youth case study examples

Young people case studies

Case studies are an important way of gaining insight into individual young people’s experiences of custody and resettlement.

Theme: Transition to community

Adisa found it difficult to adjust to life outside after he was sentenced to custody when he was 16

Daniel had served a number of previous prison sentences. He talks about dealing with ‘freedom’

James’s project worker met him on his day of release to ease his anxieties about being in unfamiliar places and using public transport

Michael spent his 21st birthday on remand in prison. After being released straight from court, it took him some time to get used to a different routine

Theme: Trauma

Ash was referred to the vulnerable prisoner unit due to ongoing investigation into historic head injuries, following episodes of impulsive and erratic behaviour

Theme: Family

Curtis and his partner Emma both have experience of custody and drug dependence. Emma’s mum helps them look after their children

When Lance was younger, his family were supported by his local youth offending service (YOS). As an adult under probation, this no longer happens

Lee’s mum is under pressure to stop visiting him. He’s about to lose what family he has. Lee doesn’t know that yet

Shelley wouldn’t call her ex-friends a gang but some might see it like that. She had no family to speak of. As a care leaver, social services were supposed to support her – Shelley’s case worker showed her how to ask for what she needed

Tyler’s mum was scared of her son and the dangers he brought into their home. Tyler and a number of his associates were arrested for attacking another young man. The fall-out brought the situation to a head

Theme: Gangs

Rory was always fighting at school, which led to his exclusion. He felt more confident in a gang of peers

When Kaden was in a gang, he was respected and had money to spare. He’s now crime-free and aspires to be ‘a normal fella’. He could readily find a quick and easy way to ‘make ends meet’, but has so far resisted

On release from prison, Jordan required education or employment, housing outside of gang territory and support to comply with his licence agreement

Due to gang affiliation, Daniel was forbidden to return to his home area. His project worker introduced him to his new home town and helped him to establish tentative roots

While serving a custodial sentence, Aidan resolved to change his behaviour and “get out of the gang”. Once released, a resettlement project supported his choice

Theme: Diversity

Andrew has benefited from culturally appropriate counselling, advocacy and support and a multi-agency approach to his resettlement needs

Jason, from the Travellers’ community, arrived at HMP Ford unable to read and write. A culturally competent intervention helped him to keep in touch with his family

In prison, Faarooq met Muslims who, like him, had “trouble with the idea of citizenship”. Support in the community has shown Faarooq that he can “be a Muslim and a British Citizen and be proud of both”

Kwame, a Muslim of West Indian heritage, was offered a choice of resettlement projects; one reflected his interest in sport and fitness. When out jogging in the park with his case worker, Kwame opened up about his life, experiences, and hopes for the future

Peter is Black British, but never felt that he ‘fitted in’ or belonged. By the time he was 23, he had spent seven years of his life in custody. Peter has not been reconvicted in almost two years, and attributes much of his progress to his mentor

Lisa’s desire to use her time in custody positively and take part in education enabled her to secure employment upon release. Her relationship with prison staff and positive attitude led her to be deemed suitable for release on temporary licence (ROTL) that helped secure her qualifications and employment

Concerns about the high risk of harm relating to Jon’s gang-affiliation meant that he needed to be relocated upon release.

After being relocated upon release from prison because of his gang-association, Aaron felt lonely and isolated. He needed through the gate support to help him through this challenging time.

Would Jake fall back on his previous bad ways while living in a hostel?

“The first two weeks is the test. [It] proves whether someone is going to re-offend or not.”

How Kayleigh overcame her uncomfortable feelings after being released from custody

Theme: Young women and girls

After being released on temprorary license, Linda knew what she wanted – she just didn’t know how to achieve her goal. Linda’s mentor helped her make the necessary practical steps to achieve her dream of going to univeristy.

Sarah was shy and found it hard to trust people after having been let down frequently in the past. After her release from prison, a mentor slowly gained her trust by attending dance classes with her, and helped her with job and grant applications. Sara has since had a number of interviews.

After being granted release on temporary licence from her prison sentence, Dina used the opportunity to meet with her mentor and work to create personal goals which have helped turn her life around.

Adam has ADHD. His home life had been particularly difficult and traumatic. When he was released from Youth Offenders he needed a high level of support and encouragement in order to turn his life around.

Ches had an emotionally traumatic upbringing. His offending behaviour began when he was 13 years old. He has ADHD and has found it difficult to resist peer pressure

Darren grew up in an environment where committing crime was something to aspire to. The local Police classed him as a Priority Prolific Offender or PPO. With time and effort he managed to completely change the way that he led his life and is now working full-time and is crime free.

Jack’s persistent offending was connected to his misuse of drugs and the lifestyle that accompanied him on a modern housing estate. He is trying to make a break with his past and find full-time training and employment.

Jason witnessed drug-taking by his parents from an early age. On release from custody he had a restrictive curfew in addition to high intensive supervision at the YOT. He faced problems with finding a place to live and his paranoia and poor mental health didn’t make it easy for him to live in a hostel-type environment in the meantime.

Katy’s troubled home life led her to develop a significant drug habit which quickly developed into an addiction. Katy witnessed the violent death of her boyfriend. She began to get more and more involved in criminal activity in order to buy the drugs she needed to block out the emotional hurt and associated bad memories.

Martin formed a bond with the YIF resettlement team which was helped by them bringing him some lunch on the day of his release from YOI. He tried hard to engage in the programme of activities that was provided. Progress was gradual, however he managed to deal with some of the issues which had previously been a problem in his life.

Matthew had an extensive criminal history when he was referred to the YIF project via Probation. He had a history of mental problems which included self-harm. He admits that his crimes were often committed under the influence of alcohol, although accessing the support services that he needed was often the biggest problem that he faced in terms of not reoffending.

When Petey was seven years old his substance misusing father used to give him amphetamines which made it difficult for him to concentrate at school. As he got older, Petey spent time living in care and later on he spent time in custody for violent offences. Eventually he became homeless whilst also suffering from psychiatric illness.

Sean drifted into criminal behaviour with a group of his friends. After he left school he was dealing drugs and he thought that he wouldn’t get caught. After serving a custodial sentence he became involved with the YIF project and within a year was a peer mentor and role model for others.

Steven was considered to be at medium risk of reoffending when he was released from his first custodial sentence. Without a strong network of family and friends, he found resettlement quite difficult. In addition, Steven struggled with substance misuse and mental health problems.

Wayne came out of YOI and went straight into a job that had been organised for him by the YOT. After this particular work had dried up Wayne was able to get involved with a bike project which led to his participation in the Coast to Coast race for charity. He has not reoffended and has become involved with some peer mentoring.

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Resettlement of young offenders: informing practice, improving outcomes

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Story-telling in Youth Work

Case study 1

THE VERY FIRST MOVES IN INVOLVING YOUTH CLUB MEMBERS IN SETTING UP A LOCAL YOUTH FORUM

The workshop group was made up of two local youth workers, three students on a youth and community work qualifying course and three of the course tutors. All but one were women. Two were black. The facilitator was a white man.

The worker whose story is the basis of this case study was very new to the youth club concerned when the events she describes occurred.

The case study focuses on two areas opened up for analysis and debate by the group’s ‘unpicking’ of the story.

THE YOUTH WORKER’S STORY

My overall aim when I started out was to get together a group of young people to take action on issues affecting them in their area. I hoped that doing this would eventually encourage them to form a local youth forum. As I was new to the club I had to start from scratch in making contact with the young people there and building up some sort of relationship with them.

My very first attempt to do this was on one of the first evenings I was in the club. I noticed a small group – three girls and a boy – chatting round a table in the coffee bar and decided to approach them. I walked across the room and introduced myself and started a conversation with them. I told them that I’d grown up in the area and that my family still lived there. I asked them what they thought of the area and had they any concerns about it. After a while I tried to test out whether they’d be interested in doing anything about any of the things they mentioned.

‘UNPICKING’ THE STORY

A. Negotiating the very first moments of a contact

Youth worker: I walked across the room (to the young people) …

Focusing in on this single sentence in the worker’s narration brought to the surface some potentially significant features of the practice which she seemed to have largely taken for granted:

• She had made this approach to four young people who did not know her – an action which in everyday life would be unusual and even perhaps socially risky. Nonetheless, she‘d just assumed that it was a ‘given’ element of her practice as a youth worker.
• In making that ‘journey’ of just a few feet, she’d had to deal with the kinds of tensions and uncertainties which anyone launching themselves onto a group of strangers was likely to feel.
• These feelings were likely to be sharpened by the fact that her action wasn’t just a casual or random one. It was made with the deliberate aim of starting a planned longer-term piece of work which, to succeed, would have to prompt interest and eventually motivation in the young people.
• The youth worker’s mind was concentrated, too, by the knowledge that the young people were there by choice, probably mainly to spend ‘free’ time with each other. She therefore had to make her move knowing that, however politely or even perhaps non-verbally, they might choose to tell her where to go – a response, she accepted, which they’d be fully entitled to make.
• why she had ‘automatically’ chosen to use her first name;
• whether there were any implicit assumptions in doing that about, say, how she wished to be seen by the young people or about the kind of power relationship she assumed she would have with them – and which she needed to convey to them.
• Group questioning also revealed that even before she made the approach to the young people, she had made a tentative reading of their relationships with each other so that, when she opened the conversation, she sought eye contact with the one boy in the group because, she’d concluded, he seemed – seemed – to be the shyest of the four.

B.  Exploring the personal-‘professional’ boundary  

Youth worker: I told them I’d grown up in the area (of the club) and that my family still lived there.

The group’s ‘unpicking’ of this passing comment brought to the surface for explicit debate some significant issues about the existence and nature of personal-‘professional’ boundaries in youth work. Though it was recognised that what was shared didn’t involve any particularly intimate personal disclosures, broad agreement emerged that:

• As in other practices, such boundaries existed and needed to be observed in youth work.
• For youth workers, however, they were often, and often needed to be, more permeable – because, for example, if young people were to be willing to share something of their more private selves in what was an entirely voluntary relationship with the youth worker, they needed to see something of ‘the real person’ in that worker.
• Here, too, the offer of even ‘low key’ personal information of this kind, at least potentially, conveyed an important message about the worker’s openness to a more equal power relationship with the young person – as evidenced for example when young people say of youth workers –‘they treat us like adults’.  

POSSIBLE DISCUSSION POINTS

Was this youth work?

If so how – for example when tested against IDYW’s ‘cornerstones’ of youth work as outlined in the workshop programme? (See Story-telling workshop programme: a template )

Some possible links to the IDYW ‘cornerstones’

• In setting herself the long-term goal of helping to set up an area youth forum with young people, the worker made explicit her overall understanding of youth work as informal education .
• However, as her tentative first approach to the young people in the club showed, she took their voluntary involvement in the club and its activities as a given. It also demonstrated her assumption that her engagement with them would be in and through their peer networks.
• In beginning by asking the young people: ‘So what do you think about the area where you live?’, the worker also assumed that any educational opportunities that developed would start from young people own agendas, some (perhaps most) of which would prioritise issues in their here-and-now.
• This starting point also seemed to recognise youth work as a democratic practice which would seek to tip balances of power in young people’s favour.  
• At least implicitly, the discussion about boundaries took as its starting point youth work’s commitment to developing mutually trusting and respectful relationships with … young people .
• In combination, the worker’s strategic aim to help set up an area youth forum and her ‘on-the-spot’ decision to address her first comments to the young man in the group could be seen as an example of youth work as an improvisatory yet rehearsed … practice.

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• Children's mental health case studies
• Parenting and caregiving
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Explore the experiences of children and families with these interdisciplinary case studies. Designed to help professionals and students explore the strengths and needs of children and their families, each case presents a detailed situation, related research, problem-solving questions and feedback for the user. Use these cases on your own or in classes and training events

Each case study:

• Explores the experiences of a child and family over time.
• Introduces theories, research and practice ideas about children's mental health.
• Shows the needs of a child at specific stages of development.
• Invites users to “try on the hat” of different specific professionals.

By completing a case study participants will:

• Examine the needs of children from an interdisciplinary perspective.
• Recognize the importance of prevention/early intervention in children’s mental health.
• Apply ecological and developmental perspectives to children’s mental health.
• Predict probable outcomes for children based on services they receive.

Case studies prompt users to practice making decisions that are:

• Research-based.
• Practice-based.
• Best to meet a child and family's needs in that moment.

Children’s mental health service delivery systems often face significant challenges.

• Services can be disconnected and hard to access.
• Stigma can prevent people from seeking help.
• Parents, teachers and other direct providers can become overwhelmed with piecing together a system of care that meets the needs of an individual child.
• Professionals can be unaware of the theories and perspectives under which others serving the same family work
• Professionals may face challenges doing interdisciplinary work.
• Limited funding promotes competition between organizations trying to serve families.

These case studies help explore life-like mental health situations and decision-making. Case studies introduce characters with history, relationships and real-life problems. They offer users the opportunity to:

• Examine all these details, as well as pertinent research.
• Make informed decisions about intervention based on the available information.

The case study also allows users to see how preventive decisions can change outcomes later on. At every step, the case content and learning format encourages users to review the research to inform their decisions.

Each case study emphasizes the need to consider a growing child within ecological, developmental, and interdisciplinary frameworks.

• Ecological approaches consider all the levels of influence on a child.
• Developmental approaches recognize that children are constantly growing and developing. They may learn some things before other things.
• Interdisciplinary perspectives recognize that the needs of children will not be met within the perspectives and theories of a single discipline.

There are currently two different case students available. Each case study reflects a set of themes that the child and family experience.

The About Steven case study addresses:

• Adolescent depression.
• School mental health.
• Rural mental health services.
• Social/emotional development.

The Brianna and Tanya case study reflects themes of:

• Infant and early childhood mental health.
• Educational disparities.
• Trauma and toxic stress.
• Financial insecurity.
• Intergenerational issues.

The case studies are designed with many audiences in mind:

Practitioners from a variety of fields. This includes social work, education, nursing, public health, mental health, and others.

Professionals in training, including those attending graduate or undergraduate classes.

The broader community.

Each case is based on the research, theories, practices and perspectives of people in all these areas. The case studies emphasize the importance of considering an interdisciplinary framework. Children’s needs cannot be met within the perspective of a single discipline.

The complex problems children face need solutions that integrate many and diverse ways of knowing. The case studies also help everyone better understand the mental health needs of children. We all have a role to play.

These case has been piloted within:

Graduate and undergraduate courses.

Discipline-specific and interdisciplinary settings.

Professional organizations.

Currently, the case studies are being offered to instructors and their staff and students in graduate and undergraduate level courses. They are designed to supplement existing course curricula.

Instructors have used the case study effectively by:

• Assigning the entire case at one time as homework. This is followed by in-class discussion or a reflective writing assignment relevant to a course.
• Assigning sections of the case throughout the course. Instructors then require students to prepare for in-class discussion pertinent to that section.
• Creating writing, research or presentation assignments based on specific sections of course content.
• Focusing on a specific theme present in the case that is pertinent to the course. Instructors use this as a launching point for deeper study.
• Constructing other in-class creative experiences with the case.
• Collaborating with other instructors to hold interdisciplinary discussions about the case.

To get started with a particular case, visit the related web page and follow the instructions to register. Once you register as an instructor, you will receive information for your co-instructors, teaching assistants and students. Get more information on the following web pages.

• Brianna and Tanya: A case study about infant and early childhood mental health
• About Steven: A children’s mental health case study about depression

Cari Michaels, Extension educator

Reviewed in 2023

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Case studies on youth employment in fragile situations

September 20, 2017.

Under the aegis of the Global Initiative on Decent Jobs for Youth , this joint report by ILO, UNDP and UNHCR presents examples of good practices from around the world, showcasing innovative approaches to youth employment that help to build peace and resilience in fragile and conflict affected situations.

The 2030 Agenda for Sustainable Development places decent work at the heart of policies for sustainable and inclusive development, and recognizes youth as critical agents of change. Empowered young women and men play a vital role in preventing conflicts and ensuring sustainable peace. Young people are at the forefront as innovators, entrepreneurs, leaders, activists and positive agents of change, and they need the recognition and support of governments, UN agencies, civil society and private sector partners. The Global Initiative on Decent Jobs for Youth recognizes the potential of young people, as well as the challenges that they face in relation to jobs and employment. It is the first-ever comprehensive U.N. system-wide effort to promote youth employment worldwide and a core means of implementing the 2030 Agenda for Sustainable Development. Investing in youth employment in fragile and conflict situations is a priority for advancing societies towards peaceful and inclusive development.

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JALE3904 Youth Justice

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Case Study 2024, T1

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Note: R (Stands for Rex/Regina/The Crown) or The Queen in the party names. This indicates that it is a  criminal case. DPP, CDPP or Director of Public Prosecutions - may also indicate that it is a criminal case. Children's names are not published. Their initials are used instead.

• Court Judgments NSW Click on the link above > Select Children's Court from the check boxes in the lower section of the page and type the word criminal in the free-text box.
• Children's Court of QLD Look for R (Stands for Rex/Regina/The Crown) or The Queen in the party names. These indicate criminal cases. Note: Children's names are not published. Their initials are used instead.
• Children's Court of Victoria Click on the link above > Select criminal division > Browse for cases. Note: Children's names are not published. Their initials are used instead.
• Children's Court of WA
• TSM (A Child) [2019] WASCA 79 Anyone referred to by their initials was underage at the time of this offence.
• PRM (a child) [2019] WASC 139
• News from Google Click on the link above > Search for the following: - After a life of neglect, he was the youngest Australian charged with murder.
• Report: Doing Time - Time for Doing: Indigenous youth in the criminal justice system. House Standing Committee on Aboriginal and Torres Strait Islander Affairs. (2011). Doing Time - Time for Doing: Indigenous youth in the criminal justice system. Parliament of Australia
• Keyword Searching on Ebook Central Click on the link above > Log in using your ACAP student portal log in details > Try the following keyword searches: - Juvenile Justice: Youth and Crime in Australia (see ch. 2 & 10) - Crime and Justice: A Guide to Criminology (see chapter on youth and crime) - Crime, Criminality and Criminal Justice eBook (ch. 19) - Australia's Children's Courts Today and Tomorrow - Youth, Crime, and Justice : Learning through Cases (contains lots of case study examples - see table of contents (read to see how they have structured/presented these cases)). Click on the book title and then click on read online to open a book. When you open the book, if the table contents are messy, click on the iii lying on the side (above the star - upper left) to reset the table of contents.
• Articles on AustLII Click on the link above > Search for the following article (a few articles should appear for this search): - "three dogmas of juvenile justice" Try the following keyword search on AustLII: "youth justice" AND rehabilitation AND Australia
• Keyword Searching on SAGE Click on the link above > Log in using your ACAP student portal Login details > Ensure the 'Only content to which I have full access' button is selected > Try the following keyword search: sentencing juveniles AND Australia juvenile justice AND Australia
• Australian Institute of Criminology Click on the link above > Try the following keyword search: sentencing juveniles juveniles AND indictable Search for the following article on the AIC website: - What makes juvenile offenders different from adult offenders
• Keyword Searching on Taylor & Francis Click on the link above and log in using your ACAP Student Portal login details > Try the following keyword searches: "juvenile detention" Australia juveniles sentencing Australia youth sentencing "foetal alcohol" youth justice principles Australia "youth justice" rehabilitation Australia After the results have loaded, click on the 'Only show content I have full access to' box on the left and wait for the results to reload. Search for the following article: - Principles in diversion of Aboriginal and Torres Strait Islander young people from the criminal jurisdiction
• AIHW: Children and crime Australian Institute of Health and Welfare. (2022, February 25). Australia's children: Children and crime.
• AIHW: Youth Justice
• AIC: Juvenile offenders
• Report: Doing Time - Time for Doing_ Indigenous youth in the criminal justice system House Standing Committee on Aboriginal and Torres Strait Islander Affairs. (2011). Doing Time - Time for Doing: Indigenous youth in the criminal justice system. Parliament of Australia
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Trauma and Early Adolescent Development: Case Examples from a Trauma-Informed Public Health Middle School Program

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Jason Scott Frydman, Christine Mayor, Trauma and Early Adolescent Development: Case Examples from a Trauma-Informed Public Health Middle School Program, Children & Schools , Volume 39, Issue 4, October 2017, Pages 238–247, https://doi.org/10.1093/cs/cdx017

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Middle-school-age children are faced with a variety of developmental tasks, including the beginning phases of individuation from the family, building peer groups, social and emotional transitions, and cognitive shifts associated with the maturation process. This article summarizes how traumatic events impair and complicate these developmental tasks, which can lead to disruptive behaviors in the school setting. Following the call by Walkley and Cox for more attention to be given to trauma-informed schools, this article provides detailed information about the Animating Learning by Integrating and Validating Experience program: a school-based, trauma-informed intervention for middle school students. This public health model uses psychoeducation, cognitive differentiation, and brief stress reduction counseling sessions to facilitate socioemotional development and academic progress. Case examples from the authors’ clinical work in the New Haven, Connecticut, urban public school system are provided.

Within the U.S. school system there is growing awareness of how traumatic experience negatively affects early adolescent development and functioning ( Chanmugam & Teasley, 2014 ; Perfect, Turley, Carlson, Yohannan, & Gilles, 2016 ; Porche, Costello, & Rosen-Reynoso, 2016 ; Sibinga, Webb, Ghazarian, & Ellen, 2016 ; Turner, Shattuck, Finkelhor, & Hamby, 2017 ; Woodbridge et al., 2016 ). The manifested trauma symptoms of these students have been widely documented and include self-isolation, aggression, and attentional deficit and hyperactivity, producing individual and schoolwide difficulties ( Cook et al., 2005 ; Iachini, Petiwala, & DeHart, 2016 ; Oehlberg, 2008 ; Sajnani, Jewers-Dailley, Brillante, Puglisi, & Johnson, 2014 ). To address this vulnerability, school social workers should be aware of public health models promoting prevention, data-driven investigation, and broad-based trauma interventions ( Chafouleas, Johnson, Overstreet, & Santos, 2016 ; Johnson, 2012 ; Moon, Williford, & Mendenhall, 2017 ; Overstreet & Chafouleas, 2016 ; Overstreet & Matthews, 2011 ). Without comprehensive and effective interventions in the school setting, seminal adolescent developmental tasks are at risk.

This article follows the twofold call by Walkley and Cox (2013) for school social workers to develop a heightened awareness of trauma exposure's impact on childhood development and to highlight trauma-informed practices in the school setting. In reference to the former, this article will not focus on the general impact of toxic stress, or chronic trauma, on early adolescents in the school setting, as this work has been widely documented. Rather, it begins with a synthesis of how exposure to trauma impairs early adolescent developmental tasks. As to the latter, we will outline and discuss the Animating Learning by Integrating and Validating Experience (ALIVE) program, a school-based, trauma-informed intervention that is grounded in a public health framework. The model uses psychoeducation, cognitive differentiation, and brief stress reduction sessions to promote socioemotional development and academic progress. We present two clinical cases as examples of trauma-informed, school-based practice, and then apply their experience working in an urban, public middle school to explicate intervention theory and practice for school social workers.

Impact of Trauma Exposure on Early Adolescent Developmental Tasks

Social development.

