This presentation describes the impacts of trauma and minority stress on LGBTQ youth and discusses resultant health outcomes. Targeted resources for providers are highlighted.

1. Trauma and Health Issues
Among LGBTQ Youth
Jean-Michel Brevelle
Sexual Minorities Program Manager
Maryland Department of Health & Mental Hygiene
Prevention and Health Promotion Administration
Infectious Disease Bureau

2. Mission and Vision
2
Mission
 The mission of the Prevention and Health Promotion Administration is
to protect, promote and improve the health and well-being of all
Marylanders and their families through provision of public health
leadership and through community-based public health efforts in
partnership with local health departments, providers, community
based organizations, and public and private sector agencies, giving
special attention to at-risk and vulnerable populations.
Vision
 The Prevention and Health Promotion Administration envisions a
future in which all Marylanders and their families enjoy optimal health
and well-being.
Prevention and Health Promotion Administration
December 19, 2013

3. Objectives
3
By the end of this presentation, you will be able to:
 Recognize key terms and culturally appropriate
usage of language with LGBTQ communities
 Identify impacts of negative messaging in the lives of
sexual and gender minorities
 Discuss trauma in relation to health disparities
among LGBTQ youth
 Locate culturally and linguistically appropriate
resources for supporting wellness of LGBTQ
adolescents and young adults
Prevention and Health Promotion Administration
December 19, 2013

4. Words and Definitions
4
“I know you think you understand
what you thought I said but I'm not
sure you realize that what you
heard is not what I meant.”
Alan Greenspan
Prevention and Health Promotion Administration
December 19, 2013

5. Definitions: Sex
5
 Sex - Physical identity – specific body design that
constitutes our understanding of sex. (e.g, penis and
testes for males, vagina and ovaries for females.)


May also be referred to as ―birth sex‖, ―natal sex‖, or ―assigned
sex at birth‖.
Current social preferences do not tolerate a mixing of physical
sexual characteristics (e.g. intersex individuals born with
mixed or ambiguous characteristics).
Prevention and Health Promotion Administration
December 19, 2013

6. Definitions: Gender
6
 Gender - Psychosocial identity – your sense of
maleness, femaleness, or otherness as it relates to
social and cultural expectations of male and female
gender roles.


Refers to the socially constructed
roles, behaviors, activities, and attributes that a given society
considers appropriate for men and women. In many, but not
all cultures, gender is expected to align with a person’s sex.
There are 3 important components to gender:
Gender Identity
 Gender Expression
 Gender Attribution

Prevention and Health Promotion Administration
December 19, 2013

7. Definitions: More Definitions
7
 Gender Identity



An individual’s perception of self as being a man/boy or
woman/girl, or another gender entirely.
Gender identity is formed very early in human development
and, in its most fundamental sense, is not related to the way in
which a child is raised.
An internal sense of gender is a deeply engrained and enduring
trait that presents challenges when not aligned with the
physical sexual attributes of the body.
Prevention and Health Promotion Administration
December 19, 2013

8. Definitions: Sexual Orientation
8
 Sexual Orientation
 Refers to the sex of those to whom one is sexually and
romantically attracted. Categories of sexual orientation
typically have included attraction to members of one’s own
sex (gay men or lesbians), attraction to members of the
other sex (heterosexuals), and attraction to members of
both sexes (bisexuals). While these categories (LGB)
continue to be widely used, research has suggested that
sexual orientation does not always appear in such definable
categories and instead occurs on a continuum.
Prevention and Health Promotion Administration
December 19, 2013

9. Definitions: LGB
9
 Lesbian – a woman with romantic, emotional, and
sexual attraction to other women.
 Gay – a man with romantic, emotional, and sexual
attraction to other men. (Can also mean same-sex
attraction in general.)
 Bisexual – someone with romantic, emotional, and
sexual attraction to both men and women.
These words refer to one’s attraction to others.
Prevention and Health Promotion Administration
December 19, 2013

