Knowledge, Attitudes, and Perceptions of Social Workers

KNOWLEDGE, ATTITUDES, AND PERCEPTIONS OF SOCIAL WORKERS

TOWARDS TRANSGENDER YOUTH IN CHILD WELFARE

A Project

Presented to the faculty of the Division of Social Work

California State University, Sacramento

Submitted in partial satisfaction of the requirements for the degree of

MASTER OF SOCIAL WORK

Amanda Molteni

SUMMER 2020

Amanda Molteni

KNOWLEDGE, ATTITUDES, AND PERCEPTIONS OF SOCIAL WORKERS

TOWARDS TRANSGENDER YOUTH IN CHILD WELFARE

A Project

Amanda Molteni

Approved by:

______, Committee Chair David Nylund, Ph.D.

______Date

iii

Student: Amanda Molteni

I certify that this student has met the requirements for format contained in the University format manual, and this project is suitable for electronic submission to the library and credit is to be awarded for the project.

______, Graduate Program Director______Tyler M. Argüello, Ph.D. Date

Division of Social work

Abstract

KNOWLEDGE, ATTITUDES, AND PERCEPTIONS OF SOCIAL WORKERS

TOWARDS TRANSGENDER YOUTH IN CHILD WELFARE

Amanda Molteni

With increasing visibility of transgender individuals in the public consciousness, and the disproportionate rate of transgender youth in foster care, this researcher explored the training and knowledge of child welfare social workers and the ethical responsibility to practice social work competently. Queer Theory and Intersectionality were used to critique the heteronormative framework of gender and the pathologizing of transgender identities. Qualitative interviews with six Northern California child welfare social workers examined beliefs about gender, experiences with transgender foster youth, academic and workplace training, and what tools are needed to practice competent social work. Analysis of the interviews indicated a need for greater exposure to transgender voices, academic training and continuing education with a focus on language, needs, and policies, and training for the resource families who provide daily care for transgender foster youth.

______, Committee Chair David Nylund, Ph.D.

______Date v

ACKNOWLEDGEMENTS

I would like to thank my husband, Dave, for his unwavering belief that I am capable of anything, no matter how many times I try to tell him otherwise. He has always been able to see me before I could see myself. I am forever grateful to my children for their ability to be functional, independent people, who don’t believe my sole purpose in life is to live exclusively for them. I want to acknowledge my dog, Milo, for his willingness to be furiously hugged whenever I am anxious, which has been more often than not over the last two years, and increasingly more than that in the last few months. I want to thank my friends, who tell me no less than one time a week that I am going to do amazing things, who participate in late night group texts 80 messages deep, who make me laugh and feel and think, and who run through the woods with me for hours to soothe my worried soul.

Thank you to my advisor, Dr. David Nylund, who agreed to work with me and who has shown me grace and understanding throughout the process. And finally, I am grateful to the social work community, who showed me their humility, their willingness to show up and help those in need, and their deep desire for growth for understanding.

They have given me such hope and faith in the field of social work.

TABLE OF CONTENTS Page

Acknowledgements ...... vi

List of Tables ...... x

Chapter

1. INTRODUCTION ...... ………………………………………………………… 1

Statement of the Research Problem ...... 4

Study Purpose ...... 6

Theoretical Framework ...... 7

Definition of Terms and Abbreviations ...... 7

2. LITERATURE REVIEW ...... 10

Sex and Gender ...... 10

Gender Development ...... 12

Gender as a Mental Disorder ...... 14

Transphobia ...... 16

Social Work with Transgender Individuals ...... 19

Transgender Youth in Child Welfare Systems ...... 21

Theoretical Frameworks...... 22

Queer Theory ...... 23

Intersectionality ...... 24

Conclusion ...... 25

vii

3. METHODOLOGY ...... 26

Study Objectives ...... 26

Study Design ...... 26

Sampling Procedures ...... 28

Data Collection Procedures ...... 28

Instruments ...... 29

Data Analysis...... 30

Protection of Human Subjects ...... 30

4. STUDY FINDINGS AND DISCUSSION ...... 32

Overall Findings ...... 32

Specific Findings ...... 33

Gender as a Social Construct ...... 33

Gender as a Binary ...... 34

Gender Norms ...... 34

Gender Expression ...... 35

Training ...... 36

Training in Graduate Degree Programs ...... 36

Training in the Workplace ...... 37

Continuing Education ...... 39

Implicit Bias Training...... 40

Training for Caregivers ...... 41

Trauma ...... 42 viii

Reduced Trauma ...... 42

Trauma Unrelated to Gender Identity ...... 43

Trauma in Placement Related to Gender Identity ...... 44

Fear of Causing Offense...... 45

Sexual Orientation ...... 45

Religion ...... 47

Interpretation of the Findings ...... 47

Summary ...... 51

5. CONCLUSION ...... 52

Summary of Study ...... 52

Implications for Social Work ...... 54

Recommendations for Future Research ...... 55

Study Limitations...... 56

Conclusion ...... 57

Appendix A. Recruitment Email ...... 59

Appendix B. Verbal Consent Script ...... 60

Appendix C. Interview Guide ...... 62

References ...... 63

LIST OF TABLES Tables Page

1. Interview Participant Demographic Data…….………………………………. 33

Chapter 1

INTRODUCTION

I am what the transfeminist activist, Julia Serano refers to as, “unmarked.” To be unmarked is to be viewed as accepted, unremarkable and legitimate (Serano, 2013). In contrast, to be “marked”, is to have traits or behaviors that are different, or unexpected, and as such, receive societally condoned scrutiny or judgement. To be marked is not necessarily a bad thing. For example, my husband is an artist, which is relatively uncommon in the circles we run in, and thus he is marked. His profession garners him attention and praise from people who regard him as though he is some kind of exotic animal. But in general, to be unmarked is the safer bet, because you can be reasonably assured that your lack of notable difference will place you in the dominant group.

Members of the dominant group are granted affirmation for choices that are not really a choice, such as one’s sexual orientation, race, gender identity or presentation; and that unearned privilege allows people to move freely without oppression or discrimination.

I am a white, heterosexual, cisgender, monogamous and married, able-bodied woman. My list of identities is a long string of valuable privilege that gives me access to opportunity and safety. I have moved through much of my life, shielded, with a curtain drawn, or with blinders on my eyes, assuming that everyone lived the same life I did.

Over time, thank goodness, I’ve realized this is not the case, and I am better for that. I rely on tools to help me “see”, and when the blinders come off, or the curtain is lifted, I feel shocked, slightly ashamed, at everything I have missed. The tools I use are personal narratives about different experiences, attending events where I feel out of place, feeling

2 the awkwardness of my existence in that space, and spending time with people who are not like me.

When my awareness is expanded about an issue, it feels a little like when I’m looking at buying a new car. That particular make and model has always been there, but

I didn’t see it before. Then I start to see it everywhere I look. This is how I felt when I began to learn more about transgender individuals, gender identity and gender expression. I became sensitive to every transphobic joke on television and in film, I noticed the certainty people felt about gender, and I saw the way sex and gender combined into rigidly fixed, intangible ideas.

Working as an intern in Child Protective Services, I also became very aware of our transgender foster youth and the way I saw the youth perceived and treated by social workers. I glimpsed ignorance when a fellow intern, upon hearing that I would be visiting a foster youth who identified as transgender that afternoon, asked, “isn’t that the same as being gay?” I observed indifference when I watched a transgender foster youth request permission to begin hormone therapy, and listened to her social worker make a vague excuse and end the visit. I witnessed pain and fear in the eyes of a transgender foster youth who asked me, worriedly, if your legal name was the name that you had to have on your tombstone when you die. When I told her that any name could be on a person’s grave marker, she melted and tearfully told me how often she worried about having her given name etched in granite over her body for eternity. I have never been so grateful to be asked a question, and so worried about why I was being asked with such

3 urgency. The needs and concerns of transgender foster youth are critical, and yet worryingly, may not be getting the attention they need or deserve.

Transgender individuals have a gender identity that differs from the gender they were assigned at birth (Meadows, 2018). Gender identity is not to be confused with an individual’s sexual orientation. Gender identity is a how one perceives themselves, while sexual orientation is who a person is attracted to emotionally and physically (Human

Rights Campaign, 2020). An estimated 1.4 million adults, 0.6%, in the United States, identify as transgender, according to a 2016 report from the Williams Institute, utilizing data from the Behavioral Risk Factor Surveillance Survey (Flores, Herman, Gates, &

Brown, 2016). It is reasonable to assume the number is higher, given inadequate reporting and sampling of gender identity in surveys and research. Although transgender individuals make up a relatively small proportion of the United States population, they experience disproportionately higher rates of poverty, homelessness, violence and unemployment than their cis-gender counterparts (James et al., 2016). Additionally, the struggle to access to health care by knowledgeable medical providers, free from discrimination or stigma, attend school free from bullying or harassment, or enjoy the love and support of their families are not privileges guaranteed for transgender populations (James et al., 2016). Transgender individuals report experiences of psychological distress and attempt suicide at nearly nine times the national average

(James et al., 2016). For those who identify as transgender, who are racial or sexual minorities, or physically disabled, discrimination and hardships intersect, compounding the challenges and barriers already faced, further impacting their quality of life.

Transgender youth and adults are disproportionately represented in homelessness counts (O’Brien, Walker, Poteet, McAllister-Wallner, & Taylor, 2018). Transgender youth in foster care are particularly at risk for homelessness when they face discrimination or rejection in their family of origin or in foster placement (O’Brien et al.,

2018). When there is no safe space to call home, the streets may feel like the best option.