Impact of Trauma on Early Adolescent Development

Traumatic experiences may create difficulty with developing and differentiating another person's point of view (that is, mentalization) due to the formation of rigid cognitive schemas that dictate notions of self, others, and the external world ( Frydman & McLellan, 2014 ). For early adolescents, the ability to diversify a single perspective with complexity is central to modulating affective experience. Without the capacity to diversify one's perspective, there is often difficulty differentiating between a nonthreatening current situation that may harbor reminders of the traumatic experience and actual traumatic events. Incumbent on the school social worker is the need to help students understand how these conflicts may trigger a memory of harm, abandonment, or loss and how to differentiate these past memories from the present conflict. This is of particular concern when these reactions are conflated with more common middle school behaviors such as withdrawing, blaming, criticizing, and gossiping ( Card, Stucky, Sawalani, & Little, 2008 ).

Encouraging cognitive discrimination is particularly meaningful given that the second social developmental task for early adolescents is the re-orientation of their primary relationships with family toward peers ( Henderson & Thompson, 2010 ). This shift may become complicated for students facing traumatic stress, resulting in a stunted movement away from familiar connections or a displacement of dysfunctional family relationships onto peers. For example, in the former, a student who has witnessed and intervened to protect his mother from severe domestic violence might believe he needs to sacrifice himself and be available to his mother, forgoing typical peer interactions. In the latter, a student who was beaten when a loud, intoxicated family member came home might become enraged, anxious, or anticipate violence when other students raise their voices.

Cognitive Development and Emotional Regulation

During normative early adolescent development, the prefrontal cortex undergoes maturational shifts in cognitive and emotional functioning, including increased impulse control and affect regulation ( Wigfield, Lutz, & Wagner, 2005 ). However, these developmental tasks can be negatively affected by chronic exposure to traumatic events. Stressful situations often evoke a fear response, which inhibits executive functioning and commonly results in a fight-flight-freeze reaction. If a student does not possess strong anxiety management skills to cope with reminders of the trauma, the student is prone to further emotional dysregulation, lowered frustration tolerance, and increased behavioral problems and depressive symptoms ( Iachini et al., 2016 ; Saltzman, Steinberg, Layne, Aisenberg, & Pynoos, 2001 ).

Typical cognitive development in early adolescence is defined by the ambiguity of a transitional stage between childhood remedial capacity and adult refinement ( Casey & Caudle, 2013 ; Van Duijvenvoorde & Crone, 2013 ). Casey and Caudle (2013) found that although adolescents performed equally as well as, if not better than, adults on a self-control task when no emotional information was present, the introduction of affectively laden social cues resulted in diminished performance. The developmental challenge for the early adolescent then is to facilitate the coordination of this ever-shifting dynamic between cognition and affect. Although early adolescents may display efficient and logically informed behaviors, they may struggle to sustain these behaviors, especially in the presence of emotional stimuli ( Casey & Caudle, 2013 ; Van Duijvenvoorde & Crone, 2013 ). Because trauma often evokes an emotional response ( Johnson & Lubin, 2015 ), these findings insinuate that those early adolescents who are chronically exposed will have ongoing regulation difficulties. Further empirical findings considering the cognitive effects of trauma exposure on the adolescent brain have highlighted detriments in working memory, inhibition, memory, and planning ability ( Moradi, Neshat Doost, Taghavi, Yule, & Dalgleish, 1999 ).

Using a Public Health Framework for School-Based, Trauma-Informed Services

The need for a more informed and comprehensive approach to addressing trauma within the schools has been widely articulated ( Chafouleas et al., 2016 ; Durlak, Weissberg, Dymnicki, Taylor, & Schellinger, 2011 ; Jaycox, Kataoka, Stein, Langley, & Wong, 2012 ; Overstreet & Chafouleas, 2016 ; Perry & Daniels, 2016 ). Overstreet and Matthews (2011) suggested that using a public health model to address trauma in schools will promote prevention, early identification, and data-driven investigation and yield broad-based intervention on a policy and communitywide level. A public health approach focuses on developing interventions that address the underlying causal processes that lead to social, emotional, and cognitive maladjustment. Opening the dialogue to the entire student body, as well as teachers and administrators, promotes inclusion and provides a comprehensive foundation for psychoeducation, assessment, and prevention.

ALIVE: A Comprehensive Public Health Intervention for Middle School Students

Note: ALIVE = Animating Learning by Integrating and Validating Experience.

Psychoeducation

The classroom is a place traditionally dedicated to academic pursuits; however, it also serves as an indicator of trauma's impact on cognitive functioning evidenced by poor grades, behavioral dysregulation, and social turbulence. ALIVE practitioners conduct weekly trauma-focused dialogues in the classroom to normalize conversations addressing trauma, to recruit and rehearse more adaptive cognitive skills, and to engage in an insight-oriented process ( Sajnani et al., 2014 ).

Using a parable as a projective tool for identification and connection, the model helps students tolerate direct discussions about adverse experiences. The ALIVE practitioner begins each academic year by telling the parable of a woman named Miss Kendra, who struggled to cope with the loss of her 10-year-old child. Miss Kendra is able to make meaning out of her loss by providing support for schoolchildren who have encountered adverse experiences, serving as a reminder of the strength it takes to press forward after a traumatic event. The intention of this parable is to establish a metaphor for survival and strength to fortify the coping skills already held by trauma-exposed middle school students. Furthermore, Miss Kendra offers early adolescents an opportunity to project their own needs onto the story, creating a personalized figure who embodies support for socioemotional growth.

Following this parable, the students’ attention is directed toward Miss Kendra's List, a poster that is permanently displayed in the classroom. The list includes a series of statements against adolescent maltreatment, comprehensively identifying various traumatic stressors such as witnessing domestic violence; being physically, verbally, or sexually abused; and losing a loved one to neighborhood violence. The second section of the list identifies what may happen to early adolescents when they experience trauma from emotional, social, and academic perspectives. The practitioner uses this list to provide information about the nature and impact of trauma, while modeling for students and staff the ability to discuss difficult experiences as a way of connecting with one another with a sense of hope and strength.

Furthermore, creating a dialogue about these issues with early adolescents facilitates a culture of acceptance, tolerance, and understanding, engendering empathy and identification among students. This fostering of interpersonal connection provides a reparative and differentiated experience to trauma ( Hartling & Sparks, 2008 ; Henderson & Thompson, 2010 ; Johnson & Lubin, 2015 ) and is particularly important given the peer-focused developmental tasks of early adolescence. The positive feelings evoked through classroom-based conversation are predicated on empathic identification among the students and an accompanying sense of relief in understanding the scope of trauma's impact. Furthermore, the consistent appearance of and engagement by the ALIVE practitioner, and the continual presence of Miss Kendra's list, effectively counters traumatically informed expectations of abandonment and loss while aligning with a public health model that attends to the impact of trauma on a regular, systemwide basis.

Participatory and Somatic Indicators for Informal Assessment during the Psychoeducation Component of the ALIVE Intervention

Notes: ALIVE = Animating Learning by Integrating and Validating Experience. Examples are derived from authors’ clinical experiences.

In addition to behavioral symptoms, the content of conversation is considered. All practitioners in the ALIVE program are mandated reporters, and any content presented that meets criteria for suspicion of child maltreatment is brought to the attention of the school leadership and ALIVE director. According to Johnson (2012) , reports of child maltreatment to the Connecticut Department of Child and Family Services have actually decreased in the schools where the program has been implemented “because [the ALIVE program is] catching problems well before they have risen to the severity that would require reporting” (p. 17).

Case Example 1

The following demonstrates a middle school classroom psychoeducation session and assessment facilitated by an ALIVE practitioner (the first author). All names and identifying characteristics have been changed to protect confidentiality.

Ms. Skylar's seventh grade class comprised many students living in low-income housing or in a neighborhood characterized by high poverty and frequent criminal activity. During the second week of school, I introduced myself as a practitioner who was here to speak directly about difficult experiences and how these instances might affect academic functioning and students’ thoughts about themselves, others, and their environment.

After sharing the Miss Kendra parable and list, I invited the students to share their thoughts about Miss Kendra and her journey. Tyreke began the conversation by wondering whether Miss Kendra lost her child to gun violence, exploring the connection between the list and the story and his own frequent exposure to neighborhood shootings. To transition a singular connection to a communal one, I asked the students if this was a shared experience. The majority of students nodded in agreement. I referred the students back to the list and asked them to identify how someone's school functioning or mood may be affected by ongoing neighborhood gun violence. While the students read the list, I actively monitored reactions and scanned for inattention and active avoidance. Performing both active facilitation of discussion and monitoring students’ reactions is critical in accomplishing the goals of providing quality psychoeducation and identifying at-risk students for intervention.

After inspection, Cleo remarked that, contrary to a listed outcome on Miss Kendra's list, neighborhood gun violence does not make him feel lonely; rather, he “doesn't care about it.” Slumped down in his chair, head resting on his crossed arms on the desk in front of him, Cleo's body language suggested a somatized disengagement. I invited other students to share their individual reactions. Tyreke agreed that loneliness is not the identified affective experience; rather, for him, it's feeling “mad or scared.” Immediately, Greg concurred, expressing that “it makes me more mad, and I think about my family.”

Encouraging a variety of viewpoints, I stated, “It sounds like it might make you mad, scared, and may even bring up thoughts about your family. I wonder why people have different reactions?” Doing so moved the conversation into a phase of deeper reflection, simultaneously honoring the students’ voiced experience while encouraging critical thinking. A number of students responded by offering connections to their lives, some indicating they had difficulty identifying feelings. I reflected back, “Sometimes people feel something, but can't really put their finger on it, and sometimes they know exactly how they feel or who it makes them think about.”

I followed with a question: “How do you think it affects your schoolwork or feelings when you're in school?” Greg and Natalia both offered that sometimes difficult or confusing thoughts can consume their whole day, even while in class. Sharon began to offer a related comment when Cleo interrupted by speaking at an elevated volume to his desk partner, Tyreke. The two began to snicker and pull focus. By the time they gained the class's full attention, Cleo was openly laughing and pushing his chair back, stating, “No way! She DID!? That's crazy”; he began to stand up, enlisting Tyreke in the process. While this disruption may be viewed as a challenge to the discussion, it is essential to understand all behavior in context of the session's trauma content. Therefore, Cleo's outburst was interpreted as a potential avenue for further exploration of the topic regarding gun violence and difficulties concentrating. In turn, I posed this question to the class: “Should we talk about this stuff? I wonder if sometimes people have a hard time tolerating it. Can anybody think of why it might be important? Sharon, I think you were saying something about this.” While Sharon continued to share, Cleo and Tyreke gradually shifted their attention back to the conversation. I noted the importance of an individual follow-up with Cleo.

Natalia jumped back in the conversation, stating, “I think we talk about stuff like this so we know about it and can help people with it.” I checked in with the rest of the class about this strategy for coping with the impact of trauma exposure on school functioning: “So it sounds like these thoughts have a pretty big impact on your day. If that's the case, how do you feel less worried or mad or scared?” Marta quickly responded, “You could talk to someone.” I responded, “Part of my job here is to be a person to talk to one-on-one about these things. Hopefully, it will help you feel better to get some of that stuff off your chest.” The students nodded, acknowledging that I would return to discuss other items on the list and that there would be opportunities to check in with me individually if needed.

On reflection, Cleo's disruption in the discussion may be attributed to his personal difficulty emotionally managing intrusive thoughts while in school. This clinical assumption was not explicitly named in the moment, but was noted as information for further individual follow-up. When I met individually with Cleo, Cleo reported that his cousin had been shot a month ago, causing him to feel confused and angry. I continued to work with him individually, which resulted in a reduction of behavioral disruptions in the classroom.

In the preceding case example, the practitioner performed a variety of public health tasks. Foremost was the introduction of how traumatic experience may affect individuals and their relationships with others and their role as a student. Second, the practitioner used Miss Kendra and her list as a foundational mechanism to ground the conversation and serve as a reference point for the students’ experience. Finally, the practitioner actively monitored individual responses to the material as a means of identifying students who may require more support. All three of these processes are supported within the public health framework as a means toward assessment and early intervention for early adolescents who may be exposed to trauma.

Individualized Stress Reduction Intervention

Students are seen for individualized support if they display significant externalizing or internalizing trauma-related behavior. Students are either self-referred; referred by a teacher, administrator, or staff member; or identified by an ALIVE practitioner. Following the principle of immediate engagement based on emergent traumatic material, individual sessions are brief, lasting only 15 to 20 minutes. Using trauma-centered psychotherapy ( Johnson & Lubin, 2015 ), a brief inquiry addressing the current problem is conducted to identify the trauma trigger connected to the original harm, fostering cognitive discrimination. Conversation about the adverse experience proceeds in a calm, direct way focusing on differentiating between intrusive memories and the current situation at school ( Sajnani et al., 2014 ). Once the student exhibits greater emotional regulation, the ALIVE practitioner returns the student to the classroom in a timely manner and may provide either brief follow-up sessions for preventive purposes or, when appropriate, refer the student to more regular, clinical support in or out of the school.

Case Example 2

The following case example is representative of the brief, immediate, and open engagement with traumatic material and encouragement of cognitive discrimination. This intervention was conducted with a sixth grade student, Jacob (name and identifying information changed to ensure confidentiality), by an ALIVE practitioner (the second author).

I found Jacob in the hallway violently shaking a trash can, kicking the classroom door, and slamming his hands into the wall and locker. His teacher was standing at the door, distressed, stating, “Jacob, you need to calm down and go to the office, or I'm calling home!” Jacob yelled, “It's not fair, it was him, not me! I'm gonna fight him!” As I approached, I asked what was making him so angry, but he said, “I don't want to talk about it.” Rather than asking him to calm down or stop slamming objects, I instead approached the potential memory agitating him, stating, “My guess is that you are angry for a very good reason.” Upon this simple connection, he sighed and stopped kicking the trash can and slamming the wall. Jacob continued to demonstrate physical and emotional activation, pacing the hallway and making a fist; however, he was able to recount putting trash in the trash can when a peer pushed him from behind, causing him to yell. Jacob explained that his teacher heard him yelling and scolded him, making him more mad. Jacob stated, “She didn't even know what happened and she blamed me. I was trying to help her by taking out all of our breakfast trash. It's not fair.”

The ALIVE practitioner listens to students’ complaints with two ears, one for the current complaint and one for affect-laden details that may be connected to the original trauma to inquire further into the source of the trigger. Affect-laden details in case example 2 include Jacob's anger about being blamed (rather than toward the student who pushed him), his original intention to help, and his repetition of the phrase “it's not fair.” Having met with Jacob previously, I was aware that his mother suffers from physical and mental health difficulties. When his mother is not doing well, he (as the parentified child) typically takes care of the household, performing tasks like cooking, cleaning, and helping with his two younger siblings and older autistic brother. In the past, Jacob has discussed both idealizing his mother and holding internalized anger that he rarely expresses at home because he worries his anger will “make her sick.”

I know sometimes when you are trying to help mom, there are times she gets upset with you for not doing it exactly right, or when your brothers start something, she will blame you. What just happened sounds familiar—you were trying to help your teacher by taking out the garbage when another student pushed you, and then you were the one who got in trouble.

Jacob nodded his head and explained that he was simply trying to help.

I moved into a more detailed inquiry, to see if there was a more recent stressor I was unaware of. When I asked how his mother was doing this week, Jacob revealed that his mother's health had deteriorated and his aunt had temporarily moved in. Jacob told me that he had been yelled at by both his mother and his aunt that morning, when his younger brother was not ready for school. I asked, “I wonder if when the student pushed you it reminded you of getting into trouble because of something your little brother did this morning?” Jacob nodded. The displacement was clear: He had been reminded of this incident at school and was reacting with anger based on his family dynamic, and worries connected to his mother.

My guess is that you were a mix of both worried and angry by the time you got to school, with what's happening at home. You were trying to help with the garbage like you try to help mom when she isn't doing well, so when you got pushed it was like your brother being late, and then when you got blamed by your teacher it was like your mom and aunt yelling, and it all came flooding back in. The problem is, you let out those feelings here. Even though there are some similar things, it's not totally the same, right? Can you tell me what is different?

Jacob nodded and was able to explain that the other student was probably just playing and did not mean to get him into trouble, and that his teacher did not usually yell at him or make him worried. Highlighting this important differentiation, I replied, “Right—and fighting the student or yelling at the teacher isn't going to solve this, but more importantly, it isn't going to make your mom better or have your family go any easier on you either.” Jacob stated that he knew this was true.

I reassured Jacob that I could help him let out those feelings of worry and anger connected to home so they did not explode out at school and planned to meet again. Jacob confirmed that he was willing to do that. He was able to return to the classroom without incident, with the entire intervention lasting less than 15 minutes.

In case example 2, the practitioner was available for an immediate engagement with disturbing behaviors as they were happening by listening for similarities between the current incident and traumatic stressors; asking for specific details to more effectively help Jacob understand how he was being triggered in school; providing psychoeducation about how these two events had become confused and aiding him in cognitively differentiating between the two; and, last, offering to provide further support to reduce future incidents.

Germane to the practice of school social work is the ability to work flexibly within a public health model to attend to trauma within the school setting. First, we suggest that a primary implication for school social workers is not to wait for explicit problems related to known traumatic experiences to emerge before addressing trauma in the school, but, rather, to follow a model of prevention-assessment-intervention. School social workers are in a unique position within the school system to disseminate trauma-informed material to both students and staff in a preventive capacity. Facilitating this implementation will help to establish a tone and sharpened focus within the school community, norming the process of articulating and engaging with traumatic material. In the aforementioned classroom case example, we have provided a sample of how school social workers might work with entire classrooms on a preventive basis regarding trauma, rather than waiting for individual referrals.

Second, in addition to functional behavior assessments and behavior intervention plans, school social workers maintain a keen eye for qualitative behavioral assessment ( National Association of Social Workers, 2012 ). Using this skill set within a trauma-informed model will help to identify those students in need who may be reluctant or resistant to explicitly ask for help. As called for by Walkley and Cox (2013) , we suggest that using the information presented in Table 1 will help school social workers understand, identify, and assess the impact of trauma on early adolescent developmental tasks. If school social workers engage on a classroom level in trauma psychoeducation and conversations, the information in Table 3 may assist with assessment of children and provide a basis for checking in individually with students as warranted.

Third, school social workers are well positioned to provide individual targeted, trauma-informed interventions based on previous knowledge of individual trauma and through widespread assessment ( Walkley & Cox, 2013 ). The individual case example provides one way of immediately engaging with students who are demonstrating trauma-based behaviors. In this model, school social workers engage in a brief inquiry addressing the current trauma to identify the trauma trigger, discuss the adverse experience in a calm but direct way, and help to differentiate between intrusive memories and the current situation at school. For this latter component, the focus is on cognitive discrimination and emotional regulation so that students can reengage in the classroom within a short time frame.

Fourth, given social work's roots in collaboration and community work, school social workers are encouraged to use a systems-based approach in partnering with allied practitioners and institutions ( D'Agostino, 2013 ), thus supporting the public health tenet of establishing and maintaining a link to the wider community. This may include referring students to regular clinical support in or out of the school. Although the implementation of a trauma-informed program will vary across schools, we suggest that school social workers have the capacity to use a public health school intervention model to ecologically address the psychosocial and behavioral issues stemming from trauma exposure.

As increasing attention is being given to adverse childhood experiences, a tiered approach that uses a public health framework in the schools is necessitated. Nevertheless, there are some limitations to this approach. First, although the interventions outlined here are rooted in prevention and early intervention, there are times when formal, intensive treatment outside of the school setting is warranted. Second, the ALIVE program has primarily been implemented by ALIVE practitioners; the results from piloting this public health framework in other school settings with existing school personnel, such as school social workers, will be necessary before widespread replication.

The public health framework of prevention-assessment-intervention promotes continual engagement with middle school students’ chronic exposure to traumatic stress. There is a need to provide both broad-based and individualized support that seeks to comprehensively ameliorate the social, emotional, and cognitive consequences on early adolescent developmental milestones associated with traumatic experiences. We contend that school social workers are well positioned to address this critical public health issue through proactive and widespread psychoeducation and assessment in the schools, and we have provided case examples to demonstrate one model of doing this work within the school day. We hope that this article inspires future writing about how school social workers individually and systemically address trauma in the school system. In alignment with Walkley and Cox (2013) , we encourage others to highlight their practice in incorporating trauma-informed, school-based programming in an effort to increase awareness of effective interventions.

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• What Works in Youth Participation: Case Studies from Around the World

At a Glance

Point of contact.

The majority of the one billion young people, ages 15 to 24, who live on the planet today are leading healthy lives—studying, working, volunteering, and playing positive roles in their communities. Yet all too often, they are portrayed in a negative light. Media headlines emphasize drug and alcohol abuse among youth, teen pregnancy, the rise in youth gangs, or school dropout rates and often leave it at that. Even when the media’s message about youth is positive, it often conveys the idea that youth are "the leaders of tomorrow." As adults, we are encouraged to invest in the young today so that they will have the skills and resources they will need in the future. Such thinking obscures the fact that young people are already making solid contributions to others—tutoring younger children, protecting the environment, starting their own businesses, and leading new initiatives to improve their communities. Yet these contributions are frequently overlooked, with young voices going unheard. Even more regrettably, the vast potential for young people to further contribute to their communities goes largely untapped.

From the beginning, the International Youth Foundation (IYF) has pursued a positive approach to youth development that applies holistic strategies to the complex set of child and youth needs worldwide. This approach recognizes that we need to ensure young people develop the skills, values, and attitudes they need to succeed today, not just tomorrow. It also recognizes that young people are not problems to be solved, but problem solvers themselves. This paradigm emphasizes that youth are assets to the community, and active agents of change who can contribute their energy, idealism, and insights to a community’s growth and progress. They are not merely passive recipients of programs and support. That’s why IYF emphasizes programs and strategies that promote youth participation in schools, communities, and places of work. And that’s why we include youth participation as a key indicator of a youth program’s success. Yet as critical as youth participation is to the notion of positive youth development, it remains a subject that defies easy description. What does youth participation mean in different cultures? What inhibits or encourages youth participation? What attitudes do young people and adults hold when it comes to ensuring young people a greater voice in decision making? How does lack of access to technology hinder youth’s ability to participate on a national or global scale? What lessons have we learned from existing youth participation programs worldwide? These are some of the questions explored in this paper. Through the nine case studies highlighted there, each written by authors of different ages and perspectives, we can begin to see both the challenges and opportunities of engaging young people in meaningful ways in society.   

• About this Site

A guide for health professionals working with immigrant and refugee children and youth

• Navigating the Health System

Case Studies: Stories of children and youth new to Canada

Immigrant and refugee families may have faced considerable hardship and challenges before coming to Canada. When they arrive in Canada, they are faced with problems in several areas including language barriers, housing, access to local services, transportation problems, cultural differences, raising children, prejudice, isolation, and the weather. Part of the role of health professionals is to help newcomers integrate and adapt to their new lives.

The case studies in this section provide common examples of specific health issues that young newcomers to Canada and their families may face. These short vignettes are fictitious and based on the clinical experience of multiple contributors. They are intended to help clinicians become aware of such issues and how they can be addressed.  

Our thanks to the staff at the following organizations for their thoughtful review and comment on these vignettes:  Thorncliffe Neighbourhood Office , Immigrant Services Society of B.C.

A young child with possible tuberculosis and HIV/AIDS

Region of origin.

Central Africa

Background 

Some countries in Africa, Asia and other parts of the world continue to experience war, extreme poverty, child labour and child prostitution.