10. Definitions: The T in LGBTQ
10
 Transgender

A person who experiences and expresses their gender
differently from the sex they were assigned at birth (e.g., a
person assigned male at birth whose internal sense of sex
and/or gender aligns with expectations for females, and vice
versa.) This can also be an umbrella term inclusive of many
people with diverse gender experiences, such as people who
identify as transexual, genderqueer, bigender, agender, twospirit, and others.
This word refers to self-concept and is different from words
describing romantic, emotional, or sexual attraction.
Prevention and Health Promotion Administration
December 19, 2013

11. Definitions: The Q in LGBTQ
11
 Q can have two meanings:


Questioning – someone who is questioning their emerging sexual
or gender identity (or both). This may be related to a developmental
phase, a recent and new experience, or something that cannot be
readily identified.
Queer –
Sometimes used as an umbrella term which embraces a matrix of
sexual and gender expressions, orientations, and identities of the notexclusively-heterosexual-and-monogamous majority.
 Sometimes used as a sexual orientation label instead of ―bisexual‖ as a
way of acknowledging that there are more than two sexes or genders
to be attracted to, or as a way of stating a non-heterosexual
orientation without having to state a specific, limiting orientation.
 Queer is also a reclaimed word that was formerly used solely as a slur
but that has been semantically overturned by members of the
maligned group, who use it as a term of defiant pride.

Prevention and Health Promotion Administration
December 19, 2013

12. Definitions: More Definitions
12
 Cisgender

A person whose gender identity and expression aligns (agrees)
with the social and cultural expectations of their sex assigned
at birth. (Literally, ―same‖ (cis-) gender. )
 Gender Non-Conforming

A person whose mannerisms, appearance (clothing, hair, use
of cosmetics, etc.), social roles, and other gender-labeled
traits differ from societal expectation (e.g., ―feminine‖
behavior or appearance in a male, ―masculine‖ behavior or
appearance in a woman). Sometimes also referred to as gender
variance, gender-variant. Gay, lesbian, and bisexual people are
sometimes labeled by others as gender non-conforming.
Prevention and Health Promotion Administration
December 19, 2013

13. Definitions: Last One, I Promise
13
 Heteronormative

A term describing any of a set of societal norms that hold that
people fall into distinct and complementary genders (man and
woman) with natural roles in life. It also holds that
heterosexuality is the normal sexual orientation, and states
that sexual and marital relations are most (or only) fitting
between a man and a woman. Consequently, a
heteronormative view is one that involves alignment of
biological sex, sexuality, gender identity, and gender roles.
Prevention and Health Promotion Administration
December 19, 2013

14. Binary Gender Model
Biological Sex:
hormones, genitalia,
secondary sex
characteristics
Gender Identity:
―I am…‖
Male
Man
Gender Expression:
mannerisms, role, social
context
Masculine
Sexual Orientation:
erotic, emotional attraction
to others
Prevention and Health Promotion Administration
Women
*GENDER LINE * DO NOT CROSS!
14
Female
Woman
Feminine
Men
December 19, 2013

15. Impact of Gender Binary View
15
 Assumes, reinforces, and privileges


Cisgender identity
Heterosexual ―norm‖
 Assigns and distributes gender-exclusive
roles, mannerisms, clothing, relationships, and other
social capital
 Invalidates


Identities and expressions that do not conform to societal sex/gender
expectations
Equality of LGBT individuals
 Makes difference and nonconformity unsafe. Gives
license to stigmatize or discriminate against ―the other‖
Prevention and Health Promotion Administration
December 19, 2013

16. Quick Stats
16
What we Know about LGBT
Populations and Health
Disparities
Prevention and Health Promotion Administration
December 19, 2013

17. Key Health Issues for LGBT People
17
 Cancer
 Depression
 Heart Disease
 Anxiety
 Obesity
 Self-injury
 Injury/Violence
 Suicide
 Tobacco Use
 Substance Abuse
 Sexually Transmitted
Infections
(HIV, syphilis, HPV, etc.)
 Viral hepatitis (A,B,& C)
Prevention and Health Promotion Administration
December 19, 2013

18. Discrimination and Barriers to Health Care
18
LGBT people and people living with HIV experience enormous
challenges accessing quality, non-discriminatory health care services.
N=4,916
When Health Care Isn’t Caring: Lambda Legal’s Survey of Discrimination Against LGBT People and People with HIV
(New York: Lambda Legal, 2010). Available at www.lambdalegal.org/health-care-report
Prevention and Health Promotion Administration
December 19, 2013

