, female or woman, or another gender. This may or may not correspond with an individual’s sex assigned at birth.

Gender Expression means a person whose outward communication of gender through behavior or appearance. This may or may not correspond with their sex assigned at birth.

Gender Non-Binary means a term of self-identification for people who do not identify within the limited and binary terms that have described gender identity: male or man or female or woman.

Gender Non-Conforming means a way to describe a person whose gender expression does not correspond with their sex assigned at birth. It is not used as a personal identifier.

Intersex means a person whose combination of sex chromosomes, internal reproductive organs, and external genitalia have a rare condition where they do not develop as expected.

Lesbian means a female or woman who has an emotional and physical attraction for other females or women.

Pansexual means a person who is emotionally and physically attracted to individuals of all gender identities and expression including those who do not fit into standard gender identities.

Questioning means a person who is exploring their sexual orientation, gender identity, or gender expression.

Sex or Biological Sex means a determination of a person’s sex chromosomes, internal reproductive organs, and external genitalia.

Sexual Orientation means a person’s emotional or physical attraction to the same or another gender.

Transgender means an umbrella term used to describe a person whose gender identity and sex assigned at birth do not correspond.

Two Spirit means a term sometimes used to describe indigenous individuals who have a gender identity or gender expression that does not align with their sex assigned at birth or have a culturally distinct gender, apart from male or man and female or woman.

Laws

RCW 49.60.030 Freedom from discrimination, declaration of civil rights

Policy

  1. A child or youth who identifies as LGBTQ+ will not be subjected to discrimination or harassment on the basis of actual or perceived sex, sexual orientation, gender identity or gender expression.
  2. CA staff must:
    1. Use gender neutral and inclusive language which indicates to all children and youth they will be treated with respect and dignity when their LGBTQ+ identity is perceived or known. This includes mirroring language the child or youth uses to describe themselves.
    2. Use and allow children and youth to use a different name, pronoun and gender that reflects their LGBTQ+ identity instead of their legal name and sex assigned at birth.
    3. Allow children and youth to express their gender identity through clothing, hairstyle and mannerisms.
    4. Obtain and document a child or youth’s verbal permission to disclose their LGBTQ+ identity prior to disclosing to other individuals including parents and caregivers, providers or agencies when making placement and case planning decisions and referrals for services. This includes discussing with the child or youth:
      1. How, what and with whom their LGBTQ+ information will be shared.
      2. Identify key individuals such family members, caregivers, other professionals or community providers with whom the child or youth identifies as part of their support system.
    5. With the child or youth’s permission and prior to each placement, discuss the caregiver or facility’s ability to meet and support the child or youth’s needs including their safety and well-being in regards to their perceived or known LGBTQ+ identity, when possible.

Procedures

  1. For all children and youth involved in an open case, the caseworker must:
    1. Document the legal and preferred name, pronouns and gender identity of the child or youth in a case note and appropriate fields in FamLink as well as any forms and reports. This includes:
      1. Clearly distinguishing the legal name and gender from chosen name and gender.
      2. Considering the child or youth’s permission for disclosure and who will receive the information or documents.
    2. Discuss and refer services a child or youth needs to be referred to and wants to participate in related to their LGBTQ+ identity. LGBTQ+ related services, where available, include but are not limited to:
      1. Behavioral health and medical providers that affirm their identity.
      2. Social activities and providers who are available in the community whose work aligns with supporting LGBTQ+ children and youth.
      3. Cultural activities such as school, faith or community based groups or attending events and activities provided by community providers who support LGBTQ+ children and youth.
  2. For dependent children and youth under CA’s placement and care authority (PCA), the caseworker must:
    1. Consider the child or youth’s LGBTQ+ identity as a factor when making placement decisions. This includes:
      1. Determining, on a case-by-case basis, which placement option would be in the child or youth’s best interest for their safety and well-being.
      2. Staffing with the supervisor when assistance is needed in finding a placement for the LGBTQ+ identified child or youth.
      3. Placing by gender identity. Efforts will be made to coordinate with the caregiver to provide the child or youth with an individual bedroom to allow for privacy if necessary.
    2. Support any youth identifying as transgender and seeking gender affirming medical services. This includes, but is not limited to:
      1. Following the advice of the medical and therapeutic professionals working with the youth. Standard medical protocols must be followed.
      2. Verifying youth is receiving ongoing medical care and behavioral health support.
      3. Referring to gender affirming services, including medical care, as approved by Medicaid.
      4. Obtaining a court order or parent or legal guardian consent before providing consent for a youth to undergo gender affirming related medical care as listed below. For youth over the age of 18 parent or legal guardian consent is not required.
      5. Facilitating access to gender affirming resources available through Apple Health Core Connections as needed and appropriate, including but not limited to:
        1. Hormone blockers
        2. Hormone Replacement Therapy (HRT)
        3. Behavioral Health Services (Gender Dysphoria)
    3. Assist the youth in updating name or gender on their birth certificate by obtaining:
      1. Parent or legal guardian consent or a court order.
        1. Legally-free youth only requires a court order; and
        2. This does not apply to youth 18 years and older.
      2. Completed Sex Designation Change Application document from the youth’s licensed health care provider. Only licensed health care providers whose scope of practice allows for attestation of a sex designation change may provide this attestation. The attestation specifies that the:
        1. Youth identified on the application is under the care of the provider; and
        2. Provider has determined that the request to change sex designation on the birth certificate is consistent with the youth’s identity.

Resources

Administrative Policy 7.22 Cultural Competence

https://www.coordinatedcarehealth.com/

Promoting Safety for LGBTQ People DSHS 22-1511