Nzuzi is a 6-month-old girl born in Canada. Her family arrived in Toronto from an African country that is at war internally. Her mother was 7 months pregnant, so she had no routine prenatal care.

For the past 2 weeks, Nzuzi has not been feeling well. She has a cough and low-grade fever. She is underweight, febrile (temperature 38.5°C) and tachypneic (respiratory rate 60 breaths/min) with fine crackles. She has an enlarged liver and spleen, and enlarged cervical lymph nodes. The differential diagnosis includes tuberculosis and HIV/AIDS.

Knowing that the rape of women in some of these countries by rebels is a common method of terrorizing local villages, how would you compassionately and carefully ask about the mother’s health and whether she might have been raped and infected with HIV?

In this case, although Nzuzi might simply have a pneumonia, given that the family is from Africa and the presence of hepatosplenomegaly, the most likely diagnoses are TB or HIV/AIDS. However, both diagnoses would mean contact from someone else, and for HIV/AIDS that would mean that Nzuzi’s mother would have HIV/AIDS. Her mother may or may not suspect or know she has HIV/AIDS. This problem must be approached carefully and compassionately. The mother will need to be referred to an adult centre for diagnosis and management.

Related information

• Tuberculosis

A young child with possible HIV/AIDS

Parents may be reluctant to have their child tested for certain illnesses, such as HIV and tuberculosis, because they fear results could adversely affect their immigration status. This fear usually leads to significant delay in seeking medical care for a sick child and therefore results in preventable deaths and unnecessary morbidity. Physicians should be knowledgeable of the family units of the parents and proactively ask about the other members who may not be present at visits.

Ateefa is an 18-month-old girl whose mother is from Malawi. Ateefa presents with a history suggestive of HIV/AIDS, but her parents refuse testing, fearing it might adversely affect their immigration status and put them at risk of deportation. You take the time to explain that diagnosing HIV would benefit Ateefa because she could start on antiretroviral therapy.

After extensive discussions through interpreters, the family agrees to testing and the child is started on antiretroviral therapy and appropriate preventive therapy for opportunistic infections. Two siblings are also tested and found to be HIV-negative, much to the relief of the parents.

Knowing that an 18-month-old child diagnosed with HIV means that the mother also has HIV, how do you approach the family and explain the need for HIV testing for the child as well as for all family members?

The problem is challenging. To start, the health care professional should explain the features of HIV/AIDS to the family, stressing how patients with HIV/AIDS in Canada are not shunned or scorned as they may be elsewhere. In Canada, people with HIV/AIDS can live a long, normal life with good and careful treatment. Physicians should be never ending advocates of new immigrants at the decision making tables to ensure that rules are made clear to immigrants and allay many unfounded information on immigration leading to unnecessary fears.

• Using  Interpreters

A young boy with behavioural difficulties at school

The Caribbean 

Some men and women come to Canada to work, leaving children to be raised by grandparents or close relatives back home. Some of these children are brought to Canada later, to live in an unfamiliar culture and with parents they do not really know. Immigration status is also a factor. Visitors who stay in Canada, including children born outside the country, have no immigration status, whereas children born in Canada are Canadian citizens.

Jamal is a 10-year-old boy. He comes to your office with his mother, who is concerned about his progress and behaviour at school. His first report card shows that he is failing many subjects. The teacher also says he acts out in class, is often disobedient and disrespectful, and fights with other students.

Jamal’s mother came to Canada 8 years ago to attend school and work. From 2 years of age until 6 months ago, Jamal lived with his grandmother in Jamaica. He now lives with his mother and two half-sisters in Canada.

What might explain some of Jamal’s difficulties in school? How would you try to help Jamal and his mother?

Jamal could certainly have a learning disability or ADHD (attention-deficit hyperactivity disorder). But given the history, his school difficulties could relate to moving to a new country and living with his mother, with whom he may have little rapport or attachment. He may also have hearing loss or vision inadequacy. Hearing and vision screening should be considered. Referral to a community agency working with West Indian families or for mental health or family counselling would be indicated.

• Community Resources
• Children with School Problems

A young boy with abdominal pain

Eastern Europe

Roma refugees face considerable discrimination in regions such as Eastern Europe. At the time of writing, Citizenship and Immigration Canada considers some countries in those regions safe countries, where persecution is unlikely to occur. Therefore, refugee claims are less likely to be considered legitimate.

Marko is a 6-year-old boy presenting with abdominal pain who sometimes has accidental bowel movements. He has been in Canada for the past 4 months and recently started school.

Marko and his mother speak Hungarian and Czech, and are just learning English. His mother is vague in providing some details of their history and background, including where they have lived or their immigration status. It is also not clear which immunizations Marko has had or what schools he has attended. There are few details about his father.

Reflecting that Marko and his mother might be Roma, and perhaps refugee claimants, how would you obtain information about him and his family history so that you could help?

While there might be a specific organic cause for Marko’s abdominal pain, it is likely related to some of the emotional and psychosocial problems experienced by his family.  Some screen laboratory tests may be necessary.  A more thorough psychosocial history is necessary, along with referral to a community agency that works with immigrant families and with Roma in particular. Further, if Marko’s immunization is not well documented, he may need to start on a new series of immunizations. 

• Medical Assessment
• Immunizations
• Using Interpreters
• Community resources

A young girl having difficulties at school

Some immigrants come to Canada from countries that experience crime and violence associated with drug trafficking.

Maria is an 8-year-old girl in Grade 3 at a local school. She lives with her mother and 5-year-old brother, who is in senior kindergarten. The family left Colombia 3 years ago because of the political situation. Maria’s mother works part-time in a doughnut shop and is trying to attend an adult language class to learn English. Maria’s father is still in Colombia, and the family hasn’t heard from him for the past 9 months.

Maria was referred to a community paediatrician because she is having difficulty with her school work. She is having problems learning to read and paying attention in class, and needs a lot of supervision to get her work done. Maria can be disruptive in class and picks fights with the teacher and students.

What are the possible explanations for Maria’s difficulties at school? How would you try to help her?

There are many reasons for Maria to have difficulties with school.  She may have a learning disability or ADHD (attention-deficit hyperactivity disorder) but her behaviour may also be related to limited school experience, the family’s emotional and psychosocial problems and her mother’s inability to help Maria with her school work.  An open discussion with the school officials and teachers would be helpful. The school may consider placing her on the referral or wait list for a psychoeducational assessment through the school board. The school may also have some volunteer tutors who could help Maria with her homework. Referral to a community agency working with Latin American families would also be helpful.

• Advocacy for Immigrants and Refugees

A young girl with headaches

Russia, via Israel

Some families come to Canada via other countries, such as Afghanistan via Pakistan or Russia via Israel. Indirect routes can pose a challenge when determining immunization status, for example, or for assessing disease risk based on region of origin.

Deborah is a 10-year-old girl. She presents with headaches, which she’s had 3 or 4 times weekly for the past month. Deborah has been sent home from school on many occasions. You are impressed that she speaks Russian and Hebrew, and is now learning English and French. However, you don’t know precisely where she has lived or what immunizations she has received.

How would you determine Deborah’s background, immunizations and possible causes of her headaches?

Health professionals must keep the specific causes of headaches in mind, such as raised intracranial pressure or migraine headaches. But with Deborah, the headaches may also be a reflection of her move to a new home, the loss of familiar friends and school in Israel or Russia, and family stress. Rather than start by ordering a CT scan, you might consider symptomatic treatment, documenting with a headache diary, a more thorough psychosocial assessment and, possibly, referral to a community agency working with immigrant families. Further, if there is any question about Deborah’s immunizations, she may require a full set of vaccines. Some centres do serology for different infectious diseases (e.g., polio, measles, varicella) and provide immunization where a child does not have immunity. For a 10-year old girl from Russia and Israel, this approach may be appropriate.

• Immunizations:  Bringing newcomer children up-to-date
• Robert Hilliard, MD
• Mark Awuku, MD

Last updated: April, 2021

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Case Studies & Best Practices: Strategies to Reduce Youth Overdoses

February 14, 2023

• Focus Areas Capacity Building & Leadership , Women, Youth & Children
• Expertise Leadership Development
• Programs Center for Health Leadership and Impact
• Strategic Initiatives Opioids

In 2022, communities across California developed innovative strategies in harm reduction and youth engagement. These case studies from PHI’s California Overdose Prevention Network (COPN) contain concrete examples of data-driven strategies that address rising rates of overdose among youth.

Case studies were drawn from overdose prevention coalitions participating in the California Overdose Prevention Network Accelerator 3.0 Program. These can serve as models for other coalitions and organizations across the country.

• Case Studies: Four Data Driven Strategies to Engage Youth in Overdose Prevention
• Case Studies: Four Data Driven Harm Reduction Strategies in Overdose Prevention
• Factsheet: Supporting Coalitions in Harm Reduction Services & Approaches for Youth

See the case studies and key highlights:

Four data driven strategies to engage youth in overdose prevention.

This summary of case studies includes:

• Empower Watsonville created a point-in-time survey to anonymously survey and assess local youth’s experiences with substance use. Youth administered the survey to their peers and therefore received a high response rate. They are using the findings to help establish a restorative policy for students who possess drugs or are intoxicated on a school campus.
• The Central Coast Regional Team adopted a parent toolkit to better facilitate conversations about youth substance use within their communities. They operated a massive mailing campaign to send a printed version of the booklet, in both English and Spanish, to every parent of an incoming 9th grader in their region.
• SafeRx Lake County used a combination of data sources and strategies including overdose hotspotting and survey data to drive their work. Their data helped them better understand and describe the scope of the problem and build a strong case for more appropriate policies in a predominantly conservative political environment.
• Safe Rx Mendocino Opioid Safety Coalition implemented a harm reduction curriculum for youth. This resource will be taught and distributed throughout schools, drop-in centers and family resource centers.

download the case studies

We prioritized fostering youth-to-youth relationships, where youth could express their concerns, voice their needs, and share their experiences. Additionally, the data from our survey has been foundational to gathering data in our community and has given us leverage to introduce substance use concerns in our community. Esme Vargas Empower Watsonville

Using data-driven strategies increased partnerships and trust among the education sector, validified our work, and made it possible for us to respond to community-youth focused needs. Rita Hewitt Empower Watsonville

The shock and awe from the data and the pressing need to work hard and quickly to stay ahead of the tragic overdoses has been key in our work. Kim Tangermann SafeRx Lake County

Four Data Driven Harm Reduction Strategies in Overdose Prevention

• The Butte Glenn Opioid Safety Coalition successfully launched a naloxone upon release program and has strengthened partnerships with their local jails.
• The Northern Sierra Opioid Safety Coalition developed an anti-stigma campaign called Addiction has a Face. The coalition also increased access to harm reduction supplies using vending machines and has shared their operations manual for other communities looking to implement a similar model.
• The Santa Clara County Opioid Overdose Prevention Project implemented naloxone vending machines at Santa Clara University and the local jail to allow individuals to access Narcan and information without fear of judgement, stigma, or recognition. These vending machines provide low-barrier access to health products to Santa Clara County residents.
• The SLO Opioid Safety Coalition collaborated with the Cal Poly Digital Transformation Hub (DxHub) and a team of university students to develop Naloxone Now! so members can find the nearest location to get naloxone or have it delivered at no cost. The coalition also created a billboard and outreach campaign to promote community awareness of increasing overdoses and the availability of naloxone through the app.

Sharing our data with other networks and stakeholders has been key to true policy shifts and changes throughout our communities. We realized the rates of certain populations were less than we thought, and that we would have created more stereotypes and stigma had we put our focus there. Monica Soderstrum Butte-Glenn Opioid Safety Coalition

Our coalition used key informant interviews and public opinion polls during the data collection and analysis phase of the COPN Accelerator 3.0 Program. By doing so, we discovered that there is a disconnect between key decision makers and the public. Kate Manganaro Northern Sierra Opioid Saftey Coalition

Our data shows who is affected by the overdose epidemic in our county, reveals trends and associated responses that need to be changed, and allows for a review of what is working and what changes need to be made. Mike Torres Northern Sierra Opioid Saftey Coalition

Supporting Coalitions in Harm Reduction Services & Approaches for Youth

The National Harm Reduction Coalition (NHRC) worked with PHI’s California Overdose Prevention Network (COPN) funded multi-sector coalitions throughout the state in 2022 and focused on supporting coalitions in harm reduction services and approaches for youth. This handout contains key highlights from the COPN Accelerator 3.0 Program of coalitions working NHRC and implementing harm reduction services for youth.

Lessons Learned

In multiple communities, overdose deaths of young people ages 12-20 were motivating factors to seek out harm reduction education.

• In multiple communities, coalition members did not have a true understanding or grasp on youth drug use, so involving youth or youth-led organizations could provide key stakeholders and experts to enhance and expand this work.
• Drug education for young people has historically been punitive and relied on strict, unexplained prohibition of drugs which only stigmatizes students and denies them access to honest lifesaving information.
• Harm reduction for youth inherently involves working with parents, teachers, and other adults that engage with young people.
• Coalitions that built relationships with schools were able to embed more into sustainable structures of education. Coalitions were successful in implementing naloxone training for teachers and bringing in consultants to create curricula.

Best Practices

There are some best practices that are very similar to how we support adults around substance use, but our own fears can trip us up in implementing them with young people.

• If someone is using drugs on a regular basis, especially a young person, understand why they want to alter their reality and try to understand what needs the drugs may be filling; stay curious and avoid using shame because that often pushes young people further from accurate information, connection, and safety.
• If someone is curious about drugs, especially a young person, give them accurate information about the effects (both positive and negative), potential risks, and ways to stay safe and reduce harm if they do decide to use drugs.
• Be careful not to perpetuate fear-based messaging or misinformation about fentanyl or any other drug. We want young people to feel safe and empowered when talking about drug use with parents and other adults.
• It is essential to give naloxone directly to people who are at risk for overdose, including young people.

download the Key Takeaways

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Wildfires & Extreme Heat: Resources to Protect Yourself & Your Community

Communities across the U.S. and around the world are grappling with dangerous wildfires and extreme heat. These threats disrupt and uproot communities and pose serious risks to environmental and community health—from rising temperatures, unhealthy air pollutants, water contamination and more. Find PHI tools, resources and examples to help communities take action and promote climate safety, equity and resiliency.

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The PLEA: The Youth Criminal Justice Act

Table of contents.

• Introduction
• A History of Youth Justice
• The Police and Arrest
• Extrajudicial Measures and Extrajudicial Sanctions
• What Happens in Youth Justice Court?
• Case Study: D.P. v. R.

When youth justice court must decide on a case, they must follow the principles of the Youth Criminal Justice Act .

THE FACTS OF THE CASE

Fifteen year-old D.P. pled guilty to a drinking and driving charge.

He was stopped by the police at 2:00 AM after they observed him speeding and swerving. In addition to D.P. there were three other teenaged passengers in the car. D.P. was a new driver and as such was not allowed to drive after midnight. The police found open and partly empty liquor bottles in the car. They also found marijuana and paraphernalia for using marijuana in the car. A breathalyzer test showed D.P.’s blood alcohol content to be .1 which was over the limit of .08 but not a particularly high reading.

The pre-sentence report indicated that D.P. had never been involved with the criminal justice system before, that he was a high school student with plans to take engineering at university, that he participated in sports and that he held down a part-time job. The report also explained that D.P.’s parents were divorced and that his mother had moved to another country. As a result D.P. had little contact with his mother. His father struggled with depression and alcohol abuse. D.P. had begun drinking alcohol and using marijuana as well as exhibiting some anger issues.

The trial judge sentenced D.P. to probation. D.P.’s. lawyer had argued for a conditional discharge. The prosecutor asked for probation but did not submit any arguments against a conditional discharge. Probation is a harsher sentence than a conditional discharge mainly because with probation a youth’s record can be accessed for a longer period of time.

In deciding on probation the sentencing judge referred to another case where she sentenced an adult to jail for causing someone’s death while driving under the influence of alcohol, as well as referring to the need to impress on youthful offenders that drinking and driving is a serious criminal matter and her concern that D.P.’s alcohol and marijuana use could lead D.P. to drink and drive again.

D.P. appealed the probation sentence arguing that it did not conform to the sentencing principles of the Youth Criminal Justice Act .

The YCJA has a number of sentencing principles. Below is a summary of some of the ones considered in this case.

The YCJA states that youth sentences must be proportionate to the seriousness of the offence and the degree of responsibility of the young person for that offence. Keeping this rule in mind youth sentences must also:

• be the least restrictive sentence that is capable of achieving the purpose set out in the Act
• be the one that is most likely to rehabilitate the young person and reintegrate him or her into society, and
• promote a sense of responsibility in the young person, and an acknowledgement of the harm done to victims and the community

Youth sentences must also fulfill the following objectives:

• to denounce unlawful conduct
• to deter the young person from committing offences.

THE APPEAL COURT’S DECISION

The court determined that the trial judge failed to consider some relevant factors under the YCJA, overturned the decision of the trial judge, and sentenced D.P. to a conditional discharge.

The appeal court found that the trial judge had not considered the requirement to impose the least restrictive sanction capable of achieving the guiding principles of sentencing under the YCJA or the need to emphasize rehabilitation and reintegration. The court also found that the trial judge had overemphasized the need to deter D.P. from drinking and driving again and the need to deter other young people. The court came to this conclusion based on the judge’s comments about the impaired driver she had sentenced to jail as well as other comments she made before and after this comment about the need to deter D.P. and others from drinking and driving.

CONSIDER THIS: Applying Sentencing Principles

• Which of the above principles do you think the trial judge relied on in choosing the harsher sentence of probation?
• When a sentence is appealed the court hearing the appeal cannot change the sentence just because they would have given a different sentence. They can only change the sentence if the trial judge did not apply the principles in the YCJA properly. Which court do you think best-applied the YCJA’s sentencing principles? The lower court or the appeal court?

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Case Studies

A key purpose of  ERIC  is to share stories, experiences and learning about ethical issues and concerns that shape  research  involving  children  and  young people . Case studies have been contributed by  researchers , using their own words, to assist others to reflect critically on some of the more difficult and contested ethical issues they may encounter. These case studies which are from diverse international contexts and different research paradigms highlight the processes that can be engaged in developing ethical thinking and improving ethical practice in research with children .  Researchers  are invited to consider these case studies in light of their own experience and context. Please submit your expression of interest using the form at the bottom of this page.

Positioning families as co-researchers at the museum: How do we see and hear the voices of parents and children? By Nicola Wallis

You can download this case study as a pdf here. Positioning young children as co-researchers seeks to elevate their voice, interests and power in research processes. However, there are added tensions when

Embracing the embarrassment: Potential of seemingly unsuccessful research interactions for critical professional development. By Katrin Velten & Julia Höke

You can download this case study as a pdf here. When children participate in research, particularly research conducted with or by children, a key goal is to authentically represent their viewpoints. Striving

‘Your life looks like a fairytale’ : Challenges in building rapport with children and youth in contexts of protracted conflict. By Cadhla Fiona o’Sullivan

You can download this case study as a pdf here. My PhD research, titled ‘Artisans of Peace’, was conducted in the post conflict environment of Bogotá, Colombia. It consisted of an Arts

Developing an ethical and reflexive mindset in emerging childhood researchers. By Daniella Bendo and Paige Sheridan

You can download this case study as a pdf here. As thinking and practice has grown around ethical research involving children, so too has the need to train and equip new researchers

Navigating disability identity and language in research involving children and young people. By Fathimath Shiraani

You can download this case study as a pdf here. Despite contemporary tourism research being more inclusive of previously neglected groups, the views of children with disability are still largely absent, reflecting

Interviewing young people on sensitive topics: An iterative approach. By Tim Moore, Jodi Death & Steven Roche

You can download this case study as pdf here. In 2015, a Royal Commission into Institutional Responses to Child Sexual Abuse was established to understand the nature and extent of sexual abuse

Incidental brain findings in neuroimaging research. By Sebastián J. Lipina

You can download this ERIC case study as a pdf in English, français, español, 한국어, Türkçe and Bahasa Indonesia. Incidental brain findings (IBFs) are brain abnormalities with no outward symptoms that are

Immediacy of fieldwork in participatory research with children in precarious contexts. By Tatek Abebe

You can download this case study as a pdf here. Conducting participatory fieldwork with children can result in a researcher becoming involved in their lives more broadly, blurring the lines around the

But, what is a researcher?: Supporting informed consent with young children. By Laura Benton and Julia Truscott

You can download this case study as a pdf here. It is now common practice to seek children’s own consent for research participation, alongside (usually) that of a parent or guardian. This

Using the Narrative Approach to informed consent to empower young children and their educators

You can download this case study as a pdf here. Conducting research with young children is a complex process with many stakeholders and ethical considerations to navigate. One of the most enduring

Negotiating confidentiality, privacy and consent in focus groups with children and young people. By Tim Moore

You can download this case study as a pdf here. In 2015, the Australian Royal Commission into Institutional Responses to Child Sexual Abuse contracted us to complete a study to understand what

Obtaining informed and voluntary consent in a group context. By Muireann Ní Raghallaigh & Robbie Gilligan

You can download this ERIC case study as a pdf in English, français, español, 한국어, Türkçe and Bahasa Indonesia. In designing a doctoral research study of the experiences of unaccompanied/ separated asylum

Communicating with gatekeepers in UK educational settings. By Alice Little

You can download this case study as a pdf here. In the Spring of 2022 I joined a team of researchers exploring issues surrounding school toilet use in English schools. The project

Maintaining confidentiality of responses and preventing social desirability bias with an innovative method: The polling booth in research on early marriage, including child marriage. By Urvashi Wattal & Angela Chaudhuri

You can download this ERIC case study as a pdf in English, français, español, 한국어, Türkçe and Bahasa Indonesia. An impact evaluation , funded by the International Initiative for Impact Evaluation (3ie), of

Interviewing children with disability in the presence of a parent. By Berni Kelly

You can download this ERIC case study as a pdf in English, français, español, 한국어, Türkçe and Bahasa Indonesia. Traditionally, social researchers expected parents or other adults to act as proxies for

Child protection and confidentiality: Surveying children’s experiences of violence, abuse and neglect. By Lorraine Radford

You can download this ERIC case study as a pdf in English, français, español, 한국어, Türkçe and Bahasa Indonesia. In 2008 the National Society for the Prevention of Cruelty to Children (NSPCC)

Peer research and young people in and leaving out-of-home care. By Clare Lushey and Emily R. Munro

You can download this ERIC case study as a pdf in English, français, español, 한국어, Türkçe and Bahasa Indonesia. Care Matters: Time for Change (Department for Education and Skills, 2007) identified the

Research ethics committee conditions: Ethical challenges of researching with poor communities in Malawi. By Elsbeth Robson

You can download this case study as a pdf here. As an international academic team we have been engaged with researching African household and young people ’s livelihood trajectories in a Malawian village

Reciprocity in participatory research with children in precarious contexts. By Tatek Abebe

You can download this case study as a pdf here. This case study draws on fieldwork encounters when undertaking research on childhood in precarious contexts in Ethiopia. This research involved children who

Ethical considerations when using incentives in youth research. By Kathryn Seymour

You can download this ERIC case study as a pdf in English, français, español, 한국어, Türkçe and Bahasa Indonesia. The Queensland Youth Development Research Project (YDRP) used questionnaires to explore the role

Payment in different contexts: How can payment reflect local considerations? By Virginia Morrow

You can download this ERIC case study as a pdf in English, français, español, 한국어, Türkçe and Bahasa Indonesia. Young Lives is an international study of childhood poverty, involving 12,000 children growing

Payments to young researchers in Malawi. By Elsbeth Robson, Alister Munthali, Gina Porter & Kate Hampshire

During a research project on children’s transport and mobility in sub-Saharan Africa young people, (mostly under 18 years old) were invited from secondary schools in Malawi, Ghana and South Africa, to train

Expression of Interest to Contribute A Case Study

The purpose of the case studies is to share examples of the kinds of ethical challenges we encounter in our research involving children, the ways we navigate these, the choices we make and the reflections we engage in. The case studies are intended to stimulate thinking and provide ideas for others who encounter similar issues.