Homelessness may increase the use of survival behaviors such as sex work or drug sales in order to earn money or secure a place to sleep, increasing transgender youth’s risk of

STD’s, HIV, mental illness, substance abuse and physical and sexual assault (O’Brien et al., 2018). Furthermore, many survival behaviors are illegal, which may lead to arrest and incarceration, increasing risks faced by the youth.

Despite growing family and social support, abuse and rejection at the hands of family members is still a risk for transgender individuals. This rejection by family is often the entry point into foster care for transgender youth and adolescents (Remlin,

Cook, Erney, Cherepon, & Gentile, 2017). Transgender youth and adolescents may be physically or emotionally abused, or turned out of the home. Many transgender youth enter the foster care system having experienced trauma and rejection at the hands of family members.

Statement of Research Problem

There is a concerning overrepresentation of transgender and gender nonconforming youth in foster care. Transgender youth make up only 1-2% of the general population, but in the Los Angeles foster care system, 5.6% of the youth identify as transgender, and 11% identify as gender non-conforming (Remlin et al., 2017).

Furthermore, transgender and gender non-conforming youth are three times more likely to be removed from their homes by social workers, and five times more likely to be placed in a group or foster home, than gender conforming youth (Irvine & Canfield,

2016). Reasons for transgender and gender nonconforming youth removal from their home include high rates of physical abuse and conflict with parents (Irvine & Canfield,

2016). A parent’s negative response to the child’s gender identity and/or expression can be the reason for a transgender and gender nonconforming youth to enter the child welfare system.

Foster youth, regardless of their gender identity experience abuse and or neglect while they are dependents in the child welfare system, and have disproportionately negative outcomes as adults with higher unemployment rates, lower educational attainment, and mental health challenges (Annie E. Casey Foundation, 2018). Many foster youth experience multiple placements as dependents in the child welfare system and less than a quarter transitioning out of foster care receive services for employment, education, or housing. Roughly half of these youths age out of the system without ever reunifying with their families (Annie E. Casey Foundation, 2018). Data like this paints a picture of too many foster youths with instability and trauma, who are aging out of care as adults, lacking the relationships, resources, and opportunities to succeed.

Transgender youth who are in foster care live at an intersection of risk and harm that demands ethical and knowledgeable attention of the social workers who are tasked with their protection. And yet, social workers may be ill-equipped and poorly trained to

6 handle the unique needs and demands of this vulnerable population. By examining the knowledge, attitudes and perceptions held by child welfare social workers, regarding transgender individuals, it is possible to determine if training needs or deficits exist.

Study Purpose

The concept of gender identity is not well understood, even with conversations about gender binaries happening more now than ever. However, with the over representation of transgender and gender nonconforming youth in the foster care system, it is critical that child welfare social workers understand both the nature of gender and to examine their own understandings, bias, and beliefs. Without an informed framework with which to view gender and their feelings about it, social workers run the risk of being a person in a transgender foster youth’s life who does further harm, rather than helps.

New laws and policies regarding transgender and gender nonconforming foster youth, will require that social workers have knowledge about the unique needs of their transgender and gender nonconforming youth, and the resources available to them, in order to practice social work ethically and responsibly. The purpose of this research project is to discuss the intersections of risk, harm, and discrimination faced by transgender foster youth, and to explore the ways in which social workers can contribute to, or mitigate, that harm. The secondary purpose of this research project is to determine the knowledge, opinions, and biases held by Northern California child welfare social workers and to identify any gaps in current training curriculums that may exist.

Theoretical Framework

The theoretical frameworks utilized for this study will be queer theory and intersectionality. Queer theory challenges words and meanings as fluid and contextual, rather than fixed and true (Argüello, 2017). Furthermore, queer theory posits that power informs the meanings in language. By acknowledging the fluid and transient state of language and society, queer theory allows for the deconstruction of binaries and hierarchies that result from rigid, taken for granted belief structures (Argüello, 2017).

Using queer theory allows people to examine their beliefs about gender and binaries and gives a framework for exploring where those beliefs came from, as well as making space for reimagining what gender could be. Intersectionality provides an essential lens for understanding that the disadvantages faced by transgender foster youth cannot be understood as discrete obstacles, but rather as multiple intersections of marginalization and challenges (Crenshaw, 1989). Both queer theory and intersectionality will be discussed in greater detail in Chapter 2, with special attention paid to their relevance to discrimination, harm, and disproportionality.

Definition of Terms and Abbreviations

The definition of terms presented for this project have been adapted from the book, Trans

Kids: Being Gendered in the Twenty-First Century, by Tey Meadow.

Assigned Gender – The assignment at birth of an individual’s gender, usually based on the outward appearance of the body. This is usually determined by a physician who utilizes standard medical metrics for genital anatomy.

Cisgender – A term used to describe an individual whose assigned gender at birth, bodily characteristics, and social gender identity are in alignment.

Cisnormative – The cultural assumption that all people are cisgender and that the assigned gender identity conforms with the sex they were assigned at birth.

Gender expression – external appearance of gender identity, usually expressed through hair, clothing, behavior, and ways of speaking or moving.

Gender identity – a person’s internal identification as a man, woman, or something else, which may or not correspond to their external body, assigned sex at birth, or the identity afforded to them by law or the state.

Gender nonconforming – a term used to describe people whose gender is neither masculine or feminine, or different from typical expectations for how males and females behave.

LGBTQ – Lesbian, Gay, Bisexual, Transgender and Queer or Questioning

Medical transition – the process of undergoing medical interventions to alter the physical/sexual characteristics of one’s body in order to affirm one’s gender identity.

This can include puberty suppression in adolescents, hormone therapy and/or surgery in adults.

Puberty blockers – medications prescribed by an endocrinologist to delay the onset of puberty. These drugs prevent the unwanted secondary sex characteristic’s that occur during puberty for children whose gender identity does not align with their assigned sex at birth.

Sexual orientation – a person’s romantic, spiritual or emotional attraction to another person, typically referencing the gender category of the person to whom they are attracted.

Social gender – the gender category a person uses in the social world. This may or may not align with their assigned gender at birth, or their gender identity.

Social transition – the process of changing the gender category a person inhabits in public to take on a social role different from the one assigned. This can signify an outward change in gender presentation to express gender identity that may include dress, hairstyle, name change, and pronoun usage.

Stealth – a term used in transgender communities for individuals whose previous gender assignments are not known to another individual or the communities in which they live and work. Stealth is not the same as being “closeted”, as there is no secret life, and is instead viewed as maintaining privacy about one’s own history to avoid negative social sanctions or the risk of nonrecognition of one’s gender identity.

Transgender – An umbrella term used to describe a person whose gender identity differs from the identity associated with the sex one is assigned at birth, or from conventional expectations of masculinity and femininity.

Transition – the process through which transgender individuals change their social gender identity. Some individuals will change their outward gender appearance to better align with their internal gender identity. For some people this change will be through dress and hairstyles, but for others may include hormone therapies and surgical procedures.

Chapter 2

LITERATURE REVIEW

The following chapter is organized by key themes relevant to this research. This review of literature covers sex and gender, gender development in children, gender identity disorder as a diagnosis, transphobia, social work education and child welfare social workers working with transgender foster youth. In this chapter, gender will be analyzed, with a focus on binaries and performativity. Finally, the relevance of intersectionality and queer theory in relation to gender will also be discussed.

Sex and Gender

Sex and gender are often used interchangeably. However, despite the conflation, sex and gender are not, in fact, variations of the same word. A person’s sex is assigned at birth, and can be based on anatomy, hormones, and chromosomes (West & Zimmerman,

1987; Brill & Pepper, 2008). With the assignment of sex at birth, a person is placed into a binary sex category, either male or female (West & Zimmerman, 1987). Though sex category is determined by the assessment of observable sex characteristics at birth, the continued placement in the assigned sex category is secured mostly through displays of gendered expression. Gender, then, is not a sex characteristic that can be visually assessed, but rather, produced in social situations that are considered appropriate for one’s sex category. This is not to say that a person’s gender identity, which is an internal sense of one’s gender, is not real, but rather, that the performance of gender, and what it means to be societally affirmed as a man or a woman, is a social construct (West &

Zimmerman, 1987; Brill & Pepper, 2008; Davis, 2009). Sociologists West and

Zimmerman (1987) state that to “do gender” is to engage in appropriate socially constructed masculine and feminine activities. When we “do” gender successfully, we are affirmed, and thus read, as male or female.

Gender performance, according to Butler, is the repetition of acts, performed though gestures, movements, and the styling of the body (Butler, 1988). This act of performing gender both gains affirmation of gender from society, and reinforces what it means to be male or female, thus regulating the boundaries of gender. When one performs gender and is affirmed as a woman, this defines the boundary of what a woman does. In contrast, when performs gender, but is not affirmed as a woman, this performance is outside of the boundary of what a woman does, thus reinforcing what a woman does not do. While gender identity is internally situated, gender itself is both an action and an interaction, for gender is not performed without an audience (Meadow,

2018). Claudine Griggs (2003) writes, “attributed gender is not claimed by the militant stance, ‘I am a woman and don’t care what you think!’ Rather, it is critically dependent upon the stranger’s greeting when one stands in line at Burger King: ‘Yes, ma’am!’” (p.

126).

Gender is outwardly communicated to others by means of gender expression.

This expression includes, but is not limited to, clothing, hair, accessories, and mannerisms (Brill & Pepper, 2008). Because gender is falsely equated to sex, when a person is assigned male or female at birth, gender is correspondingly assigned, with the

12 expectation that gender identity and expression will be congruent with the sex assignment. Failure, or a refusal, to do so results in corrective actions and/or social stigma (Meadow, 2018).

