Working with Transgender and Gender-Expansive Children and Adolescents: Lessons Learned and Practical Tips to Better Serve These Wonderful, Yet Vulnerable, Kids
The Orthogenic School is proud to a leader in providing high-quality educational and clinical services to students of all genders, especially those who identify as transgender, non-binary, or gender fluid or diverse. The school’s leadership has been especially noteworthy in breaking down gender barriers in residential housing and programming; the O-School recognizes while it has done much to advance best practices for transgender and gender-expansive students, we have work to do in order to expand our expertise and level of sophistication further when working with students and families around issues of gender identity in schools and out in broader communities.
Trans and gender-expansive students are not only underserved nationally, but they are also at substantially higher risk than their same-aged peers, and this is even more so if they are people of color. Transgender Student Educational Resource (TSER) reports some very concerning data:
- 81% of transgender students feel unsafe at school due to their gender expression
- 58% of transgender students have experienced harassment due to their gender expression
- Transgender students are 50% more like to have been raped or abused by a partner.
- 49% of transgender students have experienced physical assault due to their gender expression.
- Transgender students of color are 6 times more likely to experience violence when interacting with law enforcement, as compared to white/cisgender peers.
- 41% of transgender students have attempted to commit suicide as compared to 4% of their peers.
It’s clear that transgender and gender-expansive children and adolescents desperately need safe and affirming schools and mental health providers – and the O-School is proud to act as a safe haven and a path to hope for so many of these wonderful young people.
Like all young people, the transgender/gender-expansive students we work with are at different stages in their life-long journeys of self-awareness and understanding of identity. Many of these students have clearly understood their gender expression is different from what is expected by others since early childhood – while other transgender and gender-expansive adolescents and emerging adults have started to discover this fact more recently (or have only recently become comfortable admitting or expressing it). While society has become more open to gender variation in recent years (as openness has exploded – remember, gender diversity is not a new thing!), it is still a journey to get from self-understanding, to disclosing it to others, to full and confident gender expression.
At the O-School, we strive to provide from the start support for students as they walk this path – and know there is no right or wrong way to come into one’s own gender identity. We have worked to remove signs and symbols that would have previously suggested there were right ways to be one gender or another, or that there were only two genders in the first place. We did include signage, art, and informational posters to welcome transgender and gender-expansive students to feel safe enough to think about and to talk about their own gender identity and experiences, and to make sure everyone’s identity is respected. At times, an O-School staff member (a trusted Counselor, Therapist, or Teacher) is the first person a student “comes out” to – and we train our staff members to provide a caring and affirming response to all disclosures of identity – no matter where a student is on his/her/their journey. O-School staff members are also there to provide support if the student discloses their identity to others in his/her/their circle of friends and family – and those disclosures do not go as planned or are not well received. In these cases, we know that acts of support and understanding from caring professionals can literally be the difference between life and death for a distraught child.
While being transgender or gender expansive is NOT a mental health issue – in and of itself – unfortunately, because of long-standing stigma around these issues, the resulting intense shame and isolation experienced by many in the community results in a massive negative impact on development – based on internal reactions to these societal forces. As described by Kelly George, LPCP (a former O-School counselor and currently a highly respected community provider specializing in LGBTQ consultation and training)– these reactions can include low self-esteem, anxiety, feelings of shame/inadequacy/failure, depression, suicidality, addiction, clinging to (or premature separation from) home, difficulties establishing and maintaining relationships, desire to hide/isolate/avoid, desire to please/excel, high-risk behaviors, poor impulse control, putting an over-emphasis on concepts of difference/conforming, and development of a false self.
It is important to remember transgender and gender-expansive children and adolescents have to both progress through all of the common developmental milestones as their same age peers; and on top of that, they also are reworking and reforming their gender identity while taking steps to transition to their affirmed gender. For many gender-diverse individuals at the school experience some degree of a social transition. This may include exploring and developing their affirmed gender identity by changing their physical appearance (hairstyle, makeup or not, manner of dress), participating in non-stereotypical gender-based activities, viewing media about gender/by transgender and gender non-conforming content-creators, and exploring pronoun usage/name changes/and using different bathrooms/locker facilities, etc.
This process is both incredibly brave – and very scary and complex. Young people – especially young transgender and gender-expansive people – need caring adults and professionals in their lives to help them manage this change in a healthy and thoughtful manner. While the young person needs to be driving this process (it is their life, their identity) – having the support of an informed, caring, sensitive, and affirming adult– like an Orthogenic School staff member, who has worked with numerous young people who have gone through similar journeys – can make an impactfully important difference in the trajectory of a trans or gender-queer child.
Another role O-School clinicians often play is in helping the family better understand a child’s gender identity and expression, and the journey that child – and his/her/their family – is on. While some families have fully accepted their child’s gender identity – and even have worked to gain expertise on the topic! – other families might express concern, anger, worry, sadness, and confusion when their child comes out. There are so many misconceptions about transgender people – and so much stigma – that it’s easy to understand why this reaction can occur.