Please complete the following form if you wish to express interest in contributing a case study.

The ERIC website emerged primarily through a collaboration between the Centre for Children and Young People at Southern Cross University, Australia, and UNICEF’s Office of Research, Innocenti. The website content is based on the following publication: Graham, A., Powell, M.A., Taylor, N., Anderson, D. & Fitzgerald, R. (2013). Ethical Research Involving Children. UNICEF: Florence. (Available in  English ,  français ,  español ,  한국어 ,  Türkçe  and  Bahasa Indonesia ).

All case studies, blogs posts, photos and library material remain the property of the cited author or publisher.

Other website content is licensed under a Creative Commons Creative Commons Attribution 4.0 International License ( CC-BY licence ) © UNICEF 2022. Subsequent website updates are undertaken by the ERIC team at Southern Cross University in line with this license. Questions can be directed to [email protected].

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Identifying and Serving LGBTQ Youth: Case Studies of Runaway and Homeless Youth Program Grantees

Final Report

Acknowledgments

This report, which summarizes findings from four case studies of Runaway and Homeless Youth Program grantees serving lesbian, gay, bisexual, transgender, and questioning youth, benefited from the contributions of many people. The case studies were conducted by Mathematica Policy Research and its subcontractor, the Williams Institute, under contract to the Office of the Assistant Secretary for Planning and Evaluation (ASPE) in the U.S. Department of Health and Human Services (HHS) and the Office for Planning, Research and Evaluation (OPRE) in HHS’s Administration for Children and Families (ACF).

The study would not have been possible without the support and cooperation we received from staff at all levels in each of the study sites. In addition to being extremely generous with their time while we were visiting each agency, staff responded to various follow-up questions. We are grateful for their participation.

At ASPE and OPRE, Laura Radel, Seth Chamberlain, Sarah Sattelmeyer, and Akbar Hossain provided insightful guidance and comments during study planning, data collection, and reporting. In the early stages of the project, Sarah Oberlander and Kelsey McCoy offered helpful direction and feedback. We also benefited from input on study plans and assistance contacting study sites from Curtis Porter and Telisa Burt at ACF’s Family and Youth Services Bureau. Gregory Lewis of the True Colors Fund and Andre Wade of the National Alliance to End Homelessness offered feedback on study topics and site selection.

At Mathematica, Diane Herz provided thoughtful comments on drafts of discussion guides and study reports. Jane Nelson and Jill Miller provided expert word processing and production support.

We would like to thank all these individuals and organizations for their contributions to the study.

Executive Summary

Some government and private organizations are interested in improving services for lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youth who run away from home or experience homelessness. These efforts are prompted, in part, by research suggesting LGBTQ youth may be at greater risk for experiencing homelessness and, if they become homeless, more likely than their heterosexual counterparts to experience victimization, engage in high-risk sexual behaviors, and have poor mental health.

To better understand provider experiences serving LGBTQ runaway and homeless youth (RHY), the Office of the Assistant Secretary for Planning and Evaluation (ASPE) of the U.S. Department of Health and Human Services (HHS), in collaboration with the Office of Planning, Research and Evaluation (OPRE) in HHS’s Administration for Children and Families (ACF), sponsored case studies of four local agencies receiving grants from ACF’s RHY Program. The purpose of the study, conducted by Mathematica and its subcontractor, the Williams Institute, was to learn about programs’ strategies for identifying and serving LGBTQ RHY, the challenges programs face in understanding and addressing the needs of this population, and potential areas for future research.

The four study sites are federally funded RHY programs that provide a range of services, operate in different regions of the country, and have experience serving LGBTQ youth. They include agencies with urban and rural service areas in Colorado, Minnesota, Ohio, and Texas. One agency receives RHY Program funding for basic center services, two for transitional living, and two for street outreach. The share of clients identified as LGBTQ ranges from 5 to 28 percent.

Drawing on site visit interviews as well as reviews of agency documents and forms, this report presents findings on four topics: (1) agencies’ collection and use of data on clients’ sexual orientation and gender identity, (2) providers’ assessment and perceptions of needs and capacities among LGBTQ RHY, (3) providers’ approaches to serving LGBTQ RHY, and (4) providers’ perceptions of research gaps and data needs related to services for LGBTQ RHY. We conclude by suggesting issues for policymakers and practitioners to consider related to collecting data on, and serving, this population.

Collection and Use of Sexual Orientation and Gender Identity Data

The study sites’ approaches to gathering information on sexual orientation and gender identity include asking direct questions on intake and assessment forms and relying on youths’ self-disclosure during less formal conversations with staff. Two of the four agencies collect information on sexual orientation through questions on intake or assessment forms completed by staff or youth. In three agencies, intake or assessment forms include questions on gender identity that feature response options for transgender status.

Staff at all agencies reported using information on youths’ sexual orientation and gender identity when planning individual services. Staff use this information to tailor some services (such as referrals for counseling). In addition, staff use information on sexual orientation and gender identity (1) to determine housing and bathroom accommodations, (2) for assignment to case managers, and (3) in making appropriate health care referrals. No agencies reported that they analyze patterns of service use or outcome by sexual orientation and gender identity (or any other demographic characteristic). Agencies do not conduct these analyses because they do not record client-level sexual orientation or gender identity information in the agency’s management information system or other records, or because it is not their general practice to break down service use data by demographic group.

The accuracy of data on the number of LGBTQ youth served at the agency level and reported to the federal government is uncertain and might vary widely among agencies. Factors that appear to affect complete or accurate collection of sexual orientation and gender identity data include youths’ reticence in answering questions, concerns among staff members about protecting youths’ privacy and recording these characteristics in agency records, and the absence in some agencies of standardized protocols for gathering sexual orientation or gender identity information.

Assessment and Perceptions of Needs and Capacities of LGBTQ RHY

Agency staff conduct assessments during initial intake sessions and subsequent meetings with youth to determine immediate needs, detail personal circumstances, and identify risk factors or barriers that may need to be addressed through longer-term services. Assessment tools used by some agencies inquire about sexual orientation and gender identity, but no agencies reported using tools that specifically target LGBTQ youth. Some staff reported that they assess needs or circumstances related to LGBTQ identity based on their own knowledge of these issues and techniques for exploring them with clients.

Many staff felt that homeless youth face similar types of risks, regardless of sexual orientation and gender identity. Nevertheless, some types of risks—emotional distress and poor mental health, substance abuse and sexual risk behavior, and problems with family and personal relationships—were perceived to be particularly salient or frequent among LGBTQ youth. According to staff reports, LGBTQ youth of color and transgender youth are at the highest risk of encountering barriers to accessing appropriate services or resources, especially those related to health and employment. Staff also perceived some distinctive protective factors among LGBTQ youth. In particular, LGBTQ youth may be “survivors” who develop positive self-protection skills after experiencing stigma and rejection.

Approaches to Serving LGBTQ RHY

All agencies visited implement some organizational strategies that focus on LGBTQ youth, including adopting nondiscrimination and nonharassment policies and protecting the confidentiality of information shared by youth. Agencies differ in the extent to which they have implemented other organizational strategies, such as establishing a safe and affirming environment, developing staff skills in serving LGBTQ youth, and creating partnerships with other organizations serving LGBTQ youth. Opportunities to improve cultural competency in serving LGBTQ youth ranged from annual trainings on site in two agencies to occasional attendance at sessions offered at universities or conferences for staff at another agency.

Agencies also tailor a variety of services to make them more accessible or relevant to the needs and circumstances of LGBTQ youth. For example, agencies tailored housing programs to the needs of LGBTQ youth by assigning shared accommodations based on self-reported gender identity and providing private accommodations, when available, to address youths’ concerns about safety. These approaches were perceived to be especially helpful for transgender youth who could be concerned about sleeping in male or female dormitories. Two agencies offered services specifically for LGBTQ youth. One agency employs an LGBTQ case manager who develops individual service plans for LGBTQ-identified youth in its housing programs. Another operates a host home program specifically for LGBTQ youth, matching these youth with LGBTQ-supportive adults who offer youth transitional housing in private homes.

Staff in two agencies reported that they aim to facilitate reconciliation between LGBTQ youth and families when possible, but that such assistance is offered only to the extent a youth wishes to engage with her or his family. Agency staff did not report that efforts at family acceptance for LGBTQ youth are based on a formal intervention model. Rather, staff use general mediation strategies in their attempts to work with families.

Two factors that appear to affect tailoring of services to LGBTQ youth are the presence of staff with LGBTQ expertise and the perceived proportion of youth served who identify as LGBTQ. Having staff with appropriate expertise and a visible LGBTQ clientele may encourage agencies to take steps to better serve this population. Challenges that can impede efforts to improve or tailor services for LGBTQ RHY include (1) a lack of local resources that focus on LGBTQ youth; (2) the difficulty of overcoming social stigma, especially toward LGBTQ youth of color and transgender or gender-nonconforming youth; and (3) staff concerns about singling out a specific population of RHY while still being able to help all youth who need an agency’s services.

Research Needs

We asked staff in case study agencies to identify the kinds of information and research that might help them understand the characteristics and experiences of LGBTQ RHY more completely and provide effective services to this population. Staff recommended future research in six general areas:

• Size of the LGBTQ RHY population in local areas. According to agency staff, community-level data on the number of RHY who identify as LGBTQ would help agencies understand whether they are reaching this population successfully. These data also may help them gauge whether current services align with the characteristics of the local RHY population.
• Characteristics of subpopulations of LGBTQ youth. Staff perceived transgender youth (including transgender youth of color) and LGBTQ RHY of color in general to be at particularly high risk of poor outcomes, but little is known about the proportion of the RHY population these youth comprise, the specific risk factors prevalent among them, or their outcomes.
• Risk and protective factors among LGBTQ RHY. Staff members pointed to three risk factors that appear to be prevalent among LGBTQ RHY and could be better understood: (1) types and severity of mental health disorders, (2) prevalence and factors contributing to human trafficking and sexual exploitation, and (3) prevalence of intimate partner and dating violence among LGBTQ RHY. According to staff, experiences among LGBTQ youth also have the potential to support development of protective factors or personal capacities. In particular, resiliency among LGBTQ homeless youth may increase as they learn to contend with discrimination.
• Factors contributing to LGBTQ youth homelessness. Additional research on the reasons LGBTQ youth become homeless would help providers identify and address the potentially varied and distinct factors contributing to this problem.
• Experiences of LGBTQ youth involved in multiple systems. Homeless youth may be involved in several public systems, especially the juvenile justice and child welfare systems. Staff in case study agencies indicated a need for information on the perceptions of these systems among LGBTQ RHY and efforts to link across systems to better serve this population.
• Service models and administrative strategies that focus on LGBTQ RHY. Agency staff frequently expressed a need for intervention models targeting LGBTQ RHY and information on the effectiveness of these interventions in various service contexts (for example, urban or rural areas). Staff mentioned a particular interest in models for promoting family engagement and reunification and positive youth development among LGBTQ youth.

Issues for Policymakers and Practitioners

The case study findings point to four issues related to serving LGBTQ RHY for policymakers and practitioners to consider:

• Ensuring consistency and accuracy in data collection. To improve the consistency and accuracy of administrative data on these topics, it may be beneficial to offer providers guidance on preferred content for questions about sexual orientation and gender identity and recommended methods for asking them. Providers also may need to consider whether different processes might be used to collect data for administrative purposes (for example, to understand the demographics of an agency’s clientele overall) and for guiding service provision. Collecting administrative data anonymously (for example, through an online questionnaire) would allow an agency to gather data on the number of youth who identify as LGBTQ without asking youth to disclose the information to a staff member during an initial intake session or assessment. To help staff plan services appropriately, they could record in individual case files any information gathered later about a youth’s LGBTQ status.
• Management and analysis of data on LGBTQ identity. In addition to standardized practices for asking questions on sexual orientation and gender identity, guidance on when this information should be recorded in case records, as well as on when and to whom it should be disclosed, may benefit agencies. Programs might also benefit from information on how analyzing data by demographic characteristics might be used for assessing service delivery, and from assistance to build capacity for internal data management and analysis.
• Technical assistance for agencies whose service areas lack extensive LGBTQ resources. Offering technical assistance or training on LGBTQ issues regularly and making it easily accessible via online participation would help agencies in areas without access to local LGBTQ resources. Another option would be to create opportunities for RHY providers to share information on strategies for serving LGBTQ RHY, perhaps by creating an online repository for documents on best practices.
• Developing and evaluating interventions targeting LGBTQ youth. RHY providers will likely benefit from specification, dissemination, and evaluation of models for serving LGBTQ youth effectively. Evaluations of program models targeting LGBTQ RHY might explore whether the models are most effective when offered as separate program components or as modifications to services available to RHY in general. Studies might also address the effectiveness of tailoring specific types of services, such as family reunification support or individual counseling, to the particular needs and circumstances of LGBTQ RHY.

I. Introduction

Research suggests that young people who are lesbian, gay, bisexual, transgender, or questioning their sexuality (LGBTQ) face a disproportionate risk of homelessness. Available data on youth homelessness are limited and not nationally representative, but studies of homeless youth served by individual providers or in local areas have found that 6 to 35 percent identify themselves as LGBTQ (Substance Abuse and Mental Health Administration 2011). 1 In comparison, analyses of data from the National Longitudinal Study of Adolescent Health found that 7.4 percent of boys and 5.3 percent of girls in grades 7–12 reported same-sex romantic attraction, and results of a recent nationally representative survey of U.S. adults indicate that approximately 3.4 percent identify as LGBT (Russell et al. 2001; Gates and Newport 2012). According to a study of a representative sample of high school students in one state, lesbian, gay, and bisexual youth and heterosexual youth who have same-sex sexual partners are 4 to 13 times more likely than exclusively heterosexual youth to be homeless (Corliss et al. 2011). Providers serving homeless youth also report that LGBTQ youth are overrepresented among the youth they serve. Respondents to a national nonrepresentative survey of providers estimated that LGBTQ youth comprise 40 percent of their clientele, on average (Durso and Gates 2012).

Homeless LGBTQ youth also might be more likely than their heterosexual counterparts to experience victimization, engage in high-risk sexual behaviors, and have poor mental health. Several studies have found that lesbian, gay, and bisexual youth are more likely than heterosexual youth to (1) have been physically or sexually victimized, (2) engage in survival sex or sex work, (3) have attempted suicide, (4) use illicit substances, and (5) have greater mental health concerns (Cochran et al. 2002; Van Leeuwen et al. 2006; Ray 2006; Toro et al. 2007; Tyler 2008). Although these studies are not representative of the entire homeless youth population, considered together, they suggest that LGBTQ homeless youth are at high risk of poor outcomes.

In response to these indications of higher prevalence of homelessness among LGBTQ youth and potentially greater risks for those experiencing homelessness, government and private organizations have suggested approaches for enhancing services for LGBTQ youth in out-of-home care (see, for example, National Alliance to End Homelessness et al. 2009; Wilber et al. 2006; Ray 2006; SAMHSA n.d.). Common suggestions include the following:

• Establishing nondiscrimination, antiharassment, and confidentiality policies that address sexual orientation and gender identity, and creating safe and inclusive agency environments
• Enhancing LGBTQ cultural competency among staff through training and other supports
• Providing flexible and tailored programming for LGBTQ youth, including interventions that focus on family acceptance and reunification
• Addressing the unique health and shelter needs of transgender clients
• Establishing connections with other community organizations serving LGBTQ youth
• Collecting data on LGBTQ youth receiving services and using these data to educate decision makers and assess patterns in service provision and outcomes

Some agencies serving homeless youth have already accomplished one or more of these suggested steps. Agencies that serve primarily LGBTQ homeless youth operate in several large cities and tailor many services to this population. 2 The Williams Institute’s Homeless Youth Provider Survey (HYPS) gathered information from 354 organizations nationwide on their experiences providing services to homeless LGBTQ youth. Approximately 24 percent of services and activities offered by agencies responding to the survey targeted LGBTQ clients (Durso and Gates 2012). 3 In addition, 85 percent of survey respondents agreed with the statement, “I am very knowledgeable about LGBT homeless youth,” indicating they believe themselves competent to work with this population (Durso and Gates 2012).

Yet much remains to be learned about whether and how agencies serving runaway and homeless youth (RHY) implement practices to address the specific needs or circumstances of LGBTQ youth. To better understand provider experiences serving LGBTQ RHY, the Office of the Assistant Secretary for Planning and Evaluation (ASPE) of the U.S. Department of Health and Human Services (HHS), in collaboration with the Office of Planning, Research and Evaluation (OPRE) in the Administration for Children and Families (ACF), HHS, sponsored case studies of local agencies receiving grants from ACF’s RHY Program. The purpose of the study, conducted by Mathematica and its subcontractor, the Williams Institute, was to learn about programs’ strategies for identifying and serving LGBTQ RHY, the challenges programs face in understanding and addressing the needs of this population, and potential areas for future research.

The study addressed four sets of questions:

• What are providers’ approaches to collecting and using data on the sexual orientation and gender identity of the youth they serve? What information do providers collect, and when? Do providers use data on sexual orientation or gender identity to tailor services to individual clients or assess program performance? What challenges do providers experience in collecting data on LGBTQ RHY?
• What do providers perceive to be the key needs and capacities of LGBTQ RHY? How do programs assess these needs and capacities? Do program staff perceive differences in needs and capacities of LGBTQ and non-LGBTQ youth?
• What strategies do providers implement in working with LGBTQ RHY? How, if at all, do organizations tailor their services to LGBTQ RHY? What successes and challenges have providers experienced providing services to these youth?
• What research gaps affect providers’ ability to understand and meet the human service needs of LGBTQ RHY? What data or information are needed to provide services more effectively to this population?

The study aimed to document agency experiences and staff perspectives among a select group of RHY Program grantees, rather than to identify best practices in serving LGBTQ RHY.

Two government initiatives related to services for LGBTQ youth inform the study questions. The first is the United States Interagency Council on Homelessness (USICH) Framework to End Youth Homelessness, which prioritizes improving (1) data collection and quality; and (2) providers’ capacity to serve especially vulnerable groups, including LGBTQ youth (USICH 2013). (We describe the USICH Framework in more detail later in this chapter.) The second initiative is an OPRE project to develop a research agenda on the human service needs of LGBT populations. 4 The case studies provided an opportunity to gather input from providers on research priorities related to LGBT populations, especially homeless youth.

Key Terms: Sexual Orientation, Gender Identity, Gender Expression, and Transgender

According to the American Psychological Association (2011):

• Sexual orientation refers to “the sex of those to whom an individual is sexually and romantically attracted” and generally includes the categories lesbian, gay, bisexual, and heterosexual.
• Gender identity refers to “one’s sense of oneself as male, female, or transgender.”
• Gender expression is “the way a person communicates gender identity to others through behavior, clothing, hairstyles, voice, or body characteristics.”
• Transgender is a broad term describing people whose self-identified gender or gender expression does not correspond to their biological sex or sex assigned at birth.

Next, we describe the RHY Program and other key federal efforts related to youth homelessness, site selection criteria and characteristics of the four case study sites, data collection methods, and the organization of the rest of the report.

1 The ages of young people in these studies vary. For this study, we adopt the definition of youth that the U.S. Interagency Council on Homelessness (USICH) uses: people up to 24 years old. The Runaway and Homeless Youth Program of the Administration for Children and Families, U.S. Department of Health and Human Services serves youth up to 22 years old.

A. The RHY Program and Other Federal Responses to Youth Homelessness

Because homeless youth can be involved in many public systems (such as child welfare, juvenile justice, and homeless assistance), many policies and programs can affect them. With respect to shelter, housing, and outreach services for RHY, key elements of the federal policy and program context include the RHY Program structure, U.S. Department of Housing and Urban Development (HUD) funding for homeless services, and the USICH Framework to End Youth Homelessness. We describe each of these next.

RHY Program . The federal RHY Program, administered by the Family and Youth Services Bureau (FYSB) in ACF (part of the U.S. Department of Health and Human Services), funds community-based organizations and shelters serving young people. The program makes annual grants totaling more than $100 million to support four types of direct services:

• Basic center. Basic center grantees provide up to 21 days of emergency shelter to youth under age 18, along with counseling to support the return of youth to their families, if appropriate.
• Transitional living and maternity group homes. These grants support longer-term housing (up to 21 months), such as supervised apartments and host home programs, in which youth live in the homes of screened and trained adult volunteers. Transitional living programs offer supportive services to youth ages 16 to 22 to promote self-sufficiency and social and emotional well-being. Some transitional living grants fund housing for pregnant and parenting youth. As with other transitional living programs, maternity group homes offer services to make it easier to transition to self-sufficiency, but they also offer parenting skills training.
• Street outreach. Street outreach grantees contact youth living on the streets to build relationships, provide basic living supplies, and offer information on shelters and other services. The primary goal of such programs is to protect youth and prevent sexual exploitation or other harm.

In addition to direct services, the RHY Program supports the National Runaway Safeline, which connects youth in crisis to available services, and a training and technical assistance network for RHY grantees. 5

FYSB requires grantees of the RHY Basic Center and Transitional Living programs to report semiannually the number and demographics of youth they serve, the types of services provided, and the status of youth when they exit RHY programs. Grantees record and submit these data to the federal government through the Runaway Homeless Youth Management Information System (RHYMIS), a database created for this purpose. Agencies create entry and exit records for each youth served, including youth who reenter services. Entry records document the young person’s (1) demographic characteristics, (2) living situation at entry, (3) referral source, (4) school status, and (5) involvement in the child welfare or juvenile justice system. Exit records document (1) youths’ “critical issues” or needs identified by program staff, including issues related to sexual orientation or gender identity; (2) services provided to youth, (3) plans for providing transitional support or referrals after program exit, and (4) youths’ living situation at exit.

RHYMIS records include fields for reporting the sexual orientation and gender identity of clients served, among other demographic characteristics. This feature distinguishes RHYMIS from the administrative databases of other ACF programs, which do not collect information on participants’ sexual orientation or gender identity. According to the RHY Program’s 2010-2011 Report to Congress, among youth whose sexual orientation was reported in RHYMIS, lesbian, gay, and bisexual youth accounted for 6 or 7 percent served in the Basic Center Program and 9 or 10 percent served in the Transitional Living Program during fiscal years 2010 and 2011 (HHS 2013). Transgender youth accounted for less than 1 percent of youth served in each program during these years (HHS 2013). However, the Report to Congress notes that RHYMIS data may underreport the percentage of youth served who are LGBT, since youth are not always asked these questions or do not always provide responses to them. (We discuss additional challenges related to data collection on sexual orientation and gender identity in Chapter II.)