Assigned, or attributed gender is assumed to be fixed, and yet, it is ephemeral, transitory, changeable. The woman one sees in the street up ahead can change to a man once they are close enough to assess thoroughly. The only gender that is truly immutable is gender identity, the one that is situated in the self. The irony of this, is though attributed gender is not static, it is gender identity, that which is fixed, that individuals, doctors, and society have attempted to coerce into cisnormative compliance with the use of shame, conversion therapies, and corrective actions.

Gender Development

The gender reveal of a newborn is the first act in the performance of gender for an infant who lacks the ability to engage in gender expression independently. The announcement of “it’s a boy” or “it’s a girl” allows family, friends, and society to express an infant’s gender by proxy, until the child does it of their own volition. Gendered clothing, names, toys, and accessories are provided, as well as language, gender roles, and attitudes, with the expectation of strict adherence. A quick google search for “boy onesies” reveals clothing that tells us this baby is “just like dad” and that you should

“lock up your daughters,” indicating that gender typical and heteronormative experiences begin at birth.

Children as young as two years old may express their insistence that they are, or have the desire to be, the opposite sex, at times indicating displeasure with their sex anatomy, and it is generally agreed that by the age of three years old, children have the ability to identify their own gender, as well as to recognize the gender of others (Mallon,

2000/2009; Brill & Pepper, 2008; Steensma, Kreukels, DeVries & Cohen-Kettenis,

2013). This ability to recognize gender comes largely from stereotypically gendered preferences, such as for gender coded toys, certain types of play, and the emerging preference for same-gender playmates (Steensma et al, 2013). Children who are discouraged or prohibited from engaging in stereotypical play, congruent with their gender identity, may become upset when censured or redirected (Brill & Pepper, 2008).

Children who question, or deviate from, their assigned gender, are socially corrected and encouraged to conform to gender typical behaviors. Parents are likewise socially corrected when their children deviate from gender norms, causing feelings of pressure and shame, and leading to correcting and rejecting attitudes towards their children’s gender atypical behavior (Mallon, 2000/2009; Meadow, 2018). The ability to express gender identity in early childhood is controlled by parents and caregivers, and the rejection of a child’s stated identity can result in internalized feelings of shame (Brill &

Pepper 2008).

A transgender or gender nonconforming identity may not be expressed only by the preschool years. For some children, just prior to, or during early puberty, around 9 to

14 years of age, is the time when they assert an identity that is not congruent with their assigned sex at birth (Brill & Pepper, 2008). For transgender children, the emergence of

14 secondary sex characteristics, in the form of voice changes, breast development, hair growth, or menstruation, threatens the ability for children to envision themselves as their identified gender and may cause suffering or an increase in intensity of feelings of gender dysphoria (Mallon, 2000/2009). For teens who assert a transgender identity late in adolescence, different sexual orientations may have been explored, prior to the discovery of gender identity as the cause of internal discomfort (Brill & Pepper, 2008).

There is an assumption that sex is tied to gender, and from there, that gender is natural and fixed. When a child reveals that the gender they’ve been assigned does not fit who they know themselves to be, the construct of gender is called into question. For those who do not want to consider the possibility of gender as something that can be transgressed, there is a move towards correction, and failing that, diagnosis and pathology.

Gender as a Mental Disorder

In 2013, after a fourteen-year revision process, the DSM-5 replaced the previous category of “Gender Identity Disorder” with “Gender Dysphoria”, with the stated intention of shifting the emphasis from defining “disordered identities” and towards reflecting the distress experienced by some individuals (Inch, 2015). The professionals involved in the DSM-5 workgroup were sexologists who shared a normative framework regarding gender and sexuality, who neglected to include dissenting voices and feminist social science perspectives, despite advertising the new classification as a collaborative effort with a variety of voices and diverse areas of expertise (Davy, 2015). Critics of the

15 updated DSM-5 Gender Dysphoria diagnosis note an emphasis on physical characteristics of the body, a connection to a binary heterosexual or homosexual orientation, and a reliance on gender stereotypes in the criteria (Davy, 2015). At issue in the criteria is the requirement for performative expressions of gender identity, which have been known to be used as a “script” by individuals who are looking to secure a diagnosis indicating they suffer from gender dysphoria, and as such, are candidates for gender affirming medical care (Bolin, 1988). Firsthand accounts from transgender men and women indicate they are more likely to secure the diagnosis if they are willing to engage in exaggerated displays of gender expression, which may not always match their true gender expression exposing a reliance on stereotypical ideas of masculine and feminine performativity in the diagnosis of Gender Dysphoria (Bolin, 1988; Serrano, 2007; Grace, 2016).

A diagnosis of Gender Dysphoria facilitates access to gender affirming healthcare for individuals who may lack the ability to pay for the prohibitively expensive procedures involved in a medical transition. Using a diagnosis for a mental disorder to access healthcare requires that one give up their right to make decisions for their body by virtue of their own self-determination, self-awareness and autonomy. To take the position that self-determination is the driving force behind gender identity requires letting go of essentialist notions of gender (Davy, 2015). The position of self-determination, rather than mental illness in need of a cure, also requires a change to the health care system, lest access to gender affirming health care be available only to those privileged enough to afford it. Other countries, such as Argentina, Denmark, and Malta, have made this shift,

16 no longer requiring a diagnosis of Gender Dysphoria to begin medical and legal transitions (Davy, 2015).

It remains clear that a mental illness diagnosis of Gender Dysphoria situates the cause of any distress one feels about their gender squarely within the individual who thus requires “correction” to alleviate their suffering, rather than considering the role society plays in the cause of dysphoria, as a result of normative notions of sex, gender, and deviance.

Transphobia

Despite growing visibility of transgender individuals, transphobia is still prevalent in society (Inch, 2017). Hill & Willoughby (2005) define transphobia as, “an emotional disgust towards individuals who do not conform to society’s gender expectations.”

Transgender individuals, by their very existence, confront and challenge the essential and fixed nature of gender, and with that challenge, expose the social construction on which gender roles are built. However, with the growing acceptance of transgender as a social category, assumptions are built on what it means to be transgender (Levine, 2018). These assumptions may still result in a binary, but instead of differentiating between man and woman, now one is either cisgender or transgender. This binary results in another performative way of doing gender, and instead of “doing gender,” now one is “doing transgender” (Levine, 2018). Transphobia serves as a disciplinary method for preserving the gender binary. This disciplinary challenge can present as malevolent, benevolent, or as a combination of malevolent and benevolent.

Malevolent transphobia manifests as violent, hostile, and discriminatory actions on the basis of one’s transgender identity. The 2015 US Transgender Survey Reported highlighted the multitude of harms transgender individuals experience, as a direct result of being transgender. Transgender respondents reported being denied equal treatment or service in a public space, verbal harassment, and physical attacks (James et al., 2016).

Transphobia is not exclusively perpetrated by strangers, but can come from parents or other family members, as well as friends and acquaintances. Transgender individuals report verbal and physical attacks by family members, being kicked out of the home, or rejection and exclusion from the family unit (Human Rights Campaign Foundation, n.d.).

This rejection impacts the self-worth and mental health of transgender people, as well as impacting their economic, educational, and housing stability.

Transphobia also exists on a systemic level and can come in the form of transphobic policies, at the federal, state, or community level, such as in schools.

Examples of transphobic legislation include “bathroom bills”, which restrict a transgender individual from using the bathroom that corresponds to their gender identity, lack of protections for gender identity in anti-discrimination policies, and religious exemptions for health care providers (Human Rights Campaign Foundation, n.d.).

Microaggressions in daily encounters are another form of transphobia, and can be a mixture of intentional and unintentional transphobia (Levine, 2018). Examples of microaggressions include incorrect gender pronouns; assumptions of universal transgender experience; exoticization; discomfort or disapproval of transgender identities;

18 affirmation of gender binaries or gender normativity; denial of transphobia existence; or assumption of sexual deviance or pathology (Nadal, Skolnik, & Wong, 2012). The impact on transgender individuals include feelings such as anger, betrayal, or of not being understood, and can have impacts on mental and physical health (Nadal, Davidoff, Davis,

& Wong, 2014).

Benevolent transphobia, as defined by Levine (2018) “is characterized by ostensibly positive and well-meaning attitudes that seek to produce and discipline normative enactments of transgender” (p. 48). Levine argues that benevolent transphobia results from even those who may not oppose gender nonconformance, but who still apply a normative framework to the gender variance, providing a right and wrong way to be transgender. Examples of benevolent transphobia include holding transgender individuals responsible for their own marginalization, acting in a paternalistic manner, or seeking to enforce a gender binary on transgender individuals (Levine, 2018).

It is important to examine attitudes towards transgender identities, as it is possible to be transphobic, even with the desire to be affirming. The heteronormative gendered ways in which our society is structured, and in which most people are socialized, calls into sharp relief instances of normative gender transgressions, which invite the opportunity for transphobia to surface.

Social Work with Transgender Individuals

The National Association of Social Workers (NASW) Code of Ethics serves as a professional guide for practicing social workers (NASW, 2017). This code of ethics defines the primary mission of social workers as helping to meet the needs of people who are “vulnerable, oppressed, and living in poverty”, with a nod towards the effects on the environment on an individual’s well-being (NASW, para 2, 2017).

These ethical principles are rooted in the values of service, social justice, dignity, and worth of the person, importance of human relationships, integrity, and competence

(NASW, 2017). Utilizing these values in social work, requires a social worker to advocate for social justice in an effort to serve others before themselves. There is a dual responsibility in social work to meet the needs of the individual and of society simultaneously. Social workers are expected to facilitate access to information and resources for the clients, as well as to respect and honor a client’s right to self- determination and autonomy. Furthermore, social workers are ethically bound to practice in an informed and knowledgeable manner.