19. Anti-LGBTQ Violence
19
Prevention and Health Promotion Administration
December 19, 2013

20. LGBT People & Mental Health Issues
20
 LGBT people are at higher risk for depression,
anxiety, and substance abuse disorders. 1
 LGB people are about 2 ½ times more likely than
their heterosexual peers to have had a mood, anxiety,
or substance abuse disorder in their lifetime. 1
 LGBT people who experience interpersonal trauma
and sexual discrimination have an increased
likelihood of engaging in suicidal and nonsuicidal
self-injury. 2
Prevention and Health Promotion Administration
December 19, 2013

21. LGB & PTSD
21
 In a 2010 study, lesbians and gay
men, bisexuals, and heterosexuals who reported any
same-sex sexual partners over their lifetime had
greater risk of childhood
maltreatment, interpersonal violence, trauma to a
close friend or relative, and unexpected death of
someone close than did heterosexuals with no samesex attractions or partners. 3
 LGB people were twice as likely to suffer from post
traumatic stress disorder as the heterosexual people
in the study. 3
Prevention and Health Promotion Administration
December 19, 2013

22. LGBT Youth & Suicide
22
 LGB youth are 4 times more likely, and questioning
youth are 3 times more likely, to attempt suicide as
their heterosexual peers.4
 Suicide attempts by LGB and questioning youth are
4 to 6 times more likely to result in
injury, poisoning, or overdose that requires medical
treatment, compared to their heterosexual peers. 4
 LGBT youth who come from highly rejecting families
are up to 8 times as likely to have attempted suicide
as LGBT peers who reported no or low levels of
family rejection. 5
Prevention and Health Promotion Administration
December 19, 2013

23. LGBT Youth & Suicide
23
 A recent study of LGBT youth reported that elevated
levels of depression and suicidal ideation among males
can be explained by their high rates of LGBT school
victimization. 6
 Nearly half of young transgender people have seriously
thought about taking their lives, and 25% report having
made a suicide attempt. 7
 37.4% of LGBT youth in one study reported suicidal
ideation. 8


Neither gender nor gender non-conformity was predictive of suicidal
ideation.
LGBT victimization and lower social support were associated with
greater suicidal ideation.
Prevention and Health Promotion Administration
December 19, 2013

24. Tony
24
A Health Care Story
Prevention
and Health
December 19, 2013

25. Tony’s Story
25
Credit to the Movement Advancement Project
Prevention and Health Promotion Administration
http://www.lgbtmap.org
December 19, 2013

26. Growing Up LGBT
26
Risk Factors
Minority Stress
Negative Messaging
Prevention and Health Promotion Administration
December 19, 2013

27. Stress Factors Influencing
LGBT Adolescent Development
27
 LGBT adolescents have the same basic needs as other youth:



development of self-esteem, identity, and intimacy
social and emotional well-being
physical health
 LGBT adolescents may be especially vulnerable to not having their basic needs
met.

They may feel different from their peers, and unsure how their friends and family will
react to their sexual orientation or gender identity. They often lack other outlets for
exploring their sexual identity, such as talking to mentors or same-sex dating.
 LGBT adolescents are subject to high rates of physical and verbal abuse, being
forced out of their homes, and sexual assault (D'Augelli, AR 1995).
Although most LGBT youth show remarkable resilience, these factors combined
with stigma may be related to higher rates found in LGBT adolescents of dropping
out of school, using tobacco, alcohol or drugs, suicide attempts, depression, and
HIV disease (Frankowski 2004).
Prevention and Health Promotion Administration
December 19, 2013

28. Impact of Societal Pressure and Stigma
28
 LGBT identities and lives are
stigmatized and devalued by
our society, which promotes
heterocentric norms and
ideals as the only ―right‖ or
―acceptable‖ way to be.
 LGBTQ youth are exposed to
a tremendous amount of
negative messaging about
their desires, identity, and
expression from virtually all
quarters of society.
Prevention and Health Promotion Administration
Culture
Religion
Media
Family
Community
School
Peers
December 19, 2013