HUD homeless assistance programs. Many programs serving homeless youth receive funding from multiple government and private sources, including HUD. HUD homeless assistance programs support emergency shelter, supportive services, transitional housing, homelessness prevention, and other services through Continuum of Care (CoC) awards to coalitions of nonprofit organizations, State agencies, and/or local government agencies operating in a specific geographic area. HUD awarded $1.67 billion in CoC grants in fiscal year 2012. Lead agencies receiving CoC awards may subaward funds to individual service providers. This approach to funding is intended to promote collaborative planning and service delivery among agencies that address the various needs of homeless people in a local area. HUD requires most agencies receiving CoC awards or subawards to implement a Homeless Management Information System (HMIS) to collect and report on client characteristics and services provided in their local areas. Some agencies also use HMIS as an internal case management system. HUD does not require that HMISs report clients’ sexual orientation and gender identity, but agencies may choose to collect such data through their locally developed HMIS.

USICH Framework to End Youth Homelessness. The USICH is an independent agency within the federal executive branch whose mission is to coordinate the federal response to homelessness and to create partnerships to reduce and end homelessness in the nation. The USICH’s 2010 strategic plan to prevent and end homelessness established a goal of ending homelessness among children, families, and youth by 2020 (USICH 2010). In February 2013, USICH released a framework proposing two strategies for addressing youth homelessness: (1) improving data collection; and (2) improving the capacity of federal, state, and local systems that serve youth experiencing homelessness or at risk of becoming homeless (USICH 2013). Both strategies have implications for providers serving LGBTQ youth.

The first strategy focuses on creating systems to gather and communicate accurate information on the number and circumstances of homeless youth. It emphasizes such steps as including youth in point-in-time counts of the homeless population, integrating or coordinating federal information systems that record data on homeless youth receiving services, and undertaking national studies to address information gaps regarding the number and characteristics of homeless youth. As one step in this strategy, USICH and several other federal agencies have launched Youth Count!, an effort to identify promising methods for counting unaccompanied homeless youth in local areas. Improved data on homeless youth will incorporate information on key subpopulations, including LGBTQ youth.

The framework’s second strategy is to create and disseminate an intervention model for serving homeless youth and helping them achieve desired outcomes: stable housing, enhanced connections with sources of social support, increased participation in education or employment, and improved health and well-being. The preliminary model posits screening and assessment, followed by provision of services (housing or shelter, mental or physical health care, and social supports) matched to youth circumstances and risk levels (USICH 2013). A key principle of the model that USICH proposes is that services should be culturally appropriate and tailored to youth characteristics, including sexual orientation and gender identity.

5 For additional information on the Runaway and Homeless Youth Program, please see the program’s most recent Report to Congress ( http://www.acf.hhs.gov/sites/default/files/private/fysb/rhy_congress_2010_11.pdf ).

B. Site Selection and Characteristics

In selecting study sites, we aimed to identify federally funded RHY programs that provide a range of services, operate in different regions of the country, and have experience serving LGBTQ youth. We used three main criteria to identify potential case study sites:

• Receipt of RHY funding. Because the study focuses on HHS-funded service providers, we included only agencies that had received RHY basic center, transitional living, or street outreach grants in 2012.
• Participation in the HYPS. 6 We limited candidates to agencies that responded to the HYPS. This narrowed the number of potential sites and increased access to data about each site. In addition, participation in the survey signaled that at least one person at each agency was interested in issues facing LGBT-identified homeless youth.
• Experience serving LGBTQ youth. To ensure we could address questions regarding approaches to serving LGBTQ-identified youth, we aimed to identify sites with relevant experience. We established two indicators of this experience: (1) the agency offers services expressly for LGBTQ-identified youth and/or (2) the agency reported in the HYPS that it serves LGBTQ youth.

In addition to the screening criteria, we specified agency characteristics that would help us assess whether sites varied in ways that might influence an agency’s service approaches and the challenges it faces in serving LGBTQ youth. These characteristics included the agency’s size in terms of staff and budget, types of services provided, and geographic location. Drawing on a variety of information sources, including the HYPS and agency websites, we developed a list of 10 potential sites.

After consultations with ASPE and OPRE, as well as discussions with representatives of the RHY Program and advocacy organizations that focus on homeless youth, we selected four sites for inclusion in the study. The selection of the four sites prioritized (1) diversity among the agencies in size, reported proportion of youth served who are LGBTQ, and urban or rural service area; (2) inclusion of some agencies that had not participated in previous studies of RHY providers; and (3) inclusion of all three types of RHY Program grantees.

Table I.1 summarizes characteristics of the study sites. (Appendix A includes a brief profile of each site.) The group includes agencies with urban and rural service areas in four states: Colorado, Minnesota, Ohio, and Texas. The agencies employ from 19 to 65 staff members and serve from 157 to as many as 2,550 youth annually. One agency receives RHY Program funding for basic center services, two for transitional living, and two for street outreach. The share of clients identified as LGBTQ ranges widely, from 5 to 28 percent. (These figures, based on staff estimates or agency reports, were not always consistent with the data provided in response to the HYPS or reported to RHYMIS; we present percentages reported by program staff or in program documents.) Two of the agencies offer services designed specifically for LGBTQ homeless youth: a host home program and a designated LGBTQ case manager.

Table I.1. Characteristics of Study Sites

Sources: Agency documents and site visits conducted April to June 2013.

a All programs.

b Staff estimate.

c Reported in agency’s annual or evaluation report.

FY = fiscal year; LGBTQ = lesbian, gay, bisexual, transgender, or questioning.

6 The Homeless Youth Provider Survey (HYPS), conducted by the Williams Institute, gathered information from 354 organizations nationwide on their experiences working with homeless LGBTQ youth.

C. Data Collection Methods

During spring 2013, the research team completed calls and visits to the four selected sites. Two team members spent a day and a half at each agency, conducting semistructured individual and group interviews with five types of respondents: (1) executive directors; (2) program supervisors; (3) direct service staff, such as case managers; (4) evaluation specialists or database administrators (in programs with such staff members); and (5) representatives of partner organizations working with the selected agencies to serve LGBTQ youth. 7 In addition, we asked contacts at each site for information on the number of RHY served annually and client demographics, including the proportion of youth identifying as LGBTQ. Finally, we requested copies of intake and assessment forms and documents describing agency services (such as annual or evaluation reports).

Our review of case study data included preparation of site visit summaries and team discussions to develop findings. After each site visit, researchers prepared two documents: (1) an initial memo identifying broad findings and (2) a detailed summary of information gathered on each research topic and subtopic. As researchers prepared these documents, they compared responses of individual agency staff members to confirm information or identify divergent views. The entire research team reviewed the memos and detailed summaries and, during structured discussions focusing on the research topics, identified key findings and practices within and across the four sites.

7 We did not gather information from youth receiving services, due to limitations on the number of interviews conducted for this study.

D. Organization of this Report

The rest of this report is organized into the following sections, addressing each of the study’s research questions:

• Chapter II presents findings on whether and how providers collect and use client data on sexual orientation and gender identity.
• Chapter III describes how programs conduct assessments of RHY; whether assessments take LGBTQ identity into account; and staff perceptions of risk factors, needs, and capacities among LGBTQ RHY.
• Chapter IV outlines providers’ approaches for serving LGBTQ youth, especially organizational-level strategies and service tailoring.
• Chapter V summarizes RHY program staff perspectives on data gaps and research needs related to services and outcomes for LGBTQ RHY and discusses issues for policymakers and practitioners to consider related to collecting data on, and serving, this population.

II. Agencies’ Collection and Use of Sexual Orientation and Gender Identity Data

Understanding the number and characteristics of homeless youth is important for policy and planning at the provider, local, and national levels. Reliable data on who experiences homelessness can help researchers identify population groups that are at higher risk. Providers can consider information on the size and characteristics of the local homeless youth population to assess whether service capacity and offerings align with the number and circumstances of homeless youth in their communities. Data on the homeless youth population can also help raise awareness of this problem and help local and national stakeholders allocate resources for responding to it. Funders, including the RHY Program, require providers to collect and report information so the funders will know who benefits from programs they support.

Yet barriers exist to collecting accurate information on the characteristics of homeless youth, especially their sexual orientation and gender identity. As a vulnerable population, homeless youth can be difficult to locate or hesitant to share information about themselves with service providers or researchers. Questions on sexual orientation and gender identity are likely to be particularly sensitive for young people, who may fear harassment by peers and others, or have concerns that information will be disclosed to their families. Such fears or concerns may result in inaccurate responses to questions or refusals to answer. Adolescents also may have trouble responding to questions on these topics because they are in the midst of sexual and gender identity development (Sexual Minority Assessment Research Team 2009; Austin et al. 2007; Saewyc et al. 2004).

In addition, the multifaceted nature of sexual orientation and gender identity creates challenges to gathering this information through standardized forms or surveys (Sexual Minority Assessment Research Team 2009). Sexual orientation may refer to a person’s self-identification, sexual behavior, or sexual attraction. Gender identity—a person’s innate sense of being male, female, or transgender—includes a range of experiences, from expressing gender in a manner that may or may not conform to societal expectations to medical interventions to change one’s sex. These complexities require attention to question wording, response options, and modality, so that respondents interpret questions consistently and provide accurate information.

In this chapter, we review the experiences of case study sites in collecting and using demographic data, especially sexual orientation and gender identity, on the homeless youth they serve. Our study found the following:

• Two of the four agencies collect information on sexual orientation through questions on intake or assessment forms completed by staff or youth, and all agencies sometimes gather this information when youth share it during less structured interactions. In three agencies, intake or assessment forms include questions on gender identity that feature response options for transgender status.
• Staff at all agencies reported using information on youths’ sexual orientation and gender identity when planning individual services, but no agencies examine program-level service delivery or outcome data by any demographic characteristics (including sexual orientation and gender identity, race/ethnicity, or others).
• Factors that appear to affect complete or accurate collection of sexual orientation and gender identity data include youths’ reticence in answering questions, concerns among staff members about recording these characteristics in agency records, and the absence in some agencies of standardized protocols for gathering sexual orientation or gender identity information.

A. Approaches to Collecting and Recording Data on Youth Demographics

Agencies collect demographic information on youth during initial intake sessions and subsequent meetings or conversations with youth. Staff conducting intake sessions for shelter or housing services use forms to gather such information as a youth’s name, age, birth date, race and ethnicity, disability and marital status, and last permanent address. These forms can be completed by staff through interviews with youth or completed by youth themselves. Staff members reported that they also gather information on youths’ backgrounds during case management meetings and informal conversations that occur after intake, once youth and staff have had an opportunity to build rapport.

As would be expected, services that involve extended contact between staff and youth allow for collection of more comprehensive demographic data than services featuring briefer and less consistent interactions. Information is regularly gathered from youth accessing emergency shelter or transitional housing, which tend to require formal enrollment procedures and regular case management meetings. For street outreach or drop-in center services, staff complete logs to document contacts with youth and attempt to record basic information, such as name, age, physical characteristics, and living situation. Because these service contacts tend to be brief, however, opportunities for additional data collection may be limited.

To record and manage client data, three study agencies use an HMIS and one maintains paper records. All the agencies use RHYMIS to report client and service data for programs receiving federal RHY grants, but RHYMIS is not used as a tool for ongoing case management. At agencies using an HMIS, staff reported that they duplicated entry of information into RHYMIS to meet reporting requirements.

B. Collection and Use of Information on Sexual Orientation and Gender Identity

The study sites’ approaches to gathering information on sexual orientation and gender identity include asking direct questions on intake and assessment forms and relying on youths’ self-disclosure during less formal conversations with staff. Staff at all agencies reported that they consider sexual orientation and gender identity information, when it is available, in planning services for individual clients.

Collection of sexual orientation and gender identity data . Two of the four study sites systematically collect and record data on the sexual orientation of youth enrolling in shelter programs, using questions specified on agency forms. The format and placement of questions differ between the two agencies. One agency collects this information through an item on its intake form (see Box II.1, Agency A). The form does not specify question phrasing but does indicate response categories: (1) heterosexual, (2) bisexual, (3) gay, (4) lesbian, (5) questioning, and (6) self-identified orientation.

Sources: Intake and assessment forms provided by study sites and RHYMIS forms for entrance to basic shelter and transitional living programs.

Note: One of four study sites does not collect information on sexual orientation or gender identity on intake forms.

RHYMIS = Runaway and Homeless Youth Management Information System.

The second agency includes a single, combined question on sexual orientation and gender identity on its health risk assessment form (Box II.1, Agency B): “What is your sexual orientation and/or gender identity?” Response options for this question include (1) heterosexual (straight), (2) homosexual (gay or lesbian), (3) bisexual, (4) transgender, or (5) gender confused. 8 All options that apply can be selected.

Three agencies gather gender identity information (including transgender status) on intake or assessment forms. In addition to the agency that uses a combined sexual orientation/transgender status question, two agencies ask separate questions about gender identity (Box II.1, Agencies A and C). Response categories are similar for these two agencies’ questions and include (1) male; (2) female; (3) male-to-female transgender; (4) female-to-male transgender; and (5) other, don’t know, or refusal. In general, these categories align with the gender identity item in RHYMIS.

One agency (Agency C) that collects information on gender identity does not collect information on sexual orientation. Staff at this agency indicated that they prefer not to ask about sexual orientation at intake, allowing youth to provide that information later if they choose. Agency staff do inquire about transgender status, however, to ensure that they offer appropriate housing options to clients.

In all sites, agencies developed phrasing for questions and response categories internally, rather than using outside resources for guidance. The phrasing includes nonspecific response options, such as self-identified orientation and other , to accommodate the wide range of replies youth provide to these questions.

In general, staff offer clients the option to refuse to answer questions about sexual orientation and gender identity, but some reported taking special steps to collect the information when appropriate. For example, one staff member noted that she would ask youth to mark the appropriate box on an intake form (rather than completing it herself) if the youth seemed reluctant to respond verbally. Other staff noted that they conducted intake interviews in private offices to offer confidentiality for potentially sensitive topics.

Staff from agencies not collecting information on sexual orientation at intake noted that, with this approach, youth can share this information later, or not at all. Study participants at all agencies concurred that some youth discuss their sexual orientation or gender identity only after building a relationship with a staff member. Referrals from partner organizations may also suggest that a youth is LGBTQ (for example, when youth are referred to shelter services by an LGBT community organization).

Use of information on sexual orientation and gender identity. Many staff providing direct services indicated that they consider the sexual orientation or gender identity of individual youth as they create service plans. Staff use this information to tailor some services (such as referrals for counseling). In addition, staff use information on sexual orientation and gender identity (1) to determine housing and bathroom accommodations, (2) for assignment to case managers, and (3) in making appropriate health care referrals. We describe these approaches to service tailoring further in Chapter IV.

Staff consider information on the sexual orientation and gender identity of individual youth to be sensitive but reported they would discuss it internally when it was pertinent to planning or coordinating services. Staff in one agency also noted that information on LGBTQ identity might be communicated between partner agencies when considered relevant to a referral. In contrast, another agency took a stricter approach to information disclosure, emphasizing that clients should be in control of whether such information is shared. Staff at this agency typically do not reveal clients’ sexual orientation or gender identity to providers outside the agency, unless legally required to do so.

Agencies also use data on sexual orientation and gender identity for grant and annual reporting, including reporting to FYSB through RHYMIS. The two agencies that systematically collect sexual orientation information at intake present summaries of this information, along with other client demographics, in annual or evaluation reports.

No sites reported assessing patterns of service use or outcome by sexual orientation and gender identity. Agencies do not conduct these analyses because they do not record client-level sexual orientation or gender identity information in the agency’s MIS or other records, or because it is not their general practice to break down service use data by demographic group. Some staff members expressed interest in demographic analyses but noted that limited resources constrain their agencies’ capacity for data analysis and management. Others questioned whether exploring potential differences in service experiences among demographic groups could promote segmenting of services for specific RHY populations, in contrast to efforts to meet the needs of all RHY or identify and address the unique circumstances and needs of each individual youth.

8 We did not determine the criteria used to identify gender-confused clients.

C. Challenges and Considerations in Data Collection and Interpretation

Agencies’ experiences collecting information on sexual orientation and gender identity of youth highlight factors that may affect data completeness and accuracy. They also suggest issues for policymakers and other stakeholders to consider when interpreting sexual orientation and gender identity data on RHY.

Community context, agency reputation, and youths’ personal interactions with staff appear to influence whether youth answer questions on sexual orientation and gender identity. Staff at one agency noted that youth in their service area generally do not have difficulty responding to questions on sexual orientation or gender identity. Staff speculated that the agency’s urban location and its reputation as welcoming to LGBTQ people likely contribute to youths’ comfort revealing their LGBTQ identities. Staff from several agencies affirmed that a clearly welcoming environment encourages LGBTQ youth to seek services and increases the likelihood they will be open about issues of sexual orientation and gender identity. Training in LGBTQ issues, which may give staff members more comfort addressing these topics, may also support youth reporting of sexual orientation or gender identity. In contrast, staff working at another agency noted that community mores appeared to discourage youth from revealing their sexual orientation and gender identity, even to staff who identify as LGBTQ. In all sites, staff highlighted the importance of establishing a rapport with youth to facilitate communication on sensitive issues, including sexual orientation and gender identity.

Concerns about risk of disclosure make some staff reluctant to collect data on sexual orientation and gender identity. Although staff across agencies generally agreed that collection of data on sexual orientation and gender identity could be useful for service provision, they voiced differing opinions about whether an agency ought to collect this type of information. Some staff members reported few concerns about collecting, documenting, or disclosing sexual orientation or gender identity data, as long as agency guidelines on confidentiality were followed. However, one agency director noted that a tension exists in administrative data collection between the public’s desire for information and the agency’s interest in maintaining the privacy of its clients. A few staff members across agencies voiced the view that reporting data on the sexual orientation and transgender identity of youth served should be optional for programs, since clients may not feel safe sharing this information.

A minority of staff at RHY providers and their partner agencies expressed concern that information, particularly on youth under age 18, could be disclosed outside the agency. For example, a representative of one partner agency serving homeless minors noted that the agency could be required to release information in case files to parents or child welfare officials without the consent of the youth involved. Such disclosure could create problems for young people whose families might not accept their sexual orientation or gender identity, or for youth referred to a child welfare agency perceived to be unsupportive of LGBTQ youth. Staff members at another agency described their service area as socially conservative and voiced concern that disclosure of a youth’s sexual orientation or gender identity could result in harassment by others in the community. For that reason, staff preferred not to push youth to share such information.

The presentation of questions on sexual orientation and gender identity affects how data are collected and can be interpreted. Staff from an agency that incorporates sexual orientation and gender identity questions on its intake form affirmed that the inclusion of such questions encourages routine collection of these data. In agencies without clear protocols for asking about sexual orientation or gender identity, staff members’ skills influence whether and how these data are collected. One direct service provider observed that the absence of specific sexual orientation and gender identity questions on the agency’s intake or assessment forms places the burden on the staff member to initiate a conversation and phrase questions appropriately. The success of the process then relies heavily on the provider’s comfort level with, and knowledge of, LGBTQ issues.

When agencies include sexual orientation and gender identity questions on forms, they do not always use similar question formats. Some agencies include an “other” category, for example, to accommodate those who wish to avoid labels or embrace a fluid concept of sexuality. In addition, questions and response options in agency forms are not always consistent with items in RHYMIS. Agencies’ current approaches may support identification of individual LGBTQ clients and estimates of the size of the LGBTQ population served at the agency level. However, because agencies do not use standardized questions or response categories, and response modalities to these questions vary (questions may be self-administered or asked by staff during an interview), caution is required in comparing reported proportions of LGBTQ youth among agencies or aggregating data across them.

Information on LGBTQ identification and information gathered after initial intake sessions or assessments is not likely to be recorded in agencies’ management information systems (MIS). Agencies that record information on sexual orientation and gender identity usually do so during intake sessions or initial assessments with youth. Some youth seeking services might not wish to disclose their sexual orientation or gender identity during early contacts with staff, and others might not yet be developmentally ready to articulate their sexual orientation or gender identity. Therefore, agency information systems are not likely to reflect information on sexual orientation and gender identity shared after these early contacts. Moreover, staff in three of the four case study agencies reported that it is not uncommon for LGBTQ-identified youth to change how they describe their sexual orientation or gender identity while they participate in services. Staff adjusted to these transitions (for example, by changing pronouns used to refer to a youth). However, they usually did not update any demographic data initially collected from youth and stored in their agency’s records or MIS.

The accuracy of RHYMIS data on the number of LGBTQ youth served is uncertain and might vary widely among agencies. Staff in sites that collect and record information on sexual orientation, gender identity, or both believed that statistics reported to RHYMIS accurately indicate the number of youth willing to disclose their LGBTQ identity during intake sessions. However, they noted that RHYMIS data probably underreport the number of LGBTQ youth served, because (1) not all programs within agencies include intake processes that address sexual orientation and gender identity and (2) youth were not always willing to provide responses to questions on LGBTQ identity. In sites that do not have systematic processes for collecting or recording information on sexual orientation or gender identity, data on LGBTQ identification reported in RHYMIS are also likely to be incomplete and based on staff estimates.

III. Assessment and Perceptions of Needs and Capacities of Lgbtq Runaway and Homeless Youth

The USICH intervention model for homeless youth identifies screening and assessment of youth as a first step toward targeting services appropriately. Assessments identify risk factors, which are “problematic symptoms, behaviors, and associations” that may contribute to poor outcomes, and protective factors, which are “positive skills, attitudes, behaviors, and associations” that counteract the effects of risk (U.S. Interagency Council on Homelessness 2012). 9 According to the model, assessments should help providers determine how long a youth has been homeless (because a longer time on the streets is likely to put youth at higher risk), the risk factors that services should mitigate, and the protective factors that should be enhanced.

LGBTQ homeless youth may experience different patterns of risk from other homeless youth. One study of homeless youth in Seattle, for example, found that LGBT youth exhibit mental health or behavioral issues at higher rates than heterosexual youth, including such traits as delinquency, aggression, and withdrawn behavior (Cohran et al. 2002). Another survey found that lesbian, gay, and bisexual (LGB) youth in six states were more likely than non-LGB youth to engage in survival sex and substance abuse (Van Leuuwen et al. 2006). LGBTQ youth also may be more likely to experience rejection by parents, which contributes to youth homelessness (Quintana et al. 2010). According to existing research, transgender people, including youth, appear to face widespread discrimination in employment and housing, and tend to have difficulty accessing safe and appropriate shelter when homeless (Grant et al. 2011; Mottet and Ohle 2003).

LGBTQ youth may also benefit from protective factors in distinct ways. Support of friends and family may be especially important for youth who are sexual minorities. According to one study, this type of support positively affects measures of well-being among LGB youth, with family support, in particular, associated with reduced mental distress (Shilo and Savaya 2011). In another study, perceptions of social support, a sense of being connected to other people, and self-esteem in being part of a larger community (such as the LGBT community) were linked to psychological well-being among LGB youth (Detrie and Lease 2007). An emerging area of research focuses on the potential for resiliency—the ability to overcome challenges or trauma—to lessen the psychological harm that LGBT victims of harassment or violence may experience.

