Protecting the Rights and Providing Appropriate Services to LGBTQIA2S+ Youth in Out-of-Home Care - Maryland

Date: January 2023

Rights of LGBTQIA2S+ Youth in Foster Care

Citation: Hum. Serv. Code § 8-707; Code of Regs. §; Pol. Dir. SSA 18-13

A child placed in a residential child care program has the right to not be discriminated against based on race, color, religion, national origin, sex, age, personal appearance, sexual orientation, familial status, disability, source of income, or place of residence.

In regulation: The Department of Human Services (DHS), local departments, and individuals receiving funds through the department may not engage in discriminatory practices. In the provision of services to the public, discrimination is prohibited based on sexual orientation.

In policy: All youth have the right to affirming placements, that actively promote their well-being, respect their identities, and are sensitive to their individual needs.

To express a gender identity and/or gender presentation that is consistent with their identity, lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youth should be permitted to select and wear clothing that is consistent with their gender expression. If a youth is dressed appropriately, they can wear the clothing, accessories, and/or hairstyle that suit their gender identity (i.e., someone born male has a right to wear a dress, someone born female has a right to wear men's clothing). This may include removal of facial or body hair, make-up, jewelry, and modifications of hairstyles (e.g., weaves/extensions, buzz cuts). Youth should also be called by their preferred names and pronouns. Failure to respect the youth's personal grooming, clothing, and preferred name and pronouns can deny LGBTQ youth their ability to express their identity and can endanger their physical and emotional well-being.

Supports for LGBTQIA2S+ Youth in Care

Citation: Health Occupations Code, § 1-212.1; Pol. Dir. SSA 18-13

'Conversion therapy' means a practice or treatment by a mental health or child care practitioner that seeks to change an individual's sexual orientation or gender identity. 'Conversion therapy' includes any effort to change the behavioral expression of an individual's sexual orientation, change gender expression, or eliminate or reduce sexual or romantic attractions or feelings toward individuals of the same gender. A mental health or child care practitioner may not engage in conversion therapy with an individual who is a minor.

In policy: Being in foster care can be difficult, and caseworkers shall do everything they can to make sure children and youth feel safe and respected. For LGBTQ youth, life may be even more complex. The DHS Social Services Administration (SSA) is committed to all youth in care residing with a provider where they can be open and honest about their identities.

Caseworkers shall do the following:

  • Evaluate every youth's overall safety as it relates to their sexual orientation, gender identity, and gender presentation in terms of placement, emotional, and physical well-being.
  • Not disclose a youth's sexual orientation, gender identity, or gender expression to other individuals or agencies without the youth's permission.
  • Connect youth and families with local LGBTQ resources.
  • When requested by youth or caregiver, meet with school officials to discuss steps the school needs to take to ensure safety for an LGBTQ youth at school.
  • Consult with their supervisors with any questions or concerns when they are unsure about steps to take about the well-being and safety of LGBTQ youth.

All staff are required to protect the confidentiality of the families they serve. Staff will keep in mind that when a youth discloses their sexual orientation, gender identity, or gender expression, it will be considered sensitive information and be kept confidential, given that such a disclosure could pose great risk to the youth.

Staff will not disclose a youth's sexual orientation, gender identity, or gender expression to other individuals or agencies without the youth's permission. If a youth grants permission to share information on their sexual orientation, gender identity, or gender expression, this information may also prove relevant to decisions regarding safety in a youth' s placement.

Staff are prohibited from attempting to convince or coerce an LGBTQ youth to disclose or reveal their identity or to change their gender identity or sexual orientation.

Staff are to make sure that the youth is referred to appropriate services. Foster parents must support youth in accessing appropriate and preferred services. Staff shall identify affirming resources and referrals for LGBTQ youth, including those for physical and mental health, and make them available as needed. Transgender and gender-nonconforming youth have the right to transition-related care.

Placement Considerations

Citation: Pol. Dir. SSA 18-13

LGBTQ youth in out-of-home placement may not be placed in housing situations where their identities are not respected. In some cases, this happens because staff and/or resource families are unaware about the specific needs of LGBTQ youth. In other cases, it is because there is active hostility towards youth who identify as LGBTQ or who are perceived to violate traditional gender roles. In either situation, this creates an emotionally and physically unsafe living space environment and directly increases negative outcomes for LGBTQ youth in care. LGBTQ youth shall be consulted and actively involved in the placement process to ensure that the team can work cohesively to identify a safe and affirming placement that will achieve permanency. When making the decision to place a youth in any placement, the caseworker should first consider relatives when determining placement.

Additional guidance for working with LGBTQ youth includes the following:

  • Placements should be discussed with LGBTQ youth before initiating placement in order to assess their feelings of safeness and to address concerns.
  • Caseworkers shall check in with youth at appropriate intervals to review placement, ensure that it is LGBTQ affirming, and take steps to report any mistreatment, including verbal harassment and bullying.

For placement of transgender and gender-nonconforming youth in congregate care facilities, assignment to a facility for male or female residents and other housing and programming assignments shall be made based on consideration, on a case-by-case basis, of what placement would best ensure the youth's health and safety and whether a placement would present management or security problems. For a youth who identifies as transgender or gender-nonconforming, their own views with respect to the kind of placement that would best serve their own emotional and physical safety shall be given serious consideration in the assignment decision. The assignment decision shall not be based on the youth's sex assigned at birth or on the youth's external genital anatomy.

Every effort will be made to place youth in facilities with individual sleeping quarters (one-person bedrooms) to allow for privacy. Transgender and gender-nonconforming youth shall be allowed to shower and use bathrooms privately. Staff may utilize LGBTQ subject-matter experts when determining placements for gender-nonconforming and transgender youth.

Caregiver Qualifications

Citation: Pol. Dir. SSA 18-13

Caseworkers shall ask all resource providers about their levels of acceptance for LGBTQ individuals and community members and specifically discuss scenarios around gender presentation, gender identity, sexual orientation, attendance of cultural events, dating, etc.

SSA will ensure that LGBTQ-affirming training is included as part of competency training and testing for all new staff and that it is mandated for all caseworkers and their supervisors.

SSA shall designate one or more out-of-home placement staff members who are knowledgeable about issues relevant to LGBTQ youth and families to be available to staff statewide. Local departments are encouraged to designate a child welfare staff member to be accessible as a local information and referral resource for LGBTQ youth, their families, and other staff members.

Employees and foster parents should be educated about the unique challenges and resiliencies of transgender youth. Training should include, but not be limited to, the following:

  • The difference between 'normal' and developmentally inappropriate behaviors
  • Possible responses and reactions if a child is gender nonconforming
  • Awareness and sensitivity to the unique needs of the transgender population
  • Confidentiality requirements that prohibit disclosure of a youth's sexual orientation, gender identity, or gender expression, even to other youth in the program
  • The need to treat youth as being of the gender with which they identify


Citation: Pol. Dir. SSA 18-13

The terms used in this policy are defined as follows:

  • 'Gender expression' refers to a person's expression of gender identity, including characteristics and behaviors such as appearance, dress, mannerisms, speech patterns, and social interactions.
  • 'Gender identity' refers to a person's internal, deeply felt sense of being male, female, something other, or in between. Everyone has a gender identity. Note: Sexual orientation and gender identity are separate and distinct aspects of a person's identity.
  • 'Gender nonconforming' describes a person whose behaviors or gender expression fall outside what is generally considered typical for their sex assigned at birth.
  • 'LGBTQ' is a common acronym for lesbian, gay, bisexual, transgender, and questioning.
  • 'Sexual orientation' refers to a person's romantic or sexual attraction to people of a specific gender or genders. Lesbian, gay, bisexual, and 'straight' are examples of sexual orientations. Everyone has a sexual orientation.
  • 'Transgender' is a term that describes people whose gender identity is different from their sex assigned at birth.