29. Minority Stress
29
Prejudice directed toward minorities is stressful and
may lead to adverse mental health outcomes.
Minority Stress is:
 Socially based –stems from social structures beyond
the individual’s control
 Chronic–constantly present in social and cultural
structures
 Unique–additive to general stressors
Minority Stress Model, Ilan H. Meyer, Ph.D.
Prevention and Health Promotion Administration
December 19, 2013

30. Negative Messaging Math Problem
30
Scenario: Greg is a 15 year old gay-identified male who
hears negative messages about being gay from many
sources – his family, friends, teachers, pastor, at school, on
the TV and the internet, at the mall, etc.
Greg hears negative messages about being gay at least 15
times each day.
Greg has been taking in these messages since he was
about 2 years old.
By age 15, how many ―doses‖ of anti-gay messages has
Greg received?
Prevention and Health Promotion Administration
December 19, 2013

31. Negative Messages Dosage Math
31
Prevention and Health Promotion Administration
December 19, 2013

32. Negative Messages Dosage Math – Part 2
32
 Learned Helplessness (Internalization)
 Dog experiment (Seligman and Maier, cir. 1967)
 Assisted ―unlearning‖ – 280 attempts before success
Prevention and Health Promotion Administration
December 19, 2013

33. Negative Messages Dosage Math – Part 3
33
 What will it take for Greg to overcome the effects of
these messages?
Prevention and Health Promotion Administration
December 19, 2013

34. Growing Up LGBT in America. Human Rights Campaign,
December 19, 2013
Prevention and Health Promotion Administration http://www.hrc.org/youth#.UrITefRDvng

35. Health Risk Multipliers
35
 Family rejection
 Childhood sexual abuse
 Bullying in school
 Unemployment or reliance on street economy
 Homelessness
 Sexual exploitation
 including but not limited to sex work
 Sexual assault
 Moderate to severe body dysphoria
Prevention and Health Promotion Administration
December 19, 2013

36. Trauma
36
“Childhood trauma does not
come in one single package.”
― Dr. Asa Don Brown
Prevention and Health Promotion Administration
December 19, 2013

37. What is Trauma?
37
 The key to understanding traumatic events is that it
refers to extreme stress that overwhelms the person’s
ability to cope.
 It is the individual’s subjective experience that
determines whether an event is or is not traumatic, not
the actual event.
 Psychological trauma is the unique individual experience
of an event or enduring conditions, in which


the individual's ability to integrate his/her emotional experience is
overwhelmed, or
the individual experiences (subjectively) a threat to life, bodily
integrity, or sanity. (Pearlman & Saakvitne, 1995, p. 60)
Prevention and Health Promotion Administration
December 19, 2013

38. Impacts of Trauma
38
 Trauma, especially when left untreated, can have severe
negative impacts on a person’s physical and emotional
well-being, such as:










Hallucinations
Delusions
Depression
Suicidal ideation/attempt
Chronic anxiety
Hostility
Interpersonal sensitivity (―poor social skills‖)
Somatization (chronic fatigue syndrome, etc.)
Eating disorders
Dissociation
Prevention and Health Promotion Administration
December 19, 2013

39. Trauma is Common and Pervasive
39
 Between 55% and 90% of us have experienced at least 1
traumatic event. Average is 5. (Fallot & Harris, 2009)
 Disproportionately affects the most vulnerable


People who are homeless, impoverished, diagnosed with severe
mental illness, struggle with addiction, or who are developmentally
disabled are at increased risk of trauma.
Research suggests that LGBT people may experience trauma at much
higher rates than the general population.
 Impact is broad, often deep and long-lasting
 Affects the way people approach helping relationships
 Has often occurred within the service context itself
Prevention and Health Promotion Administration
December 19, 2013

