When adolescents wrestle with questions about their sexual orientation or are harassed because of it, one of the first people they often talk to is a trusted adult--a school nurse or counselor who's been helpful in the past, for example. However, many school staff members are not trained to handle such situations and may not feel knowledgeable enough to offer guidance to these students, who may strongly need it. Research shows lesbian, gay, bisexual and questioning (LGBQ) youth are harassed by their peers more often than heterosexual students and appear to be at a higher risk for academic and other school troubles.
Moreover, LGBQ youth report higher rates of alcohol and drug use, as well as suicidal thoughts and attempts, according to research from such sources as the National Longitudinal Study of Adolescent Health. Some of these teens--especially young bisexual men--exhibit higher rates of STDs and HIV-risk behaviors, such as multiple partners and unprotected sex. Plus, some research has found bisexual girls are at a higher risk of unintended pregnancy.
APA is wrapping up a five-year effort--the Healthy Lesbian, Gay and Bisexual Students Project (HLGBSP)--designed to reduce some of these risks. Through the project, funded by the Centers for Disease Control and Prevention (CDC), APA and a team of like-minded associations created a workshop curriculum that educates school nurses, counselors, social workers and psychologists about LGBQ youth and boosts their abilities to work with them.
So far, the project has conducted 22 workshops for more than 650 professionals--who reported being responsible for a total of about 400,000 students. The workshops are offered at national and regional conferences, as well as part of a pilot project with the Connecticut State Department of Education and Department of Public Health. Although the project's five-year CDC grant expires this spring, the project partners plan to continue the workshops over the next few years.
Spreading the word about LGBQ youth is important, says HLGBSP coordinator Clinton Anderson, considering the number of these students in America: 6 percent of 12,000 seventh- through 12th-graders reported being attracted to both sexes or their own sex in the recent federally funded National Longitudinal Study of Adolescent Health. Apply those numbers to July 2002 census data, and there may be more than 19 million LGBQ 15- to 19-year-olds in America.
"The CDC wants to support a variety of programs that would reduce the risk for HIV, STDs and unintended pregnancies," says Mike Waldmiller, a project officer for the CDC's Division of Adolescent Health, which funds HLGBSP. "The fact that the program is reaching a high-risk population, namely lesbian, gay and bisexual students, was something we saw as fulfilling a need."
An evidence-based approach
HLGBSP reaches out to school professionals through a four-part training workshop that can be presented in one all-day session or as individual modules. The project features four versions of the curriculum to meet the specific needs of each of its four target professions--school psychologists, counselors, social workers and nurses.
Two aspects of the project drew the CDC's attention, says Waldmiller:
Interprofessional collaboration. Although APA serves as the hub of the project, the association works closely with six other professional organizations: the American Counseling Association (ACA), the American School Counselor Association, the National Association of School Nurses, the National Association of School Psychologists (NASP), the National Association of Social Workers and the School Social Work Association of America.
"It's very critical to have all of them involved in the project," explains psychologist Mark Pope, EdD, an associate professor at the University of Missouri-St. Louis who serves as HLGBSP's liaison between ACA and APA. "The more we work together, the better off it is for all of the students in schools." Pope, who is ACA president this year, has made better serving LGBQ youth in schools one of his primary presidential initiatives.
And although APA's original CDC grant expires this spring--the association has applied for a new CDC grant, but that decision was pending at Monitor press time--stakeholder organizations in each of the four professions plan to continue the training efforts.
ACA, for example, plans to present workshops at regional and national meetings, says Pope. In the long term, he says he hopes to build on the work of HLGBSP to organize a multidisciplinary summit on sexual minority youth in schools.
Evidence-based content and design. At the project's beginning, the seven organizations surveyed their members about their experiences with LGBQ teens and the kinds of information they'd find helpful. The project then used that data (reported in the September 2001 Monitor) and the latest research on LGBQ adolescents to design the curriculum.
Moreover, HLGBSP based the training's structure on the theory of planned behavior, which purports that the best predictor of a behavior is the intention to engage in that behavior. Hence, the workshops first supply trainees with facts about LGBQ teens to raise their comfort levels. Then, they help them lay plans for working with the teens when they return to school.
For example, workshop participants identify preventative services such as intervening in harassment situations, providing information on safer sex practices or counseling parents concerned about their child's sexual orientation. They also discuss what barriers they may face--such as administration policies--and what supports they can tap, such as other health and mental health professionals and local LGB-friendly organizations.
Representatives from each of the four professions field-tested this curriculum through presentations at national and state conventions between March 2002 and September 2003, and supplied APA's Office on Lesbian, Gay and Bisexual Concerns with feedback used to fine-tune the workshop curriculum.
One of the field testers was school psychologist Wendy Naumann, PhD, an Ohio State University professor who researches school mental health issues. She says she found the curriculum to be so thorough that it even gave her a knowledge boost.
"I consider myself to be read in the area, but these trainings took me so much further," she explains. "Doing the training has been a wonderful professional development experience."
Naumann, who got involved with the project through NASP, has taught four HLGBSP workshops for school psychologists: two locally in Columbus, Ohio, and then also at the NASP and California Association of School Psychologists meetings. She's planning a modified workshop open to all four professions at the American Educational Research Association meeting, April 12-16 in San Diego.
Piloting broader change
In addition to these national field-testing efforts, HLGBSP funded a pilot project in Connecticut state public schools and has trained about 135 professionals since the 2002-2003 school year. The state's Department of Education and Department of Public Health agreed to widely offer the training to the target professionals in public and vocational schools--with a goal of creating a critical mass of school staff trained to assist LGBQ students.
"The bottom line is just getting the information out there and getting people's skills and comfort level increased in addressing prevention and wellness issues for LGBQ youth," says Bonnie Edmonson, the Connecticut State Department of Education's HIV-prevention coordinator. She adds that the HLGBSP training has been well-received and fits with an existing education department initiative training classroom teachers about diversity and HIV prevention.
In the next round of HLGBSP training, her office plans to invite school administrators and board members to the trainings as well.
"We're really looking into more of a systems-change approach," she explains, "so that it's not just one or two people within a school district addressing the health and well-being of LGBQ youth. It is a collective approach."
In the end, say project organizers, the hope is that such outreach efforts will show schools how they can be a place where LGBQ youth can build resilience, rather than accumulate risk factors.