Practicing competent social work, in an informed and knowledgeable manner that does not stray beyond the scope of the social workers education, training, or certification, requires that when social workers find they are lacking necessary knowledge, they seek out training, in order to refrain from causing harm to their clients. Evidence suggests social work education, and subsequent professional development, focuses primarily on sexual minorities with little to no training in for gender identity (Austin, Craig, and

McInroy, 2016; Inch, 2017; Mountz et. al, 2018). Students in social work programs report little classroom content on transgender experiences or transphobia, a perceived low level of transgender specific knowledge in faculty, and a tendency towards pathologizing in any transgender education they do receive (Austin, Craig, & McInroy, 2016). Program directors for social work programs acknowledge programs do not prepare students for work with transgender populations, and research has indicated faculty place low priority on transgender specific education (Fredriksen-Goldsen, Luke, Woodford, & Gutiérrez,

2011; Craig, Dentato, Messinger, & McInroy, 2016). In focusing on sexual minorities while providing LGBT education in social work, students may feel that the “T” in LGBT has been adequately addressed (Inch, 2017). The lack of transgender specific education in social work education leaves students feeling unprepared to practice competently with transgender populations (Craig, Dentato, Messinger, & McInroy, 2016; Inch, 2017).

Lack of transgender education and exposure in social work curriculum and field placements does not address student attitudes towards gender minorities, which is an important part of developing a culturally competent social work practice (Inch, 2017).

Negative attitudes towards sexual and gender minorities has been attributed to lack of educational exposure in social work education (Fredriksen-Goldsen, Luke, Woodford, &

Gutiérrez, 2011). Both students and social work practitioners report transgender issues among the most challenging in their practice, with moral concerns about working with transgender populations, and acknowledging little or no experience about trans-specific issues (Austin, Craig, and McInroy, 2016). Given the increased risk of adverse outcomes in transgender populations, it is likely social workers will work with transgender

21 individuals in their professional practice. Transgender individuals have lamented the lack of professional knowledge, and the burden is subsequently on client to educate the provider (Inch, 2017). As a result of this lack of education and training, transgender individuals’ challenges and needs may go unrealized or unrecognized by their social workers. The lack of competence felt by social work students and practicing social workers is in direct violation of the NASW Code of Ethics, that maintains that social workers must be knowledgeable in their practice (NASW, 2017; Inch, 2017).

Transgender Youth in Child Welfare Systems

There is evidence that suggests transgender youth are disproportionately overrepresented in child welfare (Remlin, Cook, Erney, Cherepon, & Gentile, 2017). The reasons for entry into the foster care system are not solely related to gender identity, though transgender youth may have experienced familial rejection as well (Robinson,

2018). Research has shown that transgender youth in care may experience aggressions which include misgendering, violence, and harassment from foster youth, social workers, and caregivers (Mountz et. al, 2018). In addition to those aggressions, transgender youth face obstacles their cisgender peers do not, including barriers to access gender affirming care and sex segregated living facilities that may place youth in a home based on their sex assigned at birth rather than by their gender identity (Remlin et. al, 2017; Mountz et. al,

2018). Difficulties in placement are compounded by the stigma and abuse experienced outside of the home, in schools, workplaces, and societally. Furthermore, gender identity

22 is only one aspect of who someone is, and does not account for all other forms of marginalization a transgender youth suffers.

Social workers tasked with working with transgender or gender non-conforming foster youth may feel ill prepared to work competently and they may hold personal bias, consciously or otherwise. Youth with prior child welfare experience offered the following recommendations: provide gender affirming care with qualified providers; screen placements and develop affirming ones; don’t replicate harm experienced at home; respect youth; give cisgender and gender conforming adults and children time to learn about transgender and gender non-conforming youth; affirm identity in all respects; don’t blame youth for their victimization; use resources to help youth; provide safe environments; don’t gender things; and stop bullying and connect youth to LGBT supports (Remlin et al., 2017).

Theoretical Frameworks

This research uses queer theory and intersectionality as frameworks with which to guide this project. Queer theory is useful in examining normative values and beliefs, as well as the social construction of gender and sexuality. Intersectionality provides a lens through which to view the various social locations individuals reside, and the resulting impact created by those intersections.

Queer Theory

Queer theory is grounded in an analysis of sexuality that explores power and legitimacy, rather than orientation (Warner, 2012). In this analysis, binaries of gender and sexuality are challenged (Muhr, Sullivan, & Rich, 2016). Queer theory has since expanded to include analyses of more than sexuality, though still with a critical lens towards power and normativity.

Judith Butler, and her work on gender performativity, has been influential in queer theory (Muhr et al., 2016). In Butler’s (1988, 1993, 2004) work on gender performativity, she argues that gender is not something one “is” but rather that it is something that one “does.” Butler (1993) cautions that performativity is not to be confused with performance, as though gender is something that one puts on, or takes off, but that gender is a repetition of socially constructed norms and actions, that have the effect of identifying one as a feminine or masculine. Failing to do gender in socially appropriate ways results in not being recognized as fully human, which leads Butler

(2004) to ask, “who qualifies as the recognizably human and who does not” (p.2). This question, and the acknowledgement of gender as something that is socially constructed, a series of actions that are acted over and over again, starts the arduous task of dismantling gender as something permanent and factual.

Using queer theory for this research applies a critical lens to the ways in which we view gender and gender variance in people. Queer theory provides an alternative framework with which to consider our beliefs about gender binaries. “An understanding

24 of how gender is produced in social situations will afford clarification of the interactional scaffolding of social structure and the social control processes that sustain it” (West &

Zimmerman, 1987, p. 147).

Intersectionality

The term, “intersectionality” describes the experience of individuals when intersecting social locations related to one’s identity collide to create multiplied marginalization that could not be adequately understood using feminist or race theories

(Crenshaw, 1989). Those who experience multiple forms of marginalization may be erased through the other, more singular, frameworks, by using the privileged member of each discrete category as the representative for the group. In that erasure, there is a risk of creating a false narrative, by limiting the discourse to the least of the disadvantaged within the oppressed category (Crenshaw, 1989).

Theories and discourse influence policy and decision making, which makes understanding intersecting experiences critical. With transgender foster youth, there is the intersection of child involved in the child welfare system and marginalized gender identity, but it is important to consider additional identities such as sexual orientation, religion, race, poverty, disability and mental health. Transgender people of color experience disproportionate levels of transphobia, and child welfare has disproportionate numbers of children of color in the system. Applying a one size fits all approach when working with families and youth would be not only inappropriate, but potentially damaging.

Conclusion

The topics covered in this literature review provide a framework for understanding the social construct of gender and the challenges social workers face when working with transgender individuals. Given that we are all socialized with the same binary notions of gender, it is clear that additional education is critical to overcoming the effects of that socializations. Social workers in child welfare are tasked with working with vulnerable populations and may be ill equipped to do so, given the lack of education and training they receive in their academic instruction to overcome a lifetime of gender normativity.

Chapter 3

METHODOLOGY

This chapter will describe the methods used to conduct the research for this study.

Methods for recruitment, tools and methods for data collection, and methods for data analysis will be covered. Additionally, the human subject approval process will be discussed, as well as the ways in which the participants were protected from harm in the course of this research.

Study Objectives

The purpose of this study was to learn about what knowledge and attitudes child welfare social workers had towards transgender youth and adolescents in foster care.

Transgender foster youth face multiple obstacles and challenges due to intersecting marginalized identities. There is a possibility that lack of training and education for social workers to meet the unique needs and challenges for transgender youth may cause additional harm and trauma. This researcher believes the information from this study will assist child welfare agencies in determining what, if any, gaps exist in their current training model, which can then be used to make improvements if necessary, in order to better serve the youth in care.

Study Design

This study was designed using qualitative research methods. Qualitative research is an effective way to explore participants thoughts, feelings, experiences, behaviors, and

27 the meanings they attach to them (Sutton & Austin, 2015). A key feature of qualitative research is the flexibility to adjust to content through the research process (Moser &

Korstjens, 2017). This flexibility was particularly useful in this study, as it allowed this researcher to follow up on new themes as they emerged throughout the interview process.

This exploratory study made use of open ended, semi-structured interview questions to determine what knowledge, attitudes, and perceptions child welfare social worker held about transgender individuals. The use of the semi-structured interview style of questioning was to offer the participant the opportunity to provide answers in their own words. Each participant operate from their own context and reality, and the use of individual interviews gave them the opportunity to voice their own narrative and allowed this researcher to understand the unique perspective of each social worker, as opposed to providing a pre-selected narrative for them in the form of a survey in which they must select the best fit of the options available (Barriball & While, 1994; Korstjens & Moser,

2017). By using open ended, semi-structured interview questions, this researcher was able to ask the same questions of each participant, while providing the opportunity to probe answers further when needed. By asking the same questions of each participant, this researcher was able to look for common themes within the interviews.

This study used the lens of both queer theory and intersectionality. These theories guided both the development of questions for the interview guide, as well as the content analysis of the themes, giving this researcher a framework for interpreting the participants answers and reporting the findings (Korstjens & Moser, 2017).

Sampling Procedures

All subjects in this study were social workers recruited from Northern California child welfare agencies. No incentives were offered for participation in this study.