40. The Science of Trauma
40
 Trauma produces neurobiological impacts on the brain,
causing dysfunction in the hippocampus, amygdala,
medial prefrontal cortex, and other limbic structures.
 When confronted with danger, the brain moves from a
normal ―information-processing‖ state to a survivaloriented, reactive ―alarm state.‖
 Trauma causes the body’s nervous system to experience:
an extreme adrenaline rush; intense fear; information
processing problems; and a severe reduction or
shutdown of cognitive capacities, leading to confusion
and a sense of defeat.
Prevention and Health Promotion Administration
December 19, 2013

41. The Science of Trauma
41
 If there are insufficient biological or social resources to
assist in coping, the ―alarm state‖ may persist even when
the immediate danger has passed, and this can lead to
PTSD.
 Excessive and repeated stress causes the release of
chemicals that disrupt brain architecture by impairing
cell growth and interfering with the formation of healthy
neural circuits.
 When trauma occurs repeatedly, permanent changes in
the brain can occur, compromising core
mental, emotional, and social functioning – and resulting
in a brain that is focused on surviving trauma.
Prevention and Health Promotion Administration
December 19, 2013

42. Adverse Childhood Experiences
42
 ACE Study (1998 & 2009)
 Kaiser Permanente, San Diego – 17,000 (1995-1997)
 5 States via Behavioral Risk Factor Surveillance Survey 26,229 (2009) (AR, LA, NM, TN, WA)
 ACEs have been linked to a range of adverse health
outcomes in adulthood, including substance
abuse, depression, cardiovascular
disease, diabetes, cancer, and premature mortality.
Centers for Disease Control and Prevention. MMWR, December 17, 2010 / 59(49);1609-1613
Prevention and Health Promotion Administration
December 19, 2013

43. ACE Scoring
43
While you were growing up, during your first 18 years of life:
1. Did a parent or other adult in the household often or very often…
Swear at you, insult you, put you down, or humiliate you?
or
Act in a way that made you afraid that you might be physically hurt?
Yes No If yes enter 1 ________
2. Did a parent or other adult in the household often or very often…
Push, grab, slap, or throw something at you?
or
Ever hit you so hard that you had marks or were injured?
Yes No If yes enter 1 ________
Excerpted from Finding Your ACE Score, assessment tool. 092406RA4CR
Prevention and Health Promotion Administration
December 19, 2013

44. ACE Scoring
44
While you were growing up, during your first 18 years of life:
3. Did an adult or person at least 5 years older than you ever…
Touch or fondle you or have you touch their body in a sexual way?
or
Attempt or actually have oral, anal, or vaginal intercourse with you?
Yes No If yes enter 1 ________
4. Did you often or very often feel that…
No one in your family loved you or thought you were important or special?
or
Your family didn’t look out for each other, feel close to each other, or support
each other?
Yes No If yes enter 1 ________
Excerpted from Finding Your ACE Score, assessment tool. 092406RA4CR
Prevention and Health Promotion Administration
December 19, 2013

45. ACE Comprehensive Chart
45
Column 1
Column 2
Column 3
Adverse Childhood
Experiences
Neurobiological Impacts
and Health Risks
Long-Term Health and
Social Problems
the greater the
neurobiological impacts
and health risks…
the more serious the lifelong consequences to
health and well-being.
Substance Use
Violence/Bullying
Suicide Attempts
50+ Sex partners
Asthma
Liver Disease
Homelessness
HIV
The more types of
adverse childhood
experiences…
Abuse
Neglect
Trauma in the Household
Prevention and Health Promotion Administration
December 19, 2013

46. ACE Pyramid
46
http://www.theannainstitute.org/
Prevention and Health Promotion Administration
December 19, 2013

47. Highlights from the Family Acceptance Project
47
 In families where parents or caregivers highly
pressured their children to conform to
[heteronormative] gender expectations, children
were:




More than 8 times as likely to have attempted suicide;
Nearly 6 times as likely to report high levels of depression;
More than 3 times as likely to use illegal drugs; and
More than 3 times as likely to be at high risk for HIV and
STDs.
Dr. Caitlin Ryan, Family Acceptance Project
Prevention and Health Promotion Administration
http://familyproject.sfsu.edu/
December 19, 2013

48. Highlights from the Family Acceptance Project
48
When gay and
transgender youth
were accepted by their
families, they were
much more likely to
believe they would
have a good life and
would be a
happy, productive
adult.
Prevention and Health Promotion Administration
December 19, 2013