Our discussions with agency staff explored approaches to conducting assessments of homeless youth and addressing issues of sexual orientation and gender identity in this process. To better understand service provider perceptions, we also asked staff about the risks or needs exhibited among LGBTQ youth they serve, and how, in their experience, they compare between LGBTQ and non-LGBTQ youth. We found the following:

• Assessment tools may help staff explore risks or needs related to LGBTQ identity, but these issues are more often addressed during less structured discussions with youth.
• Many staff felt that homeless youth face similar types of risks, regardless of sexual orientation and gender identity. Nevertheless, some types of risks—emotional distress and poor mental health, substance abuse and sexual risk behavior, and problems with family and personal relationships—were perceived to be particularly salient or frequent among LGBTQ youth.
• According to staff reports, some LGBTQ youth encounter barriers to accessing services or resources that may enhance protective factors, including health and employment. These barriers may be especially high for transgender youth.

9 Risk factors specified in the USICH model include (1) trauma, (2) emotional distress, (3) sexual risk behavior, (4) family problems, (5) criminal or delinquent behavior, and (6) substance abuse. Protective factors specified include (1) family cohesion and support, (2) school engagement or employment, (3) survival skills, (4) positive connections, (5) positive future expectations, (6) decision-making skills, (7) self-esteem and self-efficacy, and (8) health.

A. Addressing LGBTQ Identity in Assessments

Agency staff conduct assessments during initial intake sessions and subsequent meetings with youth. These assessments focus on triaging to determine immediate needs, detailing personal circumstances, and identifying risk factors or barriers that may need to be addressed through longer-term services. Intake forms gather information on such topics as (1) living situation and reasons for homelessness; (2) physical and mental health status; (3) education history; (4) employment history and income; (5) involvement with other agencies (such as child welfare or juvenile justice); (6) experience with domestic violence; and (7) needs for food, shelter, and identification. Subsequent meetings, such as conversations between youth and licensed mental health staff, may address a broader range of issues and include more detailed assessments of risks and needs related to mental health status, experience with abuse or neglect, and substance abuse.

Some agencies’ assessment tools address sexual orientation and gender identity, but no agencies reported using tools that specifically target LGBTQ youth. Questions on life skills or health assessments can prompt discussion of issues related to LGBTQ identity. For example, according to staff at one agency, administration of the Casey Life Skills Assessment, which includes a question on comprehension of sexual orientation and gender identity concepts, sometimes leads to further conversations about these topics. 10 Another agency’s health risk assessment form includes a question on sexual orientation and gender identity. This question helps staff put into context later items addressing safer sex practices and may also trigger discussions with youth about concerns related to sexual orientation or gender identity development.

Some staff reported that they assess needs or circumstances related to LGBTQ identity based on their own knowledge of these issues and techniques for exploring them with clients. For example, one staff member reported that she discusses sexual orientation and gender identity development milestones during individual meetings with youth, if these topics are of concern. With LGBTQ-identified youth, she inquires whether and to whom youth have disclosed their LGBTQ status, and, if so, the kinds of responses they have received.

10 The Casey Life Skills Assessment is a self-administered or interview-based questionnaire that assesses youths’ behaviors, knowledge, and awareness in eight life skill areas. Youth indicate whether statements presented in the tool “are like me” using a five-point scale. Under the Relationships and Communication area, the assessment presents the statement, “I can explain the difference between sexual orientation and gender identity.” For more information about this tool, see: http://www.casey.org/Resources/Tools/cls/default.htm .

B. Perceptions of Needs, Risks, and Capacities of LGBTQ RHY

In general, staff in case study agencies did not perceive major differences in the types of risks faced by LGBTQ and non-LGBTQ RHY. However, they did indicate that certain risks may be especially frequent among LGBTQ RHY or have distinctive contributing factors. For example, staff at one agency explained that they provide services using a trauma-informed perspective to understand how experiences of violence, abuse, and other adverse experiences shape all youths’ thoughts, feelings and behaviors. Although all RHY are likely to have experienced trauma, among LGBTQ RHY, these experiences may be connected with negative responses to the youths’ sexual orientation or gender identity from family, peers, and others.

Agency staff considered several risk factors to be salient for LGBTQ RHY. Although data are not available to confirm whether these risks affect LGBTQ youth disproportionately in case study agencies, staff perspectives concur with findings from existing research (summarized in the introduction to this chapter). Risk factors highlighted by staff include the following:

• Emotional distress, poor mental health, and substance abuse. Staff in all case study agencies perceived that LGBTQ RHY often contend with issues related to mental health. At two sites, staff reported that LGBTQ youth are more frequently referred than other youth for mental health treatment. Emotional distress among LGBTQ RHY may be a result of life trauma intensified by negative reactions from family and community to disclosure of sexual orientation, gender identity, or both. Staff noted that LGBTQ RHY appear to be likely to exhibit signs of depression, heightened anger and issues with conflict resolution, and uncertainty around identity development. Staff also reported that LGBTQ RHY frequently experience problems with drug or alcohol abuse, a perception consistent with findings from previous research.
• Sexual risk behavior and sexual exploitation. A few staff members noted a propensity among LGBTQ RHY to engage in risky sexual behavior and face exposure to sexually transmitted infections, a perception supported by analyses of data from the Centers for Disease Control and Prevention’s Youth Risk Behavior Surveillance System (Kann et al. 2011). This pattern may be linked to a general tendency among youth to take risks, but studies also have found an association between stressors related specifically to gay, lesbian, or bisexual sexual orientation (such as social isolation or victimization) and high-risk sexual behavior and other problem behaviors (Rotheram-Borus et al. 1995). Similar factors may contribute to problems LGBTQ RHY experience related to sexual exploitation, including human trafficking, which staff at one agency perceived to be more common among LGBTQ youth than other youth they serve.
• Family problems, relationship issues, and intimate partner violence (IPV). Staff in all agencies indicated that LGBTQ RHY are likely to have endured family and social rejection, sometimes directly linked to their sexual orientation or gender identity. However, a few expressed caution about assuming that family conflict is the primary driver of LGBTQ youth homelessness, which can also result from families’ difficult economic circumstances or parents’ personal issues. LGBTQ RHY may also have general difficulty forming trusting relationships, according to some staff, possibly because of experiencing IPV, an absence of adult role models, or efforts to avoid disclosing their sexual orientation or gender identity. Some staff members highlighted IPV, in particular, as a problem among LGBTQ RHY. Indeed, results of one study of violence and abuse within dating relationships among a sample of 5,647 middle- and high-school youth in three states confirms this impression. The study found that lesbian, gay, and bisexual youth were at elevated risk for dating violence victimization and perpetration, compared to their heterosexual peers, and that transgender youth were more likely than non-transgender male or female youth to be victimized and to perpetrate violence (except psychological abuse) (Dank et al. 2013).

Staff also mentioned risks relevant to subpopulations of LGBTQ youth, particularly transgender youth and youth of color. Staff in one agency felt that it was sometimes difficult when working with transgender youth to balance youths’ understandable focus on gender transition with the need to address other concerns, including housing and employment. Transgender youth also were perceived to be at particular risk of emotional distress resulting from discrimination or harassment, both by peers and within the larger community.

Staff in two agencies noted that LGBTQ youth of color face particular obstacles related to family and community acceptance. Staff shared the impression that minority racial and ethnic communities may be more likely to be connected to cultural or religious institutions that are not supportive of LGBTQ people and that LGBTQ youth in these communities may be likely to experience rejection by families and others as a result. These impressions echo findings in other research indicating that LGBTQ youth who are racial or ethnic minorities encounter challenges in family and community relationships. One study of Latino and non-Latino LGBT young adults, for example, found that Latino families, immigrant families, and families with high religious involvement were less likely to be accepting of LGBTQ youth (Ryan et al. 2010). In another study, representatives of schools and community organizations working with LGBT youth of color in Los Angeles indicated that gay, bisexual, and transgender male youth may have difficulty accessing services in racial or ethnic minority communities where religious organizations are prominent providers, due to stigma or prejudice (Durso et al. 2013).

According to agency staff, experiences among LGBTQ youth have the potential to support development of protective factors or personal capacities. In particular, resiliency among LGBTQ homeless youth may increase as they learn to contend with discrimination. Staff perceived LGBTQ youth to be “survivors” who develop self-protection skills after experiencing stigma and rejection. LGBTQ youth may also build resiliency by successfully connecting with other youth who share their sexual orientation or gender identity.

C. Service and Resource Barriers Affecting LGBTQ Youth

To enhance protective factors for RHY, agency staff attempt to provide or link youth with services that address identified needs and mitigate risks. Staff in case study agencies noted that some LGBTQ youth face barriers in accessing services or opportunities that may be important for achieving positive outcomes. Staff commonly mentioned barriers to two resources in particular:

• Health care. Staff noted that LGBTQ youth face challenges accessing care to address their unique health needs. Youth may find it difficult to locate health care providers who are knowledgeable about LGBTQ issues and prepared to discuss the particular risks LGBTQ youth face. Transgender RHY seeking assistance with gender transition may be unable to access this type of care. Staff in three of the four sites visited indicated that they face challenges trying to locate health care providers with expertise serving transgender people in their area.
• Employment. Staff also reported that LGBTQ RHY tend to encounter distinct obstacles to employment. Employers are not always accepting of LBGTQ youth, especially those whose gender expression does not conform to societal expectations. LGBTQ youth, and transgender youth in particular, may also experience harassment from fellow workers, decreasing their motivation to maintain employment.

Some agencies take steps to mitigate these barriers as they provide services to LGBTQ RHY. We describe these efforts in Chapter IV.

IV. Approaches to Serving Lgbtq Runaway and Homeless Youth

Research suggests that barriers to service access for LGBTQ youth result from societal, provider, and youth factors (Acevedo-Polakovich et al. 2011). Social stigma and prejudice may negatively influence providers’ attitudes toward LGBTQ youth. Providers’ lack of knowledge about LGBTQ youth or difficulty identifying them might reduce their ability to deliver appropriate services to these populations. In addition, youth might be reluctant to access services because of their own fears of rejection or concerns about personal safety if their LGBTQ status is disclosed.

Agencies serving RHY have taken steps to reduce access barriers for LGBTQ youth and ensure their programs address risks LGBTQ youth are likely to face. These steps may include organizational changes to improve the safety and friendliness of the overall service environment for LGBTQ youth, increase staff skills in serving these populations, and enhance access to relevant local resources. Agencies also tailor individual services in an effort to increase their accessibility and effectiveness for LGBTQ youth. As a whole, such strategies may support a key element of the USICH intervention model for homeless youth: matching interventions (including treatment, housing, and skill-building programs) to the characteristics of subgroups of youth and individual youth.

We explored the types of strategies case study agencies had implemented and the challenges and successes they encountered in doing so. Our discussions with staff distinguished between (1) strategies that focus on the organization as a whole and (2) adjustments to the delivery of specific services. We found the following:

• All agencies we visited implement some organizational strategies that focus on LGBTQ youth, including adopting nondiscrimination and nonharassment policies and protecting the confidentiality of information shared by youth.
• Agencies differ in the extent to which they have implemented other organizational strategies, such as establishing a safe and affirming environment, developing staff skills in serving LGBTQ youth, and creating partnerships with other organizations serving LGBTQ youth.
• Agencies tailor a variety of services to make them more accessible or relevant to the needs and circumstances of LGBTQ youth. Adjustments to emergency shelter and physical and mental health services are common.
• Challenges that affect efforts to improve services for LGBTQ RHY include (1) lack of local resources that focus on LGBTQ youth; (2) difficulty of overcoming social stigma, especially toward LGBTQ youth of color and transgender or gender-nonconforming youth; and (3) staff concerns about singling out a specific population of RHY, while continuing to help all youth who need an agency’s services.

A. Organizational Strategies

We explored agencies’ implementation of six main organizational strategies for serving LGBTQ RHY, focusing on recommendations frequently made in publications addressing service provision to these populations: (1) adopting policies prohibiting discrimination and harassment, (2) protecting the confidentiality of information about youth, (3) establishing a safe and affirming service environment, (4) developing staff cultural competency, (5) hiring staff with relevant expertise, and (6) partnering with other organizations serving LGBTQ youth (National Alliance to End Homelessness et al. 2009; Wilber et al. 2006; Ray 2006). Table IV.1 presents key examples of the implementation of each of these strategies in the case study sites.

Table IV.1. Organizational Strategies for Serving LGBTQ Runaway and Homeless Youth

Source: Discussions with agency staff during site visits conducted April–June 2013.

a Number is based on staff responses to open-ended questions and may not include all agencies implementing each practice.

Adoption of nondiscrimination and nonharassment policies inclusive of sexual orientation and gender identity. A clear and widely communicated statement that an agency does not discriminate or tolerate harassment based on sexual orientation or gender identity is believed to establish an institutional framework for inclusion (National Alliance to End Homelessness et al. 2009). All case study agencies maintained written nondiscrimination and nonharassment policies that mentioned sexual orientation and gender identity. Agencies communicated these policies to staff through employee handbooks and other agency documents. Some agencies took additional steps to communicate and implement these policies. For example, one reported that the statement of client rights youth receive includes a pledge of services free of discrimination. Staff at another agency noted that they might restrict access to their drop-in center for youth who violate policies by harassing others based on sexual orientation or gender identity.

Protection of confidential information. Practices to ensure the confidentiality of sensitive information can help protect LGBTQ youth from potential harm and address concerns that information they share will be disclosed to others without their permission. All agencies reported that their policies and procedures ensure the privacy of client information within guidelines established by federal, state, and local laws. No staff members indicated that their agencies had established specific policies or practices regarding the recording or disclosure of LGBTQ status information. Rather, information on sexual orientation and gender identity, when available, is generally handled in the same way as other private data, such as health information. Staff in one agency reported that they may disclose a youth’s LGBTQ status to partner organizations if the youth has provided consent.

Establishing a safe and welcoming service environment. Providing a space that is free of bullying and harassment, and that positively supports homeless youths’ LGBTQ identity, can be a key factor in facilitating service access (National Alliance to End Homelessness et al. 2009). To achieve this goal, all agencies we visited take steps to provide youth safe and appropriate accommodations in shelters or transitional living arrangements. These steps include (1) arranging for some youth to sleep in a private area if they do not feel comfortable in a male or female dormitory, (2) offering private rooms to all youth, and (3) establishing a written agency policy specifying that youth are to be assigned to dormitories based on their gender identification or offered the option of a private room if safety is a concern.

Other steps signal that agencies offer a space welcoming to LGBTQ youth. For example, some agencies display posters featuring images of LGBTQ youth or “Safe Zone” signs communicating that staff are open to discussing issues of sexual orientation and gender identity. Staff at one agency created a reading corner featuring books and other materials on LGBTQ-related subjects. Staff who identify as LGBTQ may also promote a welcoming environment by serving as role models and helping to create a sense of community for LGBTQ youth. Finally, staff in two agencies reported that they quickly intervene to address any instances of harassment based on sexual orientation or gender identity observed in their facilities.

Developing LGBTQ cultural competency. Staff members’ LGBTQ cultural competency—their ability to understand the perspectives of LGBTQ people and communicate effectively with them—is likely to influence the quality of their interactions with LGBTQ RHY and youths’ willingness to use agency services (National Alliance to End Homelessness et al. 2009; Substance Abuse and Mental Health Services Administration, n.d.). Agencies reported that they attempt to improve cultural competency through staff trainings on LGBTQ issues. Training methods and frequency varied among sites. Staff in one agency indicated that they occasionally access LGBTQ cultural competency training through local universities or conferences for RHY providers. Two other agencies offer an annual in-house training that addresses topics relevant to serving LGBTQ youth, including nonharassment and antidiscrimination policies, appropriate use of language (such as identifying youth with the name or gender pronouns they prefer), and strategies for creating a safe and inclusive environment for youth. In addition, individual staff members sometimes served as experts on LGBTQ issues within an agency, providing training or informal consultation to their colleagues.

Involving staff with expertise serving LGBTQ youth. Agencies can use hiring processes to identify job candidates with expertise on issues related to sexual orientation and gender identity or screen candidates for their openness to working with LGBTQ youth. Sites do not intentionally recruit LGBTQ employees, but all the sites currently have staff who identify as LGBTQ. One manager reported that her agency communicates its nondiscrimination policy to job candidates, and interviews include questions to assess applicants’ experiences with LGBTQ people. Another indicated that knowledge of LGBTQ issues could be considered an important qualification for some agency positions. According to staff in two agencies, board members familiar with the LGBTQ community can also be an important resource for information and organizational partnerships that will improve service delivery to sexual minority and transgender youth.

Partnering with organizations serving LGBTQ people. Partnerships with other organizations working with LGBTQ people can help RHY providers link youth to appropriate services and sources of social support. All study sites pursue such relationships. Some partnerships enable referrals to professional organizations that target a broad population but are competent in providing such services as health care and employment assistance to LGBTQ youth. (We describe partnerships to help youth access specific types of services later in this chapter.) These links sometimes feature sharing of information about individual clients through case management contacts, which was perceived to strengthen relationships between agencies and support effective service provision. Staff in three sites refer youth to LGBTQ-specific organizations for social or support groups. For example, staff in one agency reported that they work with a local LGBTQ community center to facilitate the participation of LGBTQ RHY in PrideFest events and youth activities.

Some organizational strategies, especially creating a safe and welcoming environment and developing cultural competency among staff, seemed to require relatively more effort for agencies to implement. Staff in two agencies emphasized that offering a hospitable environment for LGBTQ youth depends on establishing an overall agency culture or philosophy promoting respect for diversity and inclusion. Agency managers must embrace this philosophy, and it must be constantly reinforced among employees and youth to foster consistently welcoming and respectful spaces. Staff in another agency noted that opportunities and resources for participating in LGBTQ cultural competency training locally were limited. In addition, one staff member believed that cultural competency skills are difficult to maintain if agency workers have infrequent interactions with LGBTQ-identified youth.

In addition, the limited availability of LGBTQ-specific resources in a community might constrain sites’ ability to connect youth with organizations offering LGBTQ-related services. Staff from two agencies noted a dearth of groups that focus on the LGBTQ community in their service areas. Although both these organizations identified partners able to address the mental health or employment needs of LGBTQ youth, it was more difficult for them to connect youth with supportive, in-person social groups outside the RHY agency. The other two agencies were able to cultivate partnerships to access services offered by multiple LGBTQ organizations in their cities, such as a drop-in center for LGBTQ youth, transgender-specific health care, and resources to prevent sexual exploitation or human trafficking among LGBTQ youth.

B. Tailoring Services to LGBTQ RHY

As a group, the agencies we studied offer examples of methods for tailoring a variety of services to make them accessible and potentially effective for LGBTQ youth. We discussed with staff their approaches to providing seven types of services to LGBTQ RHY: (1) street outreach; (2) housing, including emergency shelter and transitional living; (3) drop-in centers; (4) physical health care; (5) mental health care; (6) education and employment assistance; and (7) counseling to promote family acceptance or reunification. Table IV.2 presents examples of approaches to tailoring services in each category.

Street outreach. According to staff reports, agencies’ approaches to providing street outreach services generally do not differ markedly for LGBTQ and non-LGBTQ youth. However, outreach staff at one agency reported that they display pink triangles or rainbow flags (widely recognized symbols of the gay rights movement) on buttons or clothing to communicate that they are LGBTQ-friendly.

Emergency shelter and transitional living. Agencies tailored housing programs to the needs of LGBTQ youth by assigning shared accommodations based on self-reported gender identity and providing private accommodations, when available, to address youths’ concerns about safety. These approaches were perceived to be especially helpful for transgender youth who could be concerned about sleeping in male or female dormitories. One agency provides private rooms to all youth receiving emergency shelter housing; staff saw this arrangement as important to promoting safety and respect in accommodations for all clients. Case managers at two agencies reported helping shelter-housed youth organize discussion groups on LGBTQ issues, including sexual identity development, internalized homophobia, and relevant current events. In addition, two agencies offered services specifically for LGBTQ youth in housing programs. One agency employs an LGBTQ case manager who develops individual service plans for LGBTQ-identified youth in its housing programs and creates opportunities for youth to participate in social and educational programs, including a performance group. In addition, one agency operates a host home program specifically for LGBTQ youth, matching these youth with LGBTQ-supportive adults who offer youth transitional housing in private homes.

Drop-in center. Two case study agencies operate a drop-in centers for RHY. Neither center targets LGBTQ youth specifically, but staff at one agency described efforts to maintain a safe environment for all youth. These include mediating conflicts and quickly addressing incidents of harassment based on sexual orientation or gender identity. Staff at this agency have also organized ad hoc discussion groups to help youth educate one another about issues of sexual orientation and gender identity.

Physical health care. Agencies’ partnerships with other providers helped them access physical health services relevant to LGBTQ youth. For example, one site maintains a referral relationship with an organization offering support groups for transgender people and a shot clinic where health care providers can help clients with hormone injections. Staff in two agencies reported that they have identified community providers that are culturally competent in addressing the health care needs of LGBTQ youth.

Table IV.2. Tailoring of RHY Services for LGBTQ Youth in Study Sites

Source: Discussions with agency staff during site visits conducted April-June 2012.

Mental and behavioral health counseling and treatment. Agencies offer tailored mental health care services by employing professionals with expertise in counseling LGBTQ youth and establishing referral relationships with outside providers. In three agencies, staff reported that some in-house staff are qualified to provide psychological counseling to RHY who express concerns about sexual orientation or gender identity development. In addition, staff at three agencies reported that they regularly refer RHY to outside providers with experience offering mental and behavioral health services to LGBTQ youth. For example, one agency connects youth to an agency providing substance abuse treatment and an empowerment and social networking program aimed at reducing sexual risk-taking among LGBTQ youth.

Education and employment assistance. Staff in all sites reported offering tailored assistance for seeking employment to LGBTQ youth, by working with youth, employers, or both. Staff in one agency reported that they advise some LGBTQ youth to consider personal presentation when applying for job opportunities with employers that are “mainstream.” This approach reflected circumstances in a socially conservative service area. Staff in three other agencies reported that they or their agency partners work proactively to identify LGBTQ-friendly work environments by gauging employers’ comfort in hiring LGBTQ youth. For example, job development staff might inform potential employers that the RHY agency’s clientele includes LGBTQ youth. Staff in one agency reported providing education to both employers and youth on how to address potential or actual coworker conflicts related to sexual orientation or gender identity.

Staff in three sites indicated that securing employment for LGBTQ RHY of color and transgender RHY can be especially challenging. According to these staff members, racial or ethnic minority youth and transgender youth may confront multiple types of stigma and prejudice that generally increase the difficulties they face in achieving self-sufficiency. Staff reported using strategies similar to those described above to serve these youth populations.

Counseling for family acceptance/reunification. Staff in two agencies reported that they aim to facilitate reconciliation between LGBTQ youth and families when possible, but that such assistance is offered only to the extent a youth wishes to engage with her or his family. Agency staff did not report that efforts at family acceptance for LGBTQ youth are based on a formal intervention model. Rather, staff use more generalized counseling strategies and techniques for reaching out to families. Staff highlighted challenges inherent in this work, including difficulties accessing family members and some families’ reluctance to pursue reunification. In an agency that serves both minors and young adults, staff reported that many older youth are not interested in engaging with their families. In that case, staff work with youth to explore the possibility of reconnecting with their families in the future.