Participants were recruited by the use of emails requesting assistance in research on social workers knowledge of transgender individuals. Subjects in the study were informed this researcher was not sponsored by any county agency, in any way, and the subjects were under no obligation to participate in the interview process. This study used convenience sampling and snowball sampling to interview participants with a variety of experiences. Convenience sampling was accomplished by reaching out to contacts this researcher had in child welfare agencies to inquire if they would be interested in participating in a study on their knowledge of transgender foster youth. After the interview was completed, this researcher would ask participants for referrals for additional participants. Participants were recruited until data saturation was complete and no new themes or information were emerging from the interviews (Moser & Korstjens,

2018).

Data Collection Procedures

The interviews for this study took place from May 01, 2020 through May 31,

2020. The interviews lasted between 30 and 60 minutes each, and took place over the phone on a private, secure line. At the start of each interview, this researcher read a letter of implied consent, making the participant aware that by agreeing to continue with the interview, they have agreed to participate in the study. In this implied consent,

29 participants were advised this researcher would be recording the interview and participants were given the opportunity to continue with the interview, but decline to be recorded. Participants were informed the interviews would be transcribed immediately following the interview, and once the interviews were transcribed, the recordings would be destroyed. This researcher acknowledged there was a minimal risk of a breach of confidentiality, and this would be addressed by removing any link in the transcription to the participant by name or with other identifying factors. Participants were further advised that the transcripts would be stored on a password protected device kept by this researcher. The transcripts were scheduled to be destroyed on May 30, 2020. Participants were advised of their right to skip questions as well as their right to end the interview at any time, and the risk of discomfort as a result of the questions was acknowledged.

Participants were given the option to keep the implied consent letter for their records. At the completion of the interview, participants were encouraged to ask any questions they might have, and asked for the names and contact information of any social workers they felt might be interested in participating in this study. Participants were given the researcher’s contact information and encouraged to follow up with any questions or concerns.

Instruments

The interview guide was developed by this researcher and approved for use by the

Division of Social Work Research Review Committee at California State University,

Sacramento. The interviews gathered basic demographic information regarding age, educational attainment, number of years in child welfare, departments worked, and race

30 and ethnicity. In addition to demographic information, the interview explored participants knowledge of transgender individuals, resources, needs, challenges, and rights. The interview also sought information regarding the types of training and education social workers had received, as well as what training they felt they could use.

Each participant was encouraged to use any question as a jumping off point for other important information they felt might be valuable to this researcher in this study.

Data Analysis

Immediately following each interview, the recording was transcribed into a written document. After the initial transcription, the recording was played while reading along to identify any errors in the transcription process. Once transcription was complete, this researcher looked for themes and organized them into a matrix, with examples from the interview to illustrate the finding. At the end of the interview process, the matrix was analyzed for themes that were common throughout the sample.

Protection of Human Subjects

This researcher submitted a Student Application for Human Subjects Prospective

Activities to the Department of Social Work, Research Review Committee, at California

State University, Sacramento. The committee required this researcher modify the existing application to change the level of risk from “no risk” to “minimal risk” in the consent form, to be consistent with the application. The committee further required the consent form to give interviewees options to consent to participate in the study and consent to be recorded, as well as consent to participate without the use of audio- recording. The committee recommended this researcher be cognizant of questions that

31 sound like a challenge to the interviewees’ professional and personal competency, and phrase questions accordingly. Additionally, the committee stated social desirability issues and self-selection sampling bias may affect the quality of this data.

After revisions were made, the Human Subjects application for this study was approved as exempt, and assigned a Human Subject Protocol # 19-20-033. Approval of this study required this researcher inform the committee promptly should an adverse reaction occur, and that no modification in the protocol be made without prior approval of the committee.

Chapter 4

Study Findings and Discussion

This chapter begins with a description of the study participants and their demographic information. The findings that emerged from the content analysis of the interviews are then organized into pertinent themes, followed by interpretations of these findings. The chapter concludes with a brief summary of the findings and interpretations.

Overall Findings

The knowledge, attitudes, and perceptions of social workers in child welfare working with transgender foster youth were explored using a semi-structured interview format to obtain qualitative data. Six interviews were conducted with child welfare social workers located in Northern California. All six participants held Master’s degrees. The number of years they had worked in child welfare ranged from three and a half years to twenty-five years. All interview participants had worked in a variety of areas within child welfare, including permanency, foster agencies, adoptions, court services, resource family approval, and placement.

Thematic analysis of the interview transcripts revealed the six following themes regarding the knowledge, attitudes, and perceptions of social workers working with transgender youth and adolescents in child welfare: Gender as a Social Construct;

Training; Trauma; Fear of Causing Offense; Sexual Orientation; and, Religion.

Table 1

Interview Participant Demographic Data

Pronouns Gender Educational Years in child Areas worked

Identity Attainment welfare

Interview 1 She, her Female Masters 3.5 3

Interview 2 She, her, hers Female Masters 7.0 3

Interview 3 He, him, his Male Masters 25.0 5

Interview 4 She, her Decline to Masters 20.0 3

state

Interview 5 She, her Female Masters 11.0 4

Interview 6 She, her, hers Female Masters (2) 8.0 4

Specific Findings

The following sections break down, and further discuss, the themes and sub- themes found in the interviews regarding the knowledge, attitudes, and perceptions of social workers working with transgender youth and adolescents in child welfare.

Gender as a Social Construct

The meaning of gender was explored with the participants, as well as how each would define what it means to be transgender. Gender was described by all six participants as socially constructed. The participants defined transgender as incongruence between one’s sex assignment at birth based on biological markers, and the internal sense of gender identity. When questioned as to how to define “gender”,

Participant one stated, “Gender is something that someone feels inside. It’s not what

34 they’ve been assigned at birth.” Participant three described gender as, “how you define yourself. As a label or, more, more as a non-label.” Participant three later concluded,

“It’s just a label we give ourselves.”

When discussing gender, sub-themes relating to gender binaries, gender norms, and gender expression were also revealed.

Gender as a Binary

While all participants viewed gender as a social construct, some used binary terms in their definitions. Participant four offered, “Gender is, that’s how you perceive yourself in terms of male or female, right?” Others viewed gender as more of a spectrum, such as participant three, who stated, “Gender identity ranges from male to female, to in between, or choosing not to identify yourself with a gender.” When asked how they would define gender, participant five communicated, “I think if I just use…like the first word that came to mind when you said…it was ‘fluid’…gender is a fluid, undefining concept.”

Participant six stated,

Gender, to me, is something that is from a social context. It’s assigned to

us at birth, and it’s based on our sex organs. But I think as I’ve grown,

and become more educated on gender, I think it’s like, how we personally

feel. Like, how do I identify?

Gender Norms

To illustrate what gender means to them, some participants used examples of gender norms. For example, participant six discussed the role of gender norms in gender, explaining,

So, like, trying to break away from the norms of, ‘oh, you have a penis, so

you need to play with cars and trucks. And wear blue and green.’ Like,

no, your gender could be whatever you feel it is.

Gender norms were additionally called on when describing transgender individuals, to depict both children who did not conform to gender norms as transgender individuals, or to express the clues that had been picked up on when identifying a child as possibly gender nonconforming. Participant one recalled a transgender male who had been a very feminine child. “Cute as a button, super feminine. Like that was her jam, like she was all about the pinks, and the butterflies, and the princesses.” Two participants relayed stories of two male foster youth, five and six respectively, who enjoyed wearing dresses, painting their nails, and playing with Barbies. For both participants, the stories were used to describe the ways in which violations of gender norms had been used to identify a child as possibly transgender or gender nonconforming, when the child had not self- identified.

Gender Expression

Participant two used gender expression in their definition of gender, sharing, “A big part is how you are presenting yourself to the world. Usually meaning how we dress, how you do your hair, how you put your makeup on, things like that.” When defining what it means to be transgender, participant two utilized gender expression again, stating,

Transgender is when you identify as different than you were biologically

born. So, a transgender female would be a person who was born

biologically male, but who identifies and feels like a female, and therefore

presents that way in the world.

When describing what it means to be transgender, Participant one noted that gender expression still falls on a spectrum, musing,

I know that even as transgender, sometimes they don’t fit the mold of what

they’re transitioning into…I’ve met some beautiful people who will

identify as trans, and they’re very specific about, I have all these female

qualities, I am female, and this is who I am. But then you’ll meet some

other beautiful people who will identify as male to female, but will also be

more on the masculine, male side.

Training

Training was identified by all six participants as a critical factor in the ability to practice competent social work with transgender individuals in child welfare, though all admitted they have engaged in additional research when needed to supplement their training. Sub-themes that emerged within the theme of training was the lack of training in Master’s level academic programs, training in the workplace, continuing education, implicit bias training, and training for resource families.

Training in Graduate Degree Programs

The six participants equally asserted little to no attention was given specifically regarding gender identity in their graduate level academic programs. Participant two stated it was covered in the master’s program, though not in depth, perhaps over just a day or two, continuing, “I think it’s…it gets sprinkled in, I guess.” When gender identity

37 was addressed in greater depth, it was because a faculty member had expertise or because they had an internship where they were given the opportunity to practice with transgender clients. For participant three, who earned his master’s degree 30 years ago, the education in gender identity came from internship experiences, but in the academic program, gender and sexuality were expressly ignored, to the point that chapters were skipped in textbooks to avoid the subject. Participant six highlighted the importance of faculty with gender identity expertise, recalling her experience with one professor, stating, “I just feel like my mind was blown open with just the knowledge and perspective.” This participant also indicated that the experience with a professor who did not specifically address gender was instrumental in her training to practice affirmative social work with transgender and gender nonconforming individuals, saying,

She helped me externalize, so I feel like her approach of always being

mindful of the language that you’re using when you’re articulating

behaviors and what you’re seeing building upon what I had been taught in

working with transgender clients. So, it wasn’t directly tied to gender

identity, but I feel like the tools and approaches she gave definitely bleed

into working with that community.