49. Child Sexual Abuse
49
 LGBTQ youth are more likely to have experienced
sexual abuse than heterosexual youth. However,
sexual abuse does not ―cause‖ heterosexual youth to
become LGBTQ. 10, 11, 12
 LGBT kids may be disproportionately targeted by
abusers. Sexual predators look for children who are
vulnerable.
 Research indicates a connection between bullying
and child sexual abuse, with bully/victims (those
youth who bully their peers and have also been
bullied) especially at risk for child sexual abuse. 13
Prevention and Health Promotion Administration
December 19, 2013

50. School Victimization & Trauma
50
 Gender non-conforming students who experience
victimization due to sexual orientation status during
childhood are at greater risk for developing
posttraumatic stress disorder later in life than those
who are not gender non-conforming (D’Augelli et
al., 2006)
 Higher levels of self-reported adolescent gender nonconformity are associated with more LGBT school
victimization. (Toomey, et al., 2010)
Prevention and Health Promotion Administration
December 19, 2013

51. School Victimization & Trauma
51
 Gender non-conformity predicts victimization
specific to perceptions of LGBT status, and that
victimization—not the characteristic of gender
nonconformity—accounts for long-term psychosocial
adjustment problems (Toomey, et al., 2010)

This study also demonstrated that school victimization due to
gender non-conformity fully accounted for poor life
satisfaction in early adulthood among participants. No other
mediating factors were needed.
Prevention and Health Promotion Administration
December 19, 2013

52. Best Practice Tips
52
Prevention and Health Promotion Administration
December 19, 2013

53. Best Practices Tips
53
 Respect the Client’s
 Identity
 Pronouns
 Names
 Goals
 Privacy
 Right to safety
Prevention and Health Promotion Administration
December 19, 2013

54. Best Practices Tips
54
 Acknowledge
 Client’s
Isolation
 Struggle
 Resilience
 Health seeking behavior


Your
Limits of knowledge / experience
 Desire to build trust
 Commitment to providing quality, compassionate services
 Need for respite and support

Prevention and Health Promotion Administration
December 19, 2013

55. Best Practices Tips
55
 Advocate for
 Trauma-informed care
 LGBT-inclusive, affirming policies
 Professional development at all levels on LGBT health issues
 Your client’s access to culturally and medically responsive
referrals
 Your client’s right to determine their life priorities
 Strive to become the resource that you are looking
for
Prevention and Health Promotion Administration
December 19, 2013

56. Allies and Resources
56
Prevention and Health Promotion Administration
December 19, 2013

57. 57
http://militarypartners.org/resources/
Prevention and Health Promotion Administration
December 19, 2013

58. 58
Resources Available
•
•
•
•
•
Presentations
Publications and Tools
Web sites
Videos
TA Partnership Webinars
http://tapartnership.org/COP/CLC/lgbtqi2sWorkgroup.php
Prevention and Health Promotion Administration
December 19, 2013

59. 59
http://www.findyouthinfo.gov/youth-topics/lgbtq-youth
Prevention and Health Promotion Administration
December 19, 2013

60. 60
http://familyproject.sfsu.edu/
Prevention and Health Promotion Administration
December 19, 2013

61. 61
http://www.actforyouth.net/resources/n/n_healthy_adol_sx_dev/
Prevention and Health Promotion Administration
December 19, 2013

62. 62
Common Queeries are generated by HIV/AIDS service providers across the state
of Maryland. Do you have a question about LGBTQ needs, rights, or culture?
Want to subscribe or unsubscribe? Quibbles, comments or compliments? Email
Kate Bishop at kbishop@peds.umaryland.edu
Prevention and Health Promotion Administration
December 19, 2013

63. Questions?
63
Prevention and Health Promotion Administration
December 19, 2013

64. Moving Upstream
64
It’s always easier to fight the current
at the river’s source than it is at its
end.
The most significant experiences
that shift the balance of risk for
LGBT people take place in childhood
and adolescence. This is where our
efforts must be targeted.
Prevention and Health Promotion Administration
December 19, 2013

65. Contact Information
65
Jean-Michel Brevelle
Sexual Minorities Program Manager
(410) 767-5016
jean-michel.brevelle@maryland.gov
Maryland Department of Health & Mental Hygiene
Prevention and Health Promotion Administration
Infectious Disease Bureau
http://phpa.dhmh.maryland.gov/
Prevention and Health Promotion Administration
December 19, 2013

66. References & Data Sources (1)
66
1. Mental Health Issues among Gay, Lesbian, Bisexual, and Transgender (GLBT) People. NAMI Multicultural
Action Center, June 2007.
2. House, A. S.,Van Horn, E., Coppeans, C., & Stepleman, L. (in press). Interpersonal
trauma and discriminatory events as predictors of suicidal and nonsuicidal self-injury in
gay, lesbian, bisexual and transgender persons. Journal of Traumatology June 2011 vol. 17 no. 2 75-85.
3. Roberts AL, Austin SB, Corliss HL, Vandermorris AK, Koenen KC. Pervasive Trauma Exposure Among US
Sexual Orientation Minority Adults and Risk of Posttraumatic Stress Disorder. Am J Public Health. 2010
Dec;100(12):2433-41. doi: 10.2105/AJPH.2009.168971. Epub 2010 Apr 15.
4. CDC. Sexual Identity, Sex of Sexual Contacts, and Health-Risk Behaviors Among Students in Grades 9-12:
Youth Risk Behavior Surveillance, 2011.
5. Ryan, C., Russell, S. T., Huebner, D., Diaz, R. and Sanchez, J. (2010), Family Acceptance in Adolescence and
the Health of LGBT Young Adults. Journal of Child and Adolescent Psychiatric Nursing, 23: 205–213.
6. Russell ST, Ryan C, Toomey RB, Diaz RM, Sanchez J. Lesbian, gay, bisexual, and transgender adolescent
school victimization: implications for young adult health and adjustment. J Sch Health. 2011
May;81(5):223-30.
7. Grossman AH, D'Augelli AR. Transgender youth and life-threatening behaviors. Suicide Life Threat Behav.
2007, Oct;37(5):527-37.
8. Richard T. Liu, Brian Mustanski. Suicidal Ideation and Self-Harm in Lesbian, Gay, Bisexual, and Transgender
Youth. Am J Prev Med. 2012 Mar;42(3):221-8.
9. D’Augelli, A. R., Grossman, A. H., & Starks, M. T. (2006). Childhood gender atypicality, victimization, and
PTSD among lesbian, gay, and bisexual youth. Journal of Interpersonal Violence, 21, 1462–1482.
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67. References & Data Sources (2)
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10. Arreola S, Neilands T, Pollack L, et al. Childhood sexual experiences and adult health sequelae among
gay and bisexual men: defining childhood sexual abuse. J Sex Research. 2008;45:246-252.
11. Brady S. The impact of sexual abuse on sexual identity formation in gay men. J Child Sexual Abuse.
2008;17:359-376.
12. Friedman MS, Marshal MP, Guadamuz TE, et al. A meta-analysis of disparities in childhood sexual
abuse, parental physical abuse, and peer victimization among sexual minority and sexual
nonminority individuals. Am J Public Health. 2011;101:1481-1494.
13. Holt M, Finkelhor D, Kaufman Kantor G, et al. Hidden forms of victimization in elementary students
involved in bullying. School Psychology Rev. 2007;36:345-360.
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68. Trauma Informed Care
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The five core elements of TIC are:
 Safety — is everything being done to ensure physical and emotional
safety (welcoming, respectful, sufficient personal space, consistency)
 Trustworthiness — are expectations and interactions for everyone
clear and consistent (boundaries, respect, non-judgmental)
 Choice — is a condition being created so individuals experience a
feeling of choice and control (providing options, choices, optional
program supports
 Collaboration — is the approach one of sharing and collaboration in
all interactions (learning from each other, seeking input, listening first)
 Empowerment — is there a fostering of the individual's strengths,
experiences, and uniqueness for building upon (recovery, hope, skill
building)
Prevention and Health Promotion Administration
December 19, 2013