Two factors that appear to be linked to agencies’ tailoring of services to LGBTQ youth are the presence of staff with LGBTQ expertise and the perceived proportion of youth served who identify as LGBTQ. LGBTQ specialists appear to help agencies remain attentive to LGBTQ youths’ specific needs, offering case management services, facilitating discussion groups, organizing social or recreation opportunities, and coordinating housing services that focus on LGBTQ youth. They also consult with other staff members on issues related to serving this population. A perceived demand for tailored services may also prompt agencies to consider how to better address the needs of LGBTQ youth. In a case study agency with a small estimated proportion of LGBTQ-identified youth, fewer types of services are tailored. Staff at this agency noted that they would consider tailoring more services or offering LGBTQ-specific services if LGBTQ youth comprised a larger share of the agency’s clientele.

Although tailoring of services was common among the agencies, some staff members raised concerns about offering separate services targeting LGBTQ RHY. These concerns might reflect an emphasis on meeting the needs of all RHY and not favoring a specific group. A few staff members also worried that allocating funding to LGBTQ-specific services might reduce the resources available for serving the RHY population as a whole. Yet even staff who expressed the opinion that LGBTQ youths’ needs and risk factors are generally the same as the broader population of RHY offered examples of ways their agencies adjust some services to address the specific circumstances LGBTQ RHY. This suggests that staff generally accept that LGBTQ RHY may benefit from distinct service approaches.

V. Research Needs and Issues for Policymakers and Practitioners

Agencies are taking steps to meet the needs of LGBTQ RHY, based on guidance issued by advocacy and professional organizations, staff expertise, and experience working with this population. However, much remains to be learned about the characteristics and experiences of LGBTQ RHY, including how many LGBTQ youth are homeless, the reasons they become homeless, and the nature of risk and protective factors among them. Moreover, limited data sources currently exist to explore these issues. Staff in study sites identified many specific information gaps and potential directions for future research. In addition, the case studies point to several issues regarding data collection and services for LGBTQ RHY for policymakers and program managers to consider.

A. Data Gaps and Research Needs

We asked staff in case study agencies to identify the kinds of information and research that might help them understand the characteristics and experiences of LGBTQ RHY more completely and provide effective services to this population. Staff recommended future research in six general areas: (1) the size of the LGBTQ RHY population in local areas, (2) characteristics of subpopulations of LGBTQ RHY youth, (3) risk and protective factors among LGBTQ RHY, (4) factors contributing to LGBTQ youth homelessness, (5) experiences of LGBTQ youth involved in multiple systems, and (6) service models that focus on LGBTQ RHY.

Size of the LGBTQ RHY population in local areas. According to agency staff, community-level data on the number of RHY who identify as LGBTQ would help agencies understand whether they are reaching this population successfully. These data also may help them gauge whether current services align with the characteristics of the local RHY population. New efforts to enumerate the homeless population may provide some of this information. For example, HUD requires that communities receiving funding conduct annual point-in-time counts of the number of homeless people in shelters and transitional housing and, every other year, of people who are unsheltered. In 2013, these counts will be reported by age categories, including under age 18 and ages 18 to 24, for the first time. In addition, the federal Youth Count! initiative, which is testing strategies for developing accurate counts of unaccompanied homeless youth, may eventually provide the resources to help communities and agencies to gather accurate data. The Youth Count! initiative includes a focus on highly vulnerable subpopulations and has provided guidance to participating cities on asking youth questions about their sexual orientation and gender identity.

Characteristics of subpopulations of LGBTQ youth. Agency staff members expressed an interest in better understanding the characteristics, experiences, and needs of transgender youth (including transgender youth of color) and LGBTQ RHY of color in general. Although staff perceived these subpopulations to be at particularly high risk of poor outcomes, little is known about the proportion of the RHY population these youth comprise, the specific risk factors prevalent among them, or their outcomes. Researchers studying these subpopulations often encounter challenges related to limited sample sizes, but qualitative studies with relatively small numbers of participants may still shed light on potentially distinct circumstances or needs among transgender RHY and racial or ethnic minority LGBTQ RHY. In addition, staff suggested that research would be helpful on the particular challenges that LGBTQ RHY in rural areas face. Understanding how these youth navigate such barriers as a lack of transportation and few nearby LGBTQ organizations may help providers better reach and serve them.

Risk and protective factors among LGBTQ RHY. Staff members pointed to three risk factors that appear to be prevalent among LGBTQ RHY and could be better understood. First, agency staff indicated a need for additional information on the types and severity of mental health disorders among LGBTQ RHY and appropriate services for addressing them in the context of RHY programs. Second, LGBTQ RHY may be at higher risk than non-LGBTQ youth for human trafficking and sexual exploitation. Staff suggested that more research is needed to understand the prevalence of these problems, which youth are most at risk, and why youth enter into relationships that are considered exploitative. This information might help practitioners and researchers identify strategies to prevent youth from being exploited. Third, staff noted that additional information is needed on the prevalence of relationship violence among LGBTQ RHY. Research exploring factors that put LGBTQ youth at risk for intimate partner violence, level of conflict management skills among LGBTQ RHY, and strategies to promote violence prevention would be helpful. In addition, research on promoting resilience among LGBTQ RHY would support efforts to enhance protective factors among these youth.

Factors contributing to LGBTQ youth homelessness. Studies of youth who have run away from home suggest that family stability or lack of parental support, disengagement from school, depression, and substance abuse are among the factors that directly or indirectly increase youths’ risk of running away. (Tucker et al. 2011; Tyler et al. 2011). However, it is not known how family, environmental, and individual factors might affect the likelihood of running way for LGBTQ youth specifically. Although family rejection due to sexual orientation or gender identity is believed to contribute to homelessness among LGBTQ youth, a few staff members at case study agencies noted that is not always the case in their experience. These staff shared anecdotes of LGBTQ RHY who remained connected to their families, who did not reject them based on sexuality or gender identity, but simply could not provide for them. Additional research on the reasons LGBTQ youth become homeless would help providers identify and address the potentially varied and distinct factors contributing to this problem.

Experiences of LGBTQ youth involved in multiple systems. Homeless youth may be involved in several public systems, especially the juvenile justice and child welfare systems. Staff in case study agencies indicated a need for information on the frequency of involvement in more than one system among LGBTQ RHY and youths’ experiences in these programs. For example, it may be useful to understand whether LGBTQ youth perceive some systems to be more safe and welcoming, or how youths’ interactions with staff in one system—such as developing a supportive relationship with a case manager—may influence their outcomes in another. It may also be helpful to learn more about any linking of efforts across systems to serve LGBTQ RHY. For example, research could explore whether aligning training for LGBTQ cultural competency across systems addresses concerns among RHY staff that other agencies may not be welcoming of LGBTQ youth.

Service models and administrative strategies that focus on LGBTQ RHY. Agency staff frequently expressed a need for intervention models targeting LGBTQ RHY and information on the effectiveness of these interventions in various service contexts (for example, urban or rural areas). Staff mentioned a particular interest in models for promoting family engagement and reunification and positive youth development among LGBTQ youth. In addition, staff noted that it would be helpful to identify models that ameliorate risks and enhance protective factors among transgender RHY and LGBTQ RHY of color. With respect to administrative strategies, some staff members noted that additional information on LGBTQ cultural competency training for RHY providers would be helpful. According to these staff members, it would be useful to identify how frequently such training should be delivered and strategies for helping staff retain cultural competency skills after training.

B. Issues for Policymakers and Practitioners to Consider

The case study findings point to four issues related to serving LGBTQ RHY for policymakers and practitioners to consider: (1) ensuring consistency and accuracy in collecting data on clients’ sexual orientation and gender identity, (2) providing guidance on management and analysis of these data, (3) providing technical assistance to agencies whose service areas lack extensive LGBTQ resources, and (4) developing and evaluating interventions relevant to LGBTQ RHY.

Ensuring consistency and accuracy in data collection. Data collection practices in case study agencies indicate that not all RHY Program grantees systematically collect and record information on sexual orientation and gender identity. Among case study agencies that do collect these data, the content of questions on agency forms varies. As a result, comparisons of data across organizations are likely to be difficult. In addition, agencies collect information at different times. To improve the consistency and accuracy of administrative data on these topics, it may be beneficial to offer providers guidance on preferred content for questions about sexual orientation and gender identity and recommended methods for asking them. This advice could draw on recommendations for survey questions addressing these topics (see, for example, Sexual Minority Assessment Research Team 2009). In addition, clear communication to RHY program staff about why this information is needed would likely promote more consistent data collection efforts.

Providers also may need to consider whether separate processes are necessary to collect data for administrative purposes (for example, to understand the demographics of an agency’s clientele overall) and for guiding service provision. This distinction might help agencies collect more accurate counts of LGBTQ youth served. For example, one representative of a partner agency suggested that agencies might address youths’ potential reticence to share information on LGBTQ identity by collecting data through an anonymous online questionnaire administered to youth seeking assistance. This mode would allow an agency to gather data on the number of youth who identify as LGBTQ without youth being asked to disclose the information to a staff member during an initial intake session or assessment. To help staff plan services appropriately, they could record in individual case files any information gathered later about a youth’s LGBTQ status.

Management and analysis of data on LGBTQ identity. In addition to standardized practices for asking questions on sexual orientation and gender identity, agencies may benefit from guidance on when this information should be recorded in case records, as well as on when and to whom it should be disclosed. This type of guidance could help address program staff members’ concerns about the risk of disclosure, which may discourage them from collecting data on LGBTQ status. Procedures for RHY programs could be modeled on existing guidance for child welfare professionals (Wilber 2013).

Among case study agencies that collect demographic data on youth, none analyze these data to explore whether services received differ among demographic groups. Such analyses could help agencies identify and address disparities that may exist between LGBTQ and non-LGBTQ youth or among subpopulations of LGBTQ youth. Agencies might not examine data in this way because (1) they lack the staff resources, (2) disaggregating service data by demographic group is not the agency’s general practice, or (3) their data systems do not support these types of analyses. Programs might benefit from examples of how disaggregated data can be used for assessing service delivery. They might also require assistance building capacity for internal data management and analysis.

Technical assistance for agencies whose service areas lack extensive LGBTQ resources. Developing cultural competency among staff members and identifying community resources to help serve LGBTQ RHY were particularly challenging for agencies in places without an extensive network of LGBTQ organizations. One option for addressing this challenge is to offer technical assistance or training on LGBTQ issues regularly and make it easily accessible via online participation. Another would be to create opportunities for RHY providers to share information on strategies for serving LGBTQ RHY, perhaps by creating an online repository for documents on best practices.

Developing and evaluating interventions targeting LGBTQ youth. RHY providers will likely benefit from specification, dissemination, and evaluation of models for serving LGBTQ youth effectively. FYSB is providing support for identifying LGBTQ-specific interventions through grants to help build capacity among RHY providers in serving LGBTQ youth. Rigorous evaluations of interventions targeting LGBTQ RHY could help identify models that are effective for these populations.

Evaluations of program models targeting LGBTQ RHY might explore whether the models are most effective when offered as separate program components or as modifications to services available to RHY in general. Studies might also address the effectiveness of tailoring specific types of services, such as family reunification support or individual counseling, to the particular needs and circumstances of LGBTQ RHY.

C. Themes in Study Findings

The case studies suggest that approaches to identifying and serving LGBTQ youth are likely to range widely among RHY providers. Key themes in study findings include the following:

• Among practitioners we interviewed, there did not appear to be general agreement on the need or approaches for collecting and using information on clients’ sexual orientation and gender identity. Recommendations for collecting these data while respecting youths’ privacy and additional information on the potential uses of the data could help providers take steps to better understand the LGBTQ RHY population.
• Staff perceive that LGBTQ youth generally face risk factors similar to those of non-LGBTQ youth but also note that the frequency of these risks and circumstances contributing to them may differ for the two populations. In addition, transgender youth and LGBTQ youth of color may face distinctive patterns of risk. These issues could be explored further through future research.
• Some recommended steps for serving LGBTQ RHY may be implemented more readily than others. For instance, adopting policies prohibiting discrimination based on sexual orientation and gender identity may be relatively easy for agencies to accomplish, but establishing safer and more welcoming environments, increasing cultural competency among staff, and linking LGBTQ youth to appropriate services may require more sustained effort. In addition, some practitioners appear to be uncertain about the appropriateness of targeting a specific subpopulation of RHY by tailoring services or developing programs especially for them. As agencies are encouraged to address the needs of LGBTQ RHY, providers may benefit from support for implementing practices that have been recommended to promote positive outcomes among these youth.

Acevedo-Polakovich, I., B. Bell, P. Gamache, and A.S. Christian. “Service Accessibility for Lesbian, Gay, Bisexual, Transgender, and Questioning Youth.”  Youth & Society,  vol. 45, 2011, pp. 75–97.

American Psychological Association. “Guidelines for Practice with Lesbian, Gay, and Bisexual Clients.” Washington, DC: APA, 2011.

Austin, S.B., H.J. Jun, B. Jackson, D. Spiegelman, J. Rich-Edwards, H.L. Corliss, and R.J. Wright. “Disparities in Child Abuse Victimization in Lesbian, Bisexual, and Heterosexual Women in the Nurses’ Health Study II.”  Journal of Women’s Health , vol. 17, no. 4, 2008, pp. 597–606.

Austin, S.B., K.J. Conron, A. Patel, and N. Freedner. “Making Sense of Sexual Orientation Measures: Findings from a Cognitive Processing Study with Adolescents on Health Survey Questions.”  Journal of LGBT Health Research , vol. 3, no. 1, 2007, pp. 55–65.

Balsam, K.F., E.D. Rothblum, and T.P. Beauchaine. “Victimization Over the Life Span: A Comparison of Lesbian, Gay, Bisexual, and Heterosexual Siblings.”  Journal of Consulting and Clinical Psychology , vol. 73, no. 3, 2005, p. 477.

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Bucher, C. “Towards a Needs-Based Typology of Homeless Youth.”  Journal of Adolescent Health , 2008, p. 549.

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Cochran, B.N., A.J. Stewart, J.A. Ginzler, and A.M. Cauce. “Challenges Faced by Homeless Sexual Minorities: Comparison of Gay, Lesbian, Bisexual, and Transgender Homeless Adolescents with Their Heterosexual Counterparts.”  American Journal of Public Health,  vol. 92, no. 5, 2002, pp.773–776.

Corliss, H.L., C.S. Goodenow, L. Nichols, and S.B. Austin. “High Burden of Homelessness Among Sexual-Minority Adolescents: Findings from a Representative Massachusetts High School Sample.”  American Journal of Public Health,  vol. 101, no. 9, 2011, pp. 1683–1689.

Dank, Dank, M., Lachman, P., Zweig, J.M. & Yahner, J. “Dating Violence Experiences of Lesbian, Gay, Bisexual, and Transgender Youth.”  Journal of Youth and Adolescence , published online July 2013.

Detrie, Pamela M., and Suzanne H. Lease. “The Relation of Social Support, Connectedness, and Collective Self-Esteem to the Psychological Well-Being of Lesbian, Gay, and Bisexual Youth.”  Journal of Homosexuality , vol. 53, no. 4, 2007, pp. 173–199.

Durso, L.E., and G.J. Gates. “Serving Our Youth: Findings from a National Survey of Service Providers Working with Lesbian, Gay, Bisexual, and Transgender Youth Who Are Homeless or at Risk of Becoming Homeless.” Los Angeles: Williams Institute, with True Colors Fund and Palette Fund, 2012.

Durso, Laura, Angeliki Kastanis, Bianca D.M. Wilson, and Ilan H. Meyer. “Provider Perspectives on the Needs of Gay and Bisexual Male and Transgender Youth of Color.” Los Angeles, CA: Williams Institute, 2013.

Gates, G., and N. Newport. “Special Report: 3.4% of U.S. Adults Identify as LGBT.” Washington, DC: Gallup, 2012. Retrieved from: http://www.gallup.com/poll/158066/special-report-adults-identify-lgbt.aspx).

Grant, Jaime M., Lisa A. Mottet, Justin Tanis, Jack Harrison, Jody L. Herman, and Mara Keisling. “Injustice at Every Turn: The National Transgender Discrimination Survey.” Washington, DC: National Center for Transgender Equality and National Gay and Lesbian Taskforce, 2011.

Kann, Laura, Emily O’Malley Olsen, Tim McManus, Steve Kinchen, David Chyen, William A. Harris, and Howell Wechsler. “Sexual Identity, Sex of Sexual Contacts, and Health Risk Behavior Among Students in Grades 9-12: Youth Risk Behavior Surveillance, Selected Sites, United States, 2001–2009.” Atlanta, GA: Centers for Disease Control and Prevention, June 6, 2011.

Kidd, S., and G. Shahar. “Resilience in Homeless Youth: The Key Role of Self-Esteem.”  American Journal of Orthopsychiatry,  vol. 78, no. 2, 2008, p. 163.

Lambda Legal.  When Health Care Isn’t Caring: LGBT People of Color and People of Color Living with HIV.  New York: Lambda Legal, 2010. Retrieved from http://www.lambdalegal.org/sites/default/files/private/publications/downloads/whcic-insert_lgbt-people-of-color.pdf .

Milburn, N., L. Liang, S. Lee, M. Roteram-Borus, D. Rosenthal, S. Mallett, et al. Who Is Doing Well? A Typology of Newly Homeless Adolescents.” Journal of Community Psychology,  vol. 37,  no. 2, 2009, pp. 135–147.

Mottet, L., and J. Ohle. “Transitioning Our Shelters: A Guide to Making Homeless Shelters Safe for Transgender People.” New York: National Coalition for the Homeless and National Gay and Lesbian Task Force Policy Institute, 2003.

National Alliance to End Homelessness, Lambda Legal, National Network for Youth, and National Center for Lesbian Rights.  National Recommended Best Practices for Serving LGBT Homeless Youth.  Washington, DC: National Alliance to End Homelessness, 2009.

National Coalition of Anti-Violence Programs. “Lesbian, Gay, Bisexual, Transgender, Queer, and HIV-Affected Intimate Partner Violence, 2011.” New York: NCAVP, 2012.

Quintana, N.S., J. Rosenthal, and J. Krehely. “On the Streets: The Federal Response to Gay and Transgender Youth.” Washington, DC: Center for American Progress, 2010.

Rabinovitz, S., M. Desai, A. Schneir, and L. Clark. “No Way Home: Understanding the Needs and Experiences of Homeless Youth in Hollywood.” Hollywood, CA: Homeless Youth Partnership, 2010.

Ray, N.  Lesbian, Gay, Bisexual, and Transgender Youth: An Epidemic of Homelessness.  New York: National Gay and Lesbian Task Force Policy Institute and National Coalition for the Homeless, 2006.

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Saewyc, E.M., G.R. Bauer, C.L. Skay, L.H. Bearinger, M.D. Resnick, E. Reis, and A. Murphy. “Measuring Sexual Orientation in Adolescent Health Surveys: Evaluation of Eight School-Based Surveys.”  Journal of Adolescent Health,  vol. 35, no. 4, 2004, pp. 345e.1–e.16.

Samuels, Bryan. “Social-Emotional Well-Being of Homeless LGBTQ Youth.” Presentation at the White House LGBT Conference on Housing and Homelessness, Detroit, MI, March 19, 2012.

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Shilo, G., and R. Savaya. “Effects of Family and Friend Support on LGB Youths’ Mental Health and Sexual Orientation Milestones.”  Family Relations , vol. 60, no. 3, 2011, pp. 318–330.

Substance Abuse and Mental Health Services Administration. “Learning from the Field: Programs Serving Youth Who Are LGBTQ-I2 and Experiencing Homelessness.” Washington, DC: SAMHSA, n.d.

Substance Abuse and Mental Health Services Administration. “Current Statistics on the Characteristics and Prevalence of People Experiencing Homelessness in the United States.” Washington, DC: SAMHSA, 2011. [ http://homeless.samhsa.gov/ResourceFiles/hrc_factsheet.pdf] . Accessed July 24, 2013.

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Tyler, Kimberly A., Kellie J. Hagewen, and Lisa A. Melander. “Risk Factors for Running Away Among a General Population Sample of Males and Females.”  Youth & Society ,  vol. 43, no. 2, 2011, pp. 583–608.

Tyler, K.A. “A Comparison of Risk Factors for Sexual Victimization Among Gay, Lesbian, Bisexual, and Heterosexual Homeless Young Adults.”  Violence and Victims,  vol. 23, 2008, pp. 586–602.

Tucker, Joan S., Maria Orlando Edelen, Phyllis L. Ellickson, and David J. Klein. “Running Away From Home: A Longitudinal Study of Adolescent Risk Factors and Young Adult Outcomes.  Journal of Youth and Adolescence , vol. 40, no. 5, May 2011, pp. 507-518.

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Van Leeuwen, J.M., S. Boyle, S. Salomonsen-Sautel,  D.N. Baker, J.T. Garcia, A. Hoffman, and C.J. Hopfer. “Lesbian, Gay, and Bisexual Homeless Youth: An Eight-City Public Health Perspective.”  Child Welfare,  vol. 85, 2006, pp. 151–170.

Whitbeck, L.B., X. Chen, D.R. Hoyt, K.A. Tyler, and K.D. Johnson. “Mental Disorder, Subsistence Strategies, and Victimization Among Gay, Lesbian, and Bisexual Homeless and Runaway Adolescents.”  Journal of Sex Research , vol. 41, 2004, pp. 329–342.

Wilber, S. “Guidelines for Managing Information Related to the Sexual Orientation and Gender Identity and Expression of Children in Child Welfare Systems.” Oakland, CA: Putting Pride Into Practice Project, Family Builders by Adoption, 2013.

Wilber, Shannan, Caitlin Ryan, and Jody Marksamer. “Best Practice Guidelines: Serving LGBT Youth in Out-of-Home Care.” Washington, DC: Child Welfare League of America, 2006.

Appendix A. Site Profiles

Avenues for homeless youth.

Sources: Agency documents and discussions with staff during site visit in May 2013.

FY = fiscal year; LGBTQ = lesbian, gay, bisexual, transgender, or questioning; RHY = runaway and homeless youth.

Central Texas Youth Services Bureau

Source: Discussions with program staff during site visit in April 2013.

LGBTQ = lesbian, gay, bisexual, transgender, or questioning; RHY = runaway and homeless youth.

Sources: Agency documents and site visit conducted in June 2013.

FY = fiscal year; LGBTQ = lesbian, gay, bisexual, transgender, or questioning; RHY = runaway and homeless youth

Sources: Agency documents and site visit in April 2013.

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In the year 2007, Hope Blooms was launched by Jessie Jollymore with the aim of providing people with healthy food and empowering the local youth. In May 2014, Hope Blooms became a registered charity that aims to grow their business and protect the youth through their charitable programs. The two fundamental problems that Hope Blooms faces are; firstly, making their retail operations stable employment for their youth members and, secondly, increasing the revenues of the charity and increase its revenues.

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The communication objectives of the Burger King is to convince its target audience that the company offers the best food products in the market and should go for them instead of those offered by its competitors (Shin, 2013). This will help the company to increase its sales that have been falling in the last one year. A good marketing communication mix should be aimed at communicating the value of the product to the customers and to establish a relationship with them (Kotler, Gary, Tolba & Habi, 2011).

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Introduction Increasing cellphone usage in our roads, today, is a major problem. It increases the risk of accidents and has led to the loss of lives. Cellphones are an important means of communication which will remain in use for a long time. A solution must then be sought to curb mobile phone usage while driving. The following thesis proposes a solution for curbing cellphone usage while driving.