Training in the Workplace

Participants had all received varying amounts of training through their agencies for working with LGBTQ clients. The number of trainings increased depending on the length of years the participant had worked in child welfare. Trainings in the workplace fell into two categories; informative sessions and panels with transgender youth and

38 adults and parents who described their life experiences. Participant five opined that both types of trainings were important, because you need both the foundational knowledge, as well as the human experience.

Informational training sessions helped participants to find a common language for gender identity and to make sure it was understood by everyone in the same way.

Additionally, these sessions covered gender expression, sexuality versus gender, pronouns, foster care rights, and resources for youth and families.

Panel trainings were regarded as beneficial, because it helped the participants to understand someone else’s story. One participant recalled a training in which a panel of parents spoke about the experience of their children transitioning, stating, “for me, it was really great to hear from a family’s perspective.” For participant two, a transgender woman who had spoken in a class had been particularly impactful.

I’ll never forget her, she made it very clear that she started transitioning

with hormone replacements very early on, because her parents were on

board. And she’s so thankful that she was able to do that, even though

people would say, well, they’ll regret it later. And she was clearly in her

adult years and so thankful.

Participant three had a unique experience with training, sharing, “we had a LGB, a lesbian couple, who adopted three children and of the children started identifying as transgender. And they, they went through this journey and they took us on that journey with them.” Participant three went on to explain that many of the staff in the agency were quite comfortable working with transgender adults, but found themselves resistant

39 when confronted with a five-year-old who was saying, “no, you call me Jim, but my name is Jill, and I want to wear dresses.” This staff, he continued, realized through the various trainings and the family’s personal experience that they were all permitted to observe, that they had worked with children in the past who had felt the same way, and they had unknowingly reinforced negative stereotypes. Participant three recalled, “And so, there was some grieving that had to be done, and some recognition that sometimes we need to continue to grow and learn.”

Continuing Education

Five of the six participants expressed the need for continuing education on gender identity. Participant two stated that unless a social worker uses the skills that are learned in trainings, they can be quickly dropped, which is why she signs up for trainings whenever they become available. Participant five also felt that when new skills weren’t used regularly, they were lost, stating, “it’s almost like you’re starting from the ground up again.” Participant four and five indicated the knowledge continues to grow and evolve, necessitating consistent attendance at gender trainings. Participant five offered that gender identity training should be offered yearly, in the same way that you have to take

HIPPA training on an annual basis, saying “I think this is an area that is ever changing right now, just because we’re learning so much, that a training I may have taken two years ago is not necessarily relevant anymore.” Participants additionally expressed that as they worked with more clients, new questions or situations would arise, which they could potentially bring into trainings making them richer and more relevant experiences.

Implicit Bias Training

Two participants indicated that any education for gender identity needs to begin with addressing implicit biases. Participant three felt it is not enough to educate social workers on sexual orientation, gender identity, and gender expression.

I think everyone should have to take implicit bias in the school of social

work, because we all have biases. And a lot of them, we’re not even fully

conscious of, and we have a responsibility as human beings to become

conscious of our biases, and then learn how to mitigate then and start that

journey.

Participant six had similar feelings regarding gender identity training. Her feeling was that any training needed to last two days; the first day needed to be entirely about breaking down biases utilizing activities that helped attendees visualize and acknowledge their privilege. On day one, participants could assess where their beliefs came from so that people could have honest and rich conversations where they work together to unpack where their thinking originates and how it could be harmful. Day two could be more informational about gender identity and how it relates to the population social workers are serving. Participant six reasoned, “When you have closed minded people going into these trainings, or people who haven’t had their brains opened up to receive the information, I feel like it’s a moot point to have them go sit through this mandatory training.”

Training for Caregivers

Participants brought up the need to educate and train caregivers in gender identity issues. Participant two relayed concern that there were not enough training opportunities in the area for her to send resource families. Participant four stressed the importance of providing gender identity training to families in an effort to avoid displacement and minimize the number of moves a youth has until they achieve permanency. Participant four additionally felt it was ideally the role of the caregiver to be a support for a transgender youth on their journey, and preferred to provide support to the caregiver, rather than the youth. Her reasoning was, “that’s ultimately who we want to kiss the boo boos and, you know, make them safe and be that place to land,” though she added she would absolutely do whatever was needed by the youth, if the caregiver was unable or unwilling. Most participants indicated that families wanted to foster, and potentially adopt, only young children, aged zero to two, and because of this weren’t open to discussions about gender and sexuality. Participant five expressed concern with these families not engaging in LGBTQ training, remarking, “at three years old, maybe

Rebecca, but maybe at 11, Rebecca is Rob.” Participants felt that by not addressing things like gender and sexuality prior to taking a child into their care, there was a risk of non-acceptance if a child was not cisgender or heterosexual down the road. Participant two recalled a family who was on track to adopt a six-year-old youth in their care. They became concerned once the child began dressing in female clothing and expressing that he felt more comfortable with a feminine presentation. She worked closely with the family in an effort to maintain this placement and continue with the adoption, but the

42 family was transferred to a new social worker before the adoption closed. Participant two used this example to highlight the need to have these discussions and trainings with families early on, to avoid any trauma for the child as a result of nonacceptance or displacement, stating,

I guess I’m more worried about our foster parents who have these kids in

their homes every day. I feel like with as little as social workers know, I

feel like we know way more than foster parents do, who are providing

daily care to our youth.

Trauma

Trauma was brought up in the course of the interviews by five of the six participants. The discussions centered around reduced trauma related to gender identity because youth are coming out earlier in life, trauma unrelated to gender identity, and trauma from non-affirming caregivers and displacement related to gender identity.

Reduced Trauma

When discussing trauma, participant three talked about the progress that has been made in the LGBTQ community in terms of achieving rights and the comfort people feel in coming out sooner than those in the past, although he was quick to note that in general, the transgender community has not achieved the same mainstream acceptance. In this discussion, he noted that the increased visibility of the LGBTQ community on social media has been instrumental in youth achieving comfort with their identity much earlier in life. His feeling was that coming out earlier led to less trauma, stating, “Obviously, the earlier you can come out, the healthier it is, the less trauma you have to experience, the

43 hiding you have to do, the easier it is for you to make attachments, and feel secure in your environment.”

Trauma Unrelated to Gender Identity

When discussing how to work with transgender and gender nonconforming youth on her caseload, participant one expressed concern with trainings that she described as

“cookie cutter ways to work with kids.” Elaborating on this concern, she stated, “we don’t know what their traumas have been. We don’t know what they’ve been through.”

Her fear was that by lumping transgender youth into a category, and giving social workers prescribed ways of working with trans youth, their unique experiences, unrelated to their gender would be dismissed or left unaddressed. Because of this, she felt it was better to look at youth as a whole, in which gender identity was only one facet of who they were.

Participant four had similar thoughts regarding trauma when discussing transgender and gender nonconforming youth who were viewed as “not adoptable.” She shared that for most children she works with, their gender identity is not the primary issue she is working to address.

You know, it’s the other, it’s that trauma related stuff, and this other is,

that’s just who they are. It’s important and super vital that they’re able to

support that, and be an affirming place. But I also need them to be aware

that first and foremost, they’re children.

She later reported that while affirming families are critical for transgender youth, they need to be trauma informed as well, otherwise they may not be prepared to deal with trauma related behaviors that youth express.

Trauma in Placement Related to Gender Identity

Participant four spoke at length about transgender youth in care who had experienced additional trauma as a direct result of their gender identity and the lack of acceptance by caregivers. She shared a story of one trans male who had been so traumatized by his treatment in care, that he appeared to be developmentally delayed, refusing even to speak. For this child, she reflected it had been a combination of the grief and loss he had already experienced, in addition to caregivers leading him to believe there was something wrong with him.

Participant two also shared stories of transgender youth in care who had not been accepted by their caregivers. She spoke at length of one child who had learned to hide behaviors, “because the response was very clear that the way they were dressing and the way they were acting was not acceptable.” She emphasized the importance of gender identity training from the beginning, acknowledging that many resource families are not willing to open their homes to transgender youth. Her concern was additional trauma for the children when placement disruptions occurred because families were unwilling to support the child, even after adoptions had taken place. “Sadly, they do come back.

They come back to us as teens…we see a lot of that. They come back from these adoptive placements.”

Fear of Causing Offense

Three of the participants indicated they worried about saying the wrong thing to transgender or gender nonconforming clients and inadvertently offending or harming them. Participant one disclosed, “sometimes you’re almost paralyzed, you don’t want to be attacked by other people, and you also don’t want to offend that person.” Pronouns in particular were a source of concern for participant one who shared she sometimes has trouble with remembering the appropriate pronouns to use. Participant four had similar concerns, stating, “I’ve been to 100 of these classes, and I keep learning new words, but it’s difficult to make sure that I’m not offending somebody at some point.” Participant five recounted an incident that occurred during a training where she had used someone’s gender presentation to gender them, and proceeded to refer to them as “she.” The person gently corrected her each time, saying, “they.” Participant five described her confusion, followed by the realization of what was happening. “Here I was, lightweight disrespecting them, because I didn’t even know that I was.” The experience humbled her, making her aware of how people might be resistant to learning or attending these trainings because it can be difficult to change and for some, there’s a huge learning curve.

She went on, “you don’t know what you don’t know, especially when you’re learning about a different community and culture.” She emphasized the need for people to be gentle during these trainings and to create an environment of positive intent.