The O-School, over the last 20 years (but especially over the last 10 years with the support of Lurie’s Children Hospital Gender and Sexuality Development Clinic ), has helped many families through the process of understanding, through discussions about the transition. We’ve worked with students and their families around complex issues like legal transition (name change, gender demarcation change) and biological/medical interventions (hormone blockers, gender-affirming surgeries) — and how to think about these more permanent interventions with young people (under 18) who deal with mental health issues.
Much of this hard work is done during formal Family Therapy – which is a cornerstone of our program – and is imperative for transgender and gender non-conforming students and their families.
Some of the therapeutic tasks/goals for these families include:
- Communicate acceptance, affirmation, care, love
- Gather information
- Relearn gender – and understand the gender spectrum, differences between gender/sexuality
- Create a new individual/family narrative
- Strengthen the family bonds/subsystems to develop an adaptive and healthy family structure/dynamic.
- Navigate through difficult transitions and make plans that increase success
- Establish resources and a strong network at all ecological levels
We know that all families are different and that their reactions to their transgender and gender-expansive children are different at different times. Some will deny the student’s gender or show outright opposition, some will understand it but think of it as a phase that will eventually end, some believe it is being caused by the underlying mental illness, some disregard its importance regardless, some show support with professionals – but not in the home or community. On the other hand, some families rush the process and move too quickly – or make the transition about them, not the student. Our clinicians and staff members are committed to working with a family at any of these stages – with the goal, over time, of having families commit to learning and becoming more in sync with the child’s gender identity journey and process and affirming them with love and acceptance.
The O-School has been working with transgender and gender non-conforming students for years. We’ve made our mistakes, and learned from them. Through this learning process we’ve come up with a few guidelines when working with transgender and gender-expansive kids – even if you or your organization doesn’t yet have more formal processes in place.
- Ethical Rule #1 – Do No Harm
- Listen, discuss, listen, listen, listen…. decide together, it is the child’s life to live
- Be open to thinking differently – be willing to change previously held beliefs
- Proceed at a pace that promotes acknowledgment, imaginary exploration, practical implementation, and reflection – for the individual/important people in their life.
- Give students on this journey as much flexibility as possible – as there are often many starts, stops, and turns on the road to understanding identity – especially when one’s identity is more complex.
- When new people come into your community – take time to allow for introductions with names/pronouns (so the onus isn’t on just the transgender/gender diverse individuals) – and work to make this standard operating procedure in all meetings and events.
- Show physical representations of support within your building – create a bulletin board celebrating LGBTQ historical figures, put up decorations for Pride Month (June)…get creative!
- For schools and educational organizations– teach LGBTQ history, read LGBTQ authors, study LGBTQ scientists – and include other representation in school curriculum – in every subject.
- Create a safe and non-discriminatory environment (in accordance with civil rights law if you take federal dollars – but good guidance regardless)
- Address harassment and bullying promptly
- Call students by their preferred names/pronouns – and these should be reflected in their records, whenever possible.
- Protect students’ privacy and education records – including from unwanted disclosure of personal information.
- Make space for transgender people in your organization (in accordance with civil rights law if you take federal dollars – but good guidance regardless)
- Ensure access to bathrooms, locker rooms – separate and segregated is not allowed.
- Think about creating non-gendered spaces whenever possible.
- Ensure access to bathrooms, locker rooms – separate and segregated is not allowed.
It is also important to remember that, as an organization, the O-School did not pursue this expertise. We often say – we did not seek out, we were found; we did not teach, we were taught; we asked for help, we were embraced. In the 80s, 90s, and early 2000s, we did not fully understand this issue in the way we do now – and we made mistakes and, as an organization, did not provide the supportive and affirming structure we are now able to offer.
Over the past ten years, however, we have taken it upon ourselves to overcome our own biases, implement systemic changes in the ways we approach LGBTQ students (including thinking about documentation, room assignments, bathrooms…), become more sophisticated in our understanding of the dynamic between mental health and gender identity, and helped our staff, students, and families work through their own feelings and gain a better understanding of – and appreciation for – our transgender and gender-expansive community members.
And, yes, a few times we’ve needed to engage someone who has become upset that we are such an affirming and welcoming organization to those in the LGBTQ+ community – and we have done so by demonstrating our commitment to a diverse learning and treatment environment, in which all individuals are respected and able to express themselves, and in which services are provided to all students and families in a safe and non-judgmental manner. These are the values that we prize above all – and we will continue to stand by them, and our commitment to helping, supporting, and affirming all students – regardless of gender identity or expression.
Author Pete Myers currently serves as the Clinical Director of the O-School and the Brooke Whitted Center (BWC). To learn more about the O-School’s residential and day programs, please visit our website. If you have a child or loved one who you believe may benefit from the O-School’s or BWC’s services, please visit our contact page here or call our Director of Admissions, Kristin Friesen, at 773-420-2891.