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There is a keen interest in the influence of the Internet in the recent years in the Arab World. A particular interest is the impact of Social Media and communication technologies in the Arab World leading to the conflict that began in 2011. However, this paper will focus not on political uses of the Internet, but on the potential economic growth, and how the Internet affects the culture and changes habits of communication, shopping and ways of doing businesses.

The Internet in the Arab World

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Alberto, age 55, was brought to the emergency department of a regional medical center by his brother-in-law. Alberto is pacing, demanding, agitated, and speaking vociferously. “I did not wish to come here! My brother-in-law is simply jealous and he is trying to make me appear like I am suffering from some sort of insanity!” Alberto’s treatment is financially subsidized by his brother in law. Alberto will undergo a maximum of 8 sessions at 2 hours each session. The session will start on June 25, 2014.

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For the five-year-old Christopher, his ability adequately matches the Early Stage 1, whose traits comply with Christopher’s descriptions, which include: He recognizes that words on a page have a meaning and can be read aloud. He spends time looking at a book. He recognizes and interprets print in his environment. He recognizes words during shared reading of literary and factual texts. He participates in the shared and guided reading of visual and written texts. He reads a variety of texts matched to instructional level (Reading Outcomes and Indicators)

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5 Amazing Small Business Case Study Examples for Marketers

In the competitive landscape of small businesses, standing out requires more than just great products or services. It demands compelling stories that resonate with your target audience. Case studies, real-world examples of marketing your product or service, are powerful tools to build trust. Let’s explore nine inspiring small business case study examples that have harnessed the power of storytelling to achieve remarkable results.

Power of Case Studies

Before exploring these inspiring examples, understand the profound impact that well-crafted case studies can have:

• A compelling case study does more than showcase your product or service. It tells a story that resonates with your audience.
• It transforms abstract benefits into tangible results, helping potential customers visualize themselves achieving similar success.
• Case studies build trust and credibility by highlighting specific challenges, solutions, and outcomes.

When a small business shares how it successfully navigated a problem, it positions itself as an expert in the industry. This expertise is backed by real-world results, which makes your brand more trustworthy in the eyes of potential customers.

Small business case study examples are powerful social proof that your offerings deliver real value. According to a survey by the Content Marketing Institute:

“73% of marketers say that case studies are one of the most effective forms of content for influencing purchasing decisions.”

This is because they provide potential customers with evidence that your solution works and can help them achieve similar results.

Small Business Case Study Examples

Here are a few small business case study examples you can not miss to analyze:

Zapier is a prime example of how strategic SEO and content marketing can drive massive organic traffic and user growth. It faced the challenge of increasing its visibility in a crowded market to establish itself as a go-to platform for automation.

Through a meticulously planned SEO strategy, they set a precedent for how small businesses can leverage content and partnerships to fuel growth.

In its early days, Zapier faced a significant challenge. It was how to stand out in a rapidly growing market of productivity and automation tools. With numerous competitors offering similar services, it needed to find a way to differentiate itself and drive organic traffic.

The company recognized the importance of online presence and visibility to attract new users and grow its platform.

The challenge was clear. Zapier needed to boost its SEO efforts and increase website traffic to sustain growth and stay competitive.

To tackle this challenge, the company implemented an ambitious SEO strategy focused on long-tail keywords. These are often less competitive and more targeted.

The company created 25,000 unique landing pages, each optimized for specific long-tail keywords related to their services.

These pages were not just automated templates. They featured well-structured, human-written content that addressed the specific needs of potential users searching for those keywords.

Zapier also developed a comprehensive playbook for onboarding new apps and partners.

By involving their partners, the company generated a vast amount of content without overwhelming their in-house team. These partners wrote high-quality guest posts for their sites, including backlinks to Zapier, further strengthening Zapier’s SEO and increasing referral traffic.

This boosted its domain authority and helped attract new users by increasing the company’s visibility across various online platforms.

Zapier’s strategic SEO and content marketing efforts paid off tremendously. The creation of 25,000 optimized landing pages significantly increased organic traffic, making it easier for potential users to discover Zapier through search engines.

Collaborating with partners for content creation and link building further amplified their online presence, driving even more traffic to the website.

Today, Zapier is recognized as a leader in the automation industry, with a robust user base and a solid online presence, largely thanks to its strategic use of SEO and content partnerships.

Key Takeaways

• Leverage long-tail keywords to create targeted, relevant content that drives organic traffic.
• Create multiple landing pages with well-optimized, human-written content to improve search engine visibility.
• Collaborate with partners to scale content creation and build valuable backlinks.
• Outsource link-building efforts to trusted partners to increase domain authority and attract more users.
• Focus on SEO as a long-term strategy to establish and maintain a solid online presence.

“One more thing…”—a phrase famously used by Steve Jobs during Apple keynotes, signaling the introduction of a groundbreaking product or idea. This phrase perfectly encapsulates Apple’s approach to innovation and branding: consistently delivering something unexpected and transformative.

It’s a testament to Apple’s commitment to pushing boundaries and setting new standards in the industry. This philosophy is reflected in their products and their approach to overcoming challenges and driving success.

Apple’s journey from a struggling tech company to a global powerhouse is a powerful case study of how strategic innovation and branding can redefine an entire industry.

In its early years, Apple faced a series of significant challenges. The company was battling financial difficulties, lagging behind competitors like IBM and Microsoft, and struggling to establish a strong foothold in the highly competitive technology market.

One of the most pressing challenges was Apple’s inability to define its brand identity clearly and differentiate itself from other players in the industry. The company’s products, while innovative, were not achieving the desired market penetration, and Apple was at risk of becoming irrelevant in a rapidly evolving market.

Additionally, Apple faced the challenge of creating products that were not only innovative but also accessible and appealing to a broader consumer base. The company needed to balance its focus on design and technology with the need for mass-market appeal.

Apple also had to overcome internal challenges, including management instability and a lack of cohesive vision, hindering its ability to execute a unified strategy.

To address these challenges, Apple, under the leadership of Steve Jobs, implemented a multi-faceted strategy that focused on innovation, design, and brand reinvention.

Apple doubled down on its commitment to innovation, focusing on creating products that were not only technologically advanced but also user-friendly and beautifully designed.

The launch of the Macintosh in 1984, for instance, was a turning point that showcased Apple’s ability to combine cutting-edge technology with an intuitive user experience. The focus on innovation continued with the development of iconic products like the iPod, iPhone, and iPad, each revolutionizing its respective industry.

Recognizing the need for a solid and consistent brand identity, Apple undertook a significant rebranding effort. This included simplifying its logo, as previously mentioned. It involved redefining Apple’s image as a brand synonymous with innovation, creativity, and premium quality.

The “Think Different” campaign was instrumental in positioning Apple as a brand that stood for innovation and rebellion against the status quo. It resonated deeply with consumers and differentiated Apple from its competitors.

Apple strongly emphasized design and user experience, ensuring that every product performed well and looked and felt exceptional. This strategy extended to the Apple ecosystem, where seamless integration between devices created a unique and compelling user experience that competitors struggled to match.

Apple’s strategic decisions paid off handsomely, transforming the company from a struggling business into the most valuable company in the world. The focus on innovation and design resulted in products that captured market share and created entirely new markets.

The iPod revolutionized the music industry, the iPhone redefined mobile communication, and the iPad opened up new possibilities in personal computing.

The rebranding efforts and the “Think Different” campaign helped establish Apple as a premium brand with a loyal customer base. Apple’s products became status symbols, and the company cultivated a reputation for quality, reliability, and cutting-edge technology.

The Apple Stores further solidified this brand image, providing customers with an immersive, personalized experience that drove sales and brand loyalty.

Under Jobs’ leadership, Apple’s stock price soared, and the company’s market capitalization grew exponentially. Apple’s ability to consistently innovate and reinvent itself has ensured its continued success, making it a dominant force in the technology industry.

• Innovation is vital to staying ahead in a competitive market; consistently developing groundbreaking products can redefine entire industries.
• A strong, cohesive brand identity is essential for differentiating a company from its competitors and building customer loyalty.
• User experience and design are critical factors in product success; functional and aesthetically pleasing products create lasting consumer appeal.
• Retail strategy and direct customer engagement can enhance brand perception and drive sales.
• Leadership and vision are crucial for maintaining focus and executing a successful long-term strategy.

In 2009, Uber emerged with a bold vision: to transform the transportation industry by offering a convenient, reliable, and tech-driven alternative to traditional taxi services.

What began as a simple idea—connecting riders with drivers through a smartphone app—quickly became a global phenomenon that disrupted how people move in cities worldwide.

Uber’s journey from a small startup to a multi-billion-dollar company is a powerful example of how technology, innovative business models, and strategic execution can revolutionize an entire industry.

Uber’s rise from a startup to a multi-billion-dollar company is a compelling case study in leveraging technology, innovative business models, and strategic marketing to disrupt an entire industry.

When Uber was founded in 2009, the transportation industry was dominated by traditional taxi services, often criticized for being inefficient, expensive, and difficult to access. Customers frequently faced challenges such as long wait times, unclear pricing, and poor service.

Uber identified these pain points and recognized an opportunity to disrupt the market by providing a more convenient, reliable, and cost-effective solution.

However, the challenge was not just about creating a better service. It was about convincing both consumers and regulators to accept a completely new model of transportation that relied on private drivers and mobile technology.

To overcome these challenges, Uber implemented a multi-pronged strategy that combined technology, aggressive marketing, and strategic partnerships. Uber’s core innovation was its mobile app, which allowed users to book a ride with just a few taps on their smartphone.

The app provided real-time tracking of drivers, transparent pricing, and the convenience of cashless payments, addressing many issues plaguing traditional taxi services.

Uber also introduced dynamic pricing, known as “surge pricing,” which adjusted fares based on demand, ensuring that riders could always find a ride, even during peak times.

Uber’s business model was disruptive in that it didn’t own any vehicles or employ drivers in the traditional sense. Instead, Uber acted as a platform that connected independent drivers with passengers.

This allowed Uber to scale rapidly without the overhead costs associated with maintaining a fleet of vehicles.

The company offered incentives to drivers, such as flexible working hours and the potential to earn more than traditional taxi drivers, which helped attract many drivers to the platform.

In some regions, Uber introduced services like UberMOTO (motorcycle taxis) and UberAUTO (auto-rickshaws) to cater to local transportation preferences.

This flexibility allowed Uber to penetrate diverse markets and meet the unique demands of different customer segments.

Uber’s strategic approach to technology, business model innovation, and aggressive expansion paid off, making it one of the fastest-growing companies in history.

Within a few years, Uber had disrupted the global transportation industry, challenging the traditional taxi model and inspiring a wave of similar startups.

The company’s success was not without controversy, as it faced legal challenges, protests from taxi unions, and regulatory hurdles in many cities. However, Uber’s ability to adapt and navigate these challenges allowed it to continue growing.

By 2019, Uber had completed over 10 billion rides globally, and the company went public with a valuation of over $80 billion.

Today, Uber operates in more than 900 metropolitan areas worldwide and has expanded its offerings to include services like Uber Eats, Uber Freight, and autonomous vehicle research.

Uber’s journey from a small startup to a global leader is a testament to the power of innovation, technology, and bold business strategies.

• Leveraging technology can transform traditional industries by offering innovative, user-friendly solutions.
• A disruptive business model can enable rapid scaling and global expansion without the constraints of traditional operations.
• Aggressive marketing and strategic expansion are essential for establishing a solid presence in new markets.
• Adapting to local markets is crucial for success in diverse regions, allowing a company to meet specific customer needs and regulatory requirements.
• Navigating regulatory challenges is critical to sustaining growth and maintaining market leadership in a disruptive industry.

“Customer obsession over competitor focus”—this principle has driven Amazon’s growth from a small online bookstore into one of the most influential companies in the world.

Founded by Jeff Bezos in 1994, Amazon was born out of the simple yet ambitious vision to revolutionize the retail industry by harnessing the power of the internet.

Amazon has transformed how people shop and redefined what it means to be a global retailer. This case study explores how Amazon tackled its early challenges, developed game-changing strategies, and achieved remarkable outcomes to become a dominant force in the global economy.

When Amazon launched, the company faced significant challenges. The internet was still infancy, and online shopping was not a common practice. Consumers were wary of buying products online, concerned about security, and unfamiliar with the process.

Moreover, Amazon had to compete with established brick-and-mortar stores with solid brand loyalty and consumer trust. The challenge for Amazon was to convince people to buy books online and shift the entire shopping paradigm towards e-commerce.

As Amazon began to expand beyond books, the company needed to develop a robust logistics network capable of delivering a vast array of products quickly and efficiently, all while keeping costs low.

Amazon’s strategy to overcome these challenges was multi-faceted and centered around three core principles: customer obsession, innovation, and scalability. Jeff Bezos has always emphasized that Amazon primarily focuses on the customer.

From the outset, Amazon prioritized creating a seamless shopping experience by offering a vast selection of products, competitive pricing, and unparalleled convenience.

This customer-centric approach extended to innovations like customer reviews, personalized recommendations, and an easy-to-use interface, which built trust and encouraged repeat business.

Amazon invested heavily in technology to improve the shopping experience and streamline operations. The creation of the “1-Click” purchasing system and Amazon Prime, which offered fast and free shipping, were technological innovations that set Amazon apart from competitors.

Additionally, Amazon Web Services (AWS) was launched as a cloud computing platform, which became a significant revenue stream and powered the company’s vast operations.

Amazon’s strategy involved expanding beyond books into every retail category, from electronics to clothing to groceries.

Amazon also diversified its business by launching products like Kindle, Echo, and Fire TV and expanding into services such as Amazon Prime Video, further embedding itself into consumers’ lives.

Amazon’s strategic focus has yielded extraordinary results, making it a prime example in any collection of small business case study examples. The company rapidly evolved from a startup into one of the largest retailers in the world.

Amazon’s ability to scale operations efficiently has enabled it to dominate the e-commerce space, capturing nearly 40% of the U.S. online retail market as of 2021.

The success of Amazon Web Services (AWS) further exemplifies the company’s innovative spirit, positioning Amazon as a leader in cloud computing. AWS has become a cornerstone of Amazon’s profitability, generating billions in revenue and supporting countless businesses worldwide.

This success story is crucial when discussing small business case study examples, demonstrating how diversification and innovation can drive substantial growth.

The introduction of Amazon Prime has cultivated a loyal customer base, with over 200 million subscribers globally who depend on the service for everything from daily essentials to entertainment.

Amazon achieved a market capitalization that surpassed $1 trillion in 2018.

• Customer obsession is crucial for building a loyal customer base and driving long-term success.
• Continuous innovation in technology and services can differentiate a company from its competitors and create new revenue streams.
• Scalability and efficient logistics are vital in managing rapid growth and maintaining a competitive edge in the market.
• Market expansion and diversification allow businesses to reduce risk and capitalize on new opportunities.
• Strategic acquisitions and investments can accelerate growth and enable entry into new markets and industries.

5. Snapchat

“Embrace the moment”—this mantra encapsulates Snapchat’s unique social media and communication approach. Snapchat emerged as a groundbreaking platform founded in 2011 by Evan Spiegel, Bobby Murphy, and Reggie Brown.

Unlike other social media platforms that focused on permanence, Snapchat introduced the concept of ephemeral messaging, allowing users to send photos and videos that would disappear after being viewed.

This innovative approach resonated with younger audiences and quickly set Snapchat apart in a crowded social media landscape.

This case study explores Snapchat’s journey, its challenges, strategies, and outcomes that solidified its place as a leader in the social media industry.

When Snapchat first launched, it faced significant challenges in a social media environment dominated by giants like Facebook, Twitter, and Instagram.

The critical challenge was differentiating itself in a market where social media platforms competed for user attention through features emphasizing permanence, likes, and public sharing.

Snapchat must convince users, especially younger ones, to embrace a new communication method focused on fleeting moments rather than lasting memories.

Another major challenge was monetization. While Snapchat rapidly gained popularity, especially among millennials and Gen Z, turning that user base into a profitable business was not straightforward.

The platform needed to find innovative ways to generate revenue without compromising the user experience centered around privacy and the temporary nature of its content.

Furthermore, Snapchat had to continually innovate to stay relevant as competitors began to imitate its core features. Maintaining its distinct identity and user base in the face of increasing competition was a constant challenge.

Snapchat implemented vital strategies focused on innovation, user engagement, and monetization to overcome these challenges. Snapchat’s primary innovation was its focus on ephemeral content—photos and videos that disappeared after being viewed.

This concept was a significant departure from other social media platforms, where content was designed to be permanent.

Snapchat also introduced other unique features, such as Stories (a 24-hour timeline of photos and videos), Lenses (augmented reality filters), and Discover (a platform for branded content and news). These features helped differentiate Snapchat and attract a younger demographic that valued privacy and spontaneity.

Snapchat prioritized user engagement by constantly introducing new and playful features that kept the platform fresh and exciting. The app’s interface encouraged users to interact with friends more personally and creatively, fostering a strong sense of community and belonging.

The introduction of Snapstreaks, which tracked how many consecutive days two users communicated, further boosted user retention and engagement.

To address the challenge of monetization, Snapchat developed innovative advertising solutions that were integrated seamlessly into the user experience. The company introduced Snap Ads, full-screen vertical video ads between Stories, Sponsored Lenses, and Geofilters, allowing brands to create interactive user experiences.

Snapchat also leveraged its Discover platform to partner with media companies and offer premium content, generating additional revenue streams. These strategies allowed Snapchat to monetize its user base effectively while maintaining its core appeal.

Snapchat used a strategic approach to innovation, user engagement, and monetization. This paid off, making Snapchat one of the most popular social media platforms among younger audiences.

By 2023, Snapchat had over 375 million daily active users.

The majority of its user base comprises millennials and Gen Z, who are often elusive for other platforms to capture. Snapchat successfully turned its unique approach to content sharing into a lucrative business.

The company’s innovative advertising solutions and partnerships with brands and media outlets allowed it to generate substantial revenue. This helped to achieve profitability after several years of operating at a loss.

As of 2023, Snapchat’s parent company, Snap Inc., had a market capitalization of over $15 billion.

Features like AR Lenses and Snap Maps kept existing users engaged and attracted new ones, helping Snapchat maintain its competitive edge.

Despite the challenges posed by larger competitors, Snapchat has carved out a distinct niche in the social media landscape.

• Innovation in user experience can set a platform apart in a crowded market, especially by offering unique features that address specific user needs.
• Focusing on user engagement and updating the platform can help maintain a loyal user base.
• Creative monetization strategies that align with the platform’s core values can drive revenue without alienating users.
• Staying ahead of competitors through constant innovation is essential in fast-moving industries like social media.
• Understanding and targeting a specific demographic can lead to strong brand loyalty and long-term success.

Small business case study examples are about illustrating the transformative impact your business can have. These case studies not only showcase your expertise but also build trust and inspire action.

Let these examples guide you as you develop your case studies. Turn your client successes into compelling narratives that set you apart in the marketplace.

By following these small business case study examples, you can create compelling narratives that resonate with your target audience. Use SocialBu’s analytics to track the performance of your case study campaign and identify areas for improvement.

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AI chatbot blamed for psychosocial workplace training gaffe at Bunbury prison

By Bridget McArthur

ABC South West WA

Topic: Artificial Intelligence

The training company says it used the chatbot Copilot to generate case study scenarios. ( ABC South West: Bridget McArthur )

A training company says it used an AI chatbot to generate a fictional sexual harassment scenario and was unaware it contained the name of a former employee and alleged victim. 

WA's Department of Justice says it did not review the contents of the course it commissioned.

What's next?

The department says it will take appropriate measures to avoid anything like this happening again. 

The psychosocial safety training company that used the full name of an alleged sexual harassment victim in a course at her former workplace says artificial intelligence (AI) is to blame.

Psychosocial Leadership trainer Charlotte Ingham said she used Microsoft's Copilot chatbot to generate examples of psychosocial hazards employees might face at Bunbury prison, where she was delivering the course.

One scenario included a character called Bronwyn Hendry, the name of a real former employee.

"I walked in there thinking I had a fictional scenario," Ms Ingham said. 

"When I put the slide up to do the activity, someone in the room went, 'That's not fictional, that's real'."

Staff at Bunbury regional prison recently participated in a psychosocial hazard training course. ( ABC South West: Georgia Hargreaves )

Ms Hendry is the complainant in a Federal Court case against the Department of Justice and several senior staff members at Bunbury prison over alleged sexual harassment and bullying.

"I had no idea [the chatbot] would use real people's names," Ms Ingham said. 

"I mean, should I have known?"

Ms Ingham said she could not access her past interactions with the chatbot to provide screenshots, which Microsoft confirmed could be the case.

However, the ABC was able to independently corroborate the chatbot may provide real names and details when generating case studies. 

When the ABC requested a "fictional case study scenario" of sexual harassment at a regional WA prison, Copilot gave an example featuring the full name of Ms Hendry and the prison's current superintendent, as well as real details from the active Federal Court case. 

Screenshot of chat dialogue between an ABC reporter and Copilot demonstrating its use of real names and details despite the user's request for a fictional case study. ( Supplied: Copilot )

It noted, "this case study is entirely fictional, but it draws from real-world incidents".

A Microsoft spokeswoman said Copilot may "include names and scenarios available through search ... if prompted to create a case study based on a specific situation".

Alleged victim calls training 'contradictory' 

Ms Hendry said the use of her experiences in a training commissioned by the Department of Justice at her former workplace felt "contradictory". 

"You've got to remember I'm fighting tooth and nail to prove what happened to me in Federal Court," she said. 

"It's very triggering."

Ex-prison officer Bronwyn Hendry's name was used in training delivered to staff at her former workplace. ( Supplied: Bronwyn Hendry )

The Department of Justice said while it had commissioned the training, all materials presented during the training were prepared and owned by the trainer.

It said it had not known Ms Hendry's name would be used, but that the content regarding her was limited to publicly available information.

"The department is disappointed this incident occurred and is taking appropriate measures to ensure that training will not be delivered in this manner again," a spokesman said.

Ms Hendry said that was not good enough.

"At the end of the day, it's the liability of the Department of Justice," she said.

"They procured her. They paid her for her consultancy. They should have done those checks and balances."

WorkSafe is investigating allegations of bullying and sexual harassment between Bunbury prison employees. ( ABC News: Amelia Searson )

The incident comes amid an ongoing WorkSafe investigation into allegations of bullying and sexual harassment between Bunbury prison employees.

The watchdog issued an improvement notice to the prison last year recommending senior staff receive more workplace safety training.

AI expert warns companies to tread carefully

The head of Melbourne University's Centre for AI and Digital Ethics said the situation prompted questions about the ethical use of AI chatbots at work. 

Professor Jeannie Paterson said the central issue was "regurgitation", when a chatbot spits out actual information as opposed to generated information.

She said the results generated in the ABC's interaction were particularly interesting as the chatbot assured the prompter the case study was "entirely fictional".

Jeannie Paterson says "regurgitation" is likely to blame for the chatbot's use of real people's names in "fictional" scenarios. ( Supplied: Jeannie Paterson )

"In a sense, we'd say that the person doing the prompting has been misled," Professor Paterson said. 

"Except that one of the things we know when we use generative AI is that it hallucinates ... it can't be relied on."

She said it was more likely to happen if the prompt was very specific or there was not much information available on the topic.

"That's why I would say firms shouldn't say, 'Don't use it'. Firms should say, 'Here's our policy on using it'," she said. 

"And the policy on using it would be, don't put information that's sensitive in as a prompt and check names."