Sexual Orientation

Three participants discussed sexual orientation in relation to gender identity. In the interviews a heteronormative theme was apparent, both in the ways in which it was

46 applied to the youth, and the ways youth explored their sexual orientation as an answer to their gender identity.

Participant one discussed a trans male adolescent in a group home whose caregivers assumed that because he identified as male, that would automatically indicate he was interested in women. Masculine behavior was correlated to a interest in women, and his sexual orientation became the identity the caregivers wanted to affirm.

Participant four also told a story where the foster parents assumed that the transmasculine expression of the youth in their care indicated he was gay. Because of this, they entered him into a drag king contest, bought him a book about lesbian relationships, and encouraged him to “come out.” She communicated that this devastated the youth, because he felt was being pushed in different directions and not being honored for who he was.

Participant four had another foster youth who explored his sexual orientation while he was coming to terms with his gender identity. She remembered, “It was like he was trying it on, saying it out loud, joking…but it was also really important to see how we responded to it, and it was just little bits by little bits that he started becoming who he is.” Participant five had a similar story about foster youth who initially stated they were a lesbian and was dating women now, but over time realized that didn’t fit, sharing, “I think they were trying it on, because they were like, ‘Well, I have a vagina. So, I’m a girl, but I like girls, but I also don’t feel like I fit in here.”

Religion

Religious beliefs were discussed in three of the participant interviews. Participant six disclosed that she had grown up in a “very, very, very Christian” household, and as a result initially believed that anything relating to LGBTQ was a sin. It wasn’t until exposure in college, and later as a social worker, that she began to reconsider some of the things that she had been taught. These exposures made her realize that as children we are given beliefs by those around us, but as adults we have a responsibility to question those beliefs and consider where they came from. Interviews with participants one and four had similar themes of religious beliefs interfering with LGBTQ acceptance, but this time with caregivers. Participant one stated there are many potential resource parents who indicate from the beginning that they will not take any LGBTQ youth, because it violates their beliefs. Participant four shared that many resource families are very religious and she’s had foster youth who are 12 or 13 years old who have been told such things as, “I’m okay with it, but God doesn’t like it.” One parent went so far as to take the youth to church to perform an exorcism because of their gender identity. This experience compounded the confusion and conflict the youth felt over his gender identity, and participant four described the youth’s response by saying, “I mean, I’ve had a frickin’ exorcism. This has to be wrong. But it feels like the only thing that makes me feel right.”

Interpretations of the Findings

These findings give insight into not only the specific knowledge social workers have as a result of their education or trainings, but what they have learned in working

48 with youth and the resource families who provide care. The themes in the interviews indicate that social workers are starting their careers without adequate training from their academic institutions. As a result, the findings suggest they end up struggling to play catch up on the job, by educating themselves while also attempting to educate the families who provide daily care to vulnerable transgender youth who have already experienced trauma. Because we live in a gendered world, starting from birth, the process of unlearning gendered socialization can be long, and some social workers indicated they still struggle with making sure they are getting it right. These interviews indicate that not only are social workers in need of training, but also resource parents who are tasked not only with providing daily care, but with offering a safe and affirming place for youth and not adding to, or compounding, existing trauma. If social workers are not adequately prepared themselves, it may be difficult to provide what transgender youth and their resource families need. Additional areas of consideration are the need for trainings to continue regularly to provide current information, keeping skills current, as well as attention given to the intersection of religious beliefs and gender identity.

All six participants confidently asserted that gender is not biologically based, but an internal experience. One participant spoke about gender in binary terms, while three felt it was more of a spectrum. Interestingly, though all six participants indicated that gender is a social construct, and gender identity was a personal feeling, it was gender expression and gender norms, rather than personal assertions, that were used to identity children who may be transgender or gender nonconforming. Fear of causing offense was brought up by three participants, and though they asserted that gender was a social

49 construct, all three struggled to overcome visual cues with gender. This struggle indicates the importance of continuing to dig into implicit bias and unconscious normative frameworks, in addition to the benefit of providing personal narratives and foundational information training.

Of the six participants, none received significant training in their academic institutions. Having faculty members who were well versed in the subject of gender identity appeared to increase the likelihood of any discussion of the topic during their graduate programs. One participant shared that thirty years ago, any discussion of

LGBTQ issues was expressly forbidden in his program, highlighting the difference time makes in the acceptance of the LGBTQ community, though he acknowledged transgender individuals continue to not enjoy the same mainstream acknowledgement or acceptance. This difference in training for social workers who went to school years ago suggests that social workers who have been in the field may have different perceptions and biases than those who have attended graduate programs more recently.

Though all social workers acknowledged they had many transgender youths on their caseloads throughout their careers, they agreed that continual training was necessary because terminology and understandings changed over time. Though training for social workers was considered important, the greatest concern appeared to be the lack of knowledge in resource families, which implies that training for social workers potentially should be used for training caregivers, more so than aimed at working with youth, since families are the ones with the most sustained contact, and thus they potentially have the most impact, positive or negative, on transgender youth.

Trauma was a big concern for all of the social workers, though they had somewhat different perspectives. Participant three felt that coming out early for transgender youth meant less trauma because of the ability to attach more openly as their authentic selves. Other participants worried about trauma unrelated to their gender identity, as well as trauma from caregivers who did not accept a child, even when they had good intentions. Youth in foster care have already experienced trauma as a result of the general neglect or abuse they’ve experienced in their home, in addition to what may be experienced outside of the home, societally, as well as the trauma of being separated from their family of origin. Protecting them from any additional abuse was a concern shared by all participants. This protection proved particularly difficult, as participants weighed the consequences of continued rejection or shaming from caregivers against the trauma of repeated moves and lack of permanency. Compounding this issue is the reality that trauma of any kind results in behaviors that may be difficult for families to manage.

These issues indicate there is a need to provide adequate training for families, not just in

LGBTQ issues, but also in trauma, in order to proactively preserve placements for youth and protect them from additional harm.

Sexual orientation was discussed by three participants. This theme covered both confusion by caregivers, as well as the journey that adolescents may go on in discovering who they are. Sexuality and gender are commonly confused and greater attention needs to be paid to differentiating the two when educating caregivers. Western society is structured by a heteronormative matrix, meaning there is a gender binary, and that binary hinges on opposite sex attraction. Educating caregivers on this framework may help to

51 deconstruct narratives relating to gender expression and sexual orientation. Furthermore, the interviews suggest social workers and caregivers would benefit from understanding the process of discovering one’s gender identity looks different for everyone, and the youth is best served by allowing them to evolve and learn about themselves at their own pace.

Religion was a theme noted in three interviews. Religious beliefs affect both the social workers and caregivers, and provide the lens through which they view the world.

Training that educates people on the basics of gender identity does not account for the ways in which cultural and religious beliefs affect the way individuals interpret things.

The discussion of religion brings to mind that it is not only important to understand gender identity and transgender individuals, but also to practice cultural humility with caregivers and social workers, to better understand the origin of their beliefs and practices.

Summary

This study provided insight to the work social workers do with transgender youth and their caregivers. Thematic analysis uncovered six themes: Gender as a Social Construct,

Training, Trauma, Fear of Causing Offense, Sexual Orientation, and Religion.

These themes share commonalities that indicate that better training is needed to overcome gendered socialization, both in social workers and with resource families. They provide a roadmap towards understanding how to prepare our social workers and caregivers to provide affirming, safe spaces for transgender foster youth.

Chapter 5

CONCLUSION

This chapter will review the relevant findings from interviews conducted with six

Northern California child welfare social workers. In this chapter, this researcher offers recommendations for social work at the micro, mezzo, and macro level. These recommendations are intended to provide social workers with the tools they need to practice competently and ethically with their clients, as well as improve the wellbeing and outcomes for transgender foster youth. Additionally, in this chapter, recommendations for future research and limitations with this current study will be considered.

Summary of Study

The knowledge, attitudes, and perceptions of social workers working with transgender youth and adolescents in child welfare was examined using semi-structured interviews with six child welfare social workers in Northern California. All social workers held at least one Master’s degree and their experience in child welfare ranged from three and a half years to twenty-five years. An analysis of these interviews revealed the following themes: Gender as a Social Construct; Training; Trauma; Fear of Causing

Offense; Sexual Orientation; and, Religion. An interpretation of these themes indicates that more training is needed for social workers, beginning in their academic institutions, in transgender issues and awareness. Further findings indicate that annual training is necessary, in order to keep up with changing and evolving knowledge and terms, keep the

53 knowledge readily available, and to work towards familiarity and comfort with new ideas. An understanding of the differences between gender identity and sexual orientation, as well as training on gender identity development of youth was noted to be beneficial in working with transgender youth and their caregivers. These social workers indicated concern with offending youth with their lack of knowledge, at times feeling constrained by the lack of knowledge they held and an awareness of the ability to cause harm, reflecting a desire to do better and the need for greater and more consistent training.

Additional findings showed a need for training and access to resources for the resource families who provide care for transgender youth and adolescents. While social workers acknowledge the major role they play in a youth’s life, there was an awareness of the greater impact, and thus, greater potential harm, from the daily interactions with a caregiver.

Trauma was brought up as a concern in these interviews. Social workers acknowledged the trauma experienced prior to a youth’s entry into the child welfare system, as well as the additional trauma potentially suffered in their foster placement, a home that is supposed to be a safe space. An analysis of this theme highlights the intersection of trauma experienced by transgender foster youth for whom entry into the system is not an exit from the abuse experienced in their family of origin. One participant noted the reduction of trauma experienced for youth who are able to come out earlier in life rather than hide their gender identity through their adolescence, but given the transphobia and rejection that is still prevalent in society, coming out earlier creates

54 the potential for youth to be abused in the home for a greater number of years. This phenomenon of youth coming out as transgender at an earlier age may be a contributing factor in the rising numbers of transgender youth in the child welfare system.

Implications for Social Work

The interpretations of the findings from this study have broad implications for social work at the micro, mezzo, and macro level. The findings of this study indicate a need for training, both prior to social workers entering the field, as well as continuously after they complete their academic education. Social workers have been socialized in the same gendered world as everyone else, and as such, there is a need for purposeful education in order to identify, question, and deconstruct, heteronormative and cisnormative understandings and beliefs about the gender binary. To that end, social work education needs to be deliberate about the inclusion of gender nonconforming and transgender voices. The interviews in this study indicated that little to no education was given in their respected graduate level programs, and for those who did receive education, it was mostly due to individual faculty members who had an expertise in the subject matter. For child welfare social workers who are out of school and working in the field, regular training that seeks to build upon previous knowledge and continue to address implicit bias and gendered beliefs is critical for working with transgender and gender nonconforming youth, as well as for the caregivers who provide daily, out of home care. Social workers who do not feel competent and comfortable with gender identity issues are ill equipped to support caregivers and transgender youth. In addition to ensuring competency for social workers in their direct practice, this education and

55 comfort with gender identity issues lends itself towards advocacy and social justice for transgender and gender nonconforming individuals. Social workers are called upon to create transformative change, not just in their practice, but within the community, and the world at large by working for transgender rights and legislation in child welfare, housing, schools, and jobs.

This research indicated that education for social workers is not enough to address the needs of transgender youth in child welfare; trauma informed and gender affirming households were also identified as critical needs. An affirming home is not enough, if trauma behaviors are not well understood. Likewise, trauma informed homes are not safe spaces, if diverse gender identities and expressions are not affirmed. Caregivers need direct support and access to resources, in addition to education, to create caring and nurturing households for transgender youth.

Though the interviews indicated a desire to help transgender youth in foster care, it is clear that more training is necessary to provide social workers with the tools, education, and comfort they need in order to practice competent social work, as mandated by the National Association of Social Workers (NASW) Code of Ethics. It is the role of the child welfare social worker to provide a safe space for all youth, and to seek to identify and address any trauma they may have experienced, while making certain more trauma is not visited upon them while in care.

Recommendations for Future Research

Research on gender identity issues often centers around adults, and rarely focuses on youth and adolescents. Likewise, the professionals that work with transgender

56 individuals are seldom the focus of academic study. Future analysis should focus on affirming social work practices and home environments, as well as on the implicit bias and gendered beliefs held in Westernized society. This researcher feels that future research should include the voices of transgender youth and adolescents currently in care, as well as the resource families who provide homes for transgender foster youth, which particular focus on the intersection of religion, culture, and transgender individuals.

Mixed methods research, utilizing anonymous surveys and semi-structured interviews would give a fuller picture of the attitudes and beliefs the research participants held.

Study limitations

While this study provides insights and highlights the need for additional research, there were limitations that affected the research and subsequent findings. This study had a sample size of six social workers, which does not provide a broad enough view of the experience of social workers in child welfare to generalize the findings. All social workers practiced in Northern California, creating a small geographic location within which these experiences were located. Though Northern California is typically more conservative, and at times rural, California is considered a more progressive state, and has numerous protections in place for transgender foster youth in comparisons to child welfare systems in other parts of the country.

In addition to the small sample size, perceived social desirability impacts the way in which people answer questions, and it is possible the participants in this study did not answer truthfully, in an attempt to be viewed positively and as competent in their scope of practice. Given the topic of research and the face to face manner in which the

57 interview was conducted, participants may have felt uncomfortable or unwilling to assert negative views about transgender individuals.

Finally, this study was conducted by a cisgender researcher, and utilized only cisgender participants. In neglecting to capture transgender voices in this research, the cisgender voice continues to be the one that is heard the loudest. Another potential limitation of the study was the thematic analysis utilized by the researcher. This thematic analysis was shaped and restrained by the cisgender lens of this researcher. A richer, deeper understanding of cisgender privilege and other related topics would be possible with greater diversity in gender identities in the participants and researchers.

Conclusion

The results of this study provide valuable insight into the needs of social workers in child welfare working with transgender foster youth. Thematic analysis allowed this researcher to isolate key themes that indicate a need for greater training, starting from their academic education, and continuing regularly in their professional careers, as well as the need for greater education and supports for the caregivers of transgender foster youth.

Transgender individuals are deserving of the dignity, respect, understanding, and humanity afforded to cisgender individuals. The Western world in which we are socialized is heteronormative and gendered, and the process of learning sometimes includes a period of unlearning everything we thought we knew. In all six interviews, training was highlighted as a critical component in their ability to work effectively and ethically with transgender foster youth, but the social workers indicated the most valuable

58 training came from the relationships with the youth which cemented their understanding that these children needed love and support and understanding. Training must include not just a breaking down of the foundation of the fixedness of gender, but also an introduction to the stories and the voices of transgender men and women. For too many people, the only version they have of trans individuals comes from pop culture and media, which seeks to reinforce the heteronormative and cisnormative narrative that gender is fixed and transgender individuals are mentally ill or not “real” men or women.

This cultural representation of a group without personal experience, serves to define a group before the group can define themselves. It is no wonder that social workers report feeling inadequate in their first attempts to work with transgender foster youth.

Social workers in child welfare have a responsibility for the care and protection of the youth on their case load. Children in foster care have been removed from a home that was deemed unsafe, with the promise that they will be going somewhere better. For transgender youth, the family of origin may have been unsafe because of their gender identity. It is critical that the harm does not follow them into the new home, because if we allow transgender foster youth to continue to be abused and mistreated because of their gender identity, we are reinforcing the narrative that the problem lies within them, and not in the one who committed the harm. The understanding of the need, and the desire to do what is best for transgender youth, was evident in these interviews. As participant one stated, “these are our kids,” and social workers, and the institutions that train them, would do well to remember that.

APPENDIX A: RECRUITMENT EMAIL

Hello,

My name is Amanda Molteni and I am a social work graduate student at California State University, Sacramento. I am conducting research for my thesis about social workers in child welfare working with transgender youth. This study has been approved as an exempt study by the Division of Social Work Research Review Committee (DSWRCC). I am emailing to ask if you would like to take 30-60 minutes to participate in an interview for my research. Participation is completely voluntary and your answers will be kept completely anonymous.

If you are interested, please respond to this email, so that we may choose a mutually agreeable date and time to meet.

If you have any questions, please do not hesitate to contact me at [email protected], or my research advisor, Dr. Nylund at [email protected].

Thank you for your time,

Amanda Molteni She/her/hers MSW II Student

APPENDIX B: VERBAL CONSENT SCRIPT

“Hello, my name is Amanda Molteni, and I am a graduate student in the Masters of Social Work program at California State University, Sacramento and I am in undertaking research that will be used in my thesis.

I am studying the knowledge, attitudes and perceptions of social workers in child welfare, who are working with, or may work with in the future, transgender individuals. I am very interested in what you can share with me about your awareness of the unique needs and concerns that transgender youth and adolescents have, as well as any thoughts you have about working with this population, and training you have received or feel you would like to receive.

The information you share with me will be of great value in helping me to complete this research project, the results of which could significantly enhance our understanding any of training needs for social workers in child welfare.

This interview will take about 30-60 minutes of your time.

There is minimal risk of a breach of confidentiality. To minimize this risk, I will not link your name to anything you say, either in the transcript of this interview or in the text of my thesis or any other publications.

Your de-identified information will not be used or shared with other researchers.

There is a risk that hearing these questions, or the answers you give, may make you uncomfortable. If at any point you feel discomfort, you may ask to skip a question or end the interview.

Participation is voluntary. If you decide not to participate, there will be no penalty or loss of benefits to which you are otherwise entitled. You can, of course, decline to answer any question, as well as to stop participating at any time. If you choose to stop at any time, and/or would prefer your answers not be included in the final research, you have the right to request your interview not be used.

If you have any additional questions concerning this research or your participation in it, please feel free to contact me, my thesis supervisor or our university research office at any time.

I would like to make a recording of our discussion, so that I can have an accurate record of the information that you provide to me. I will transcribe that recording by hand, and will keep the transcripts confidential and securely in my possession. I will erase the recording after I transcribe it.

Do you have any questions about this research? Do you agree to participate? May I record our discussion? You may choose to still participate without audio recording, if you prefer.

APPENDIX C: INTERVIEW GUIDE

Demographics:

1. Pronouns/Gender identity 2. Educational attainment (bachelors, masters, LCSW) 3. Number of years in child welfare 4. Areas in child welfare worked 5. Current area in child welfare

Semi Structured Interview Guide:

1. How would you describe gender?

2. What does it mean to be transgender?

3. What training/education have you had in your formal education or on the job or that you’ve sought out on your own regarding gender identity?

a. What is your personal experience with gender identity?

4. How competent do you feel about working with transgender clients? a. Why do you think you feel that way? b. When considering your competence levels, is it roughly the same as far as general experience, physical needs, mental health needs, and legal advocacy and your ability to provide what is needed for trans clients and their families?

5. Are you familiar with AB2119? (provides, among other things, the right for foster youth to receive gender affirming health care) a. How do you feel about facilitating access to this for foster youth, i.e. hormones and sex reassignment surgeries?

6. What types of training and education do you feel you would like to have had or have in the future regarding gender identity?

7. Do you ask the gender identity or pronouns for your clients?

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