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

Date: January 2023

Rights of LGBTQIA2S+ Youth in Foster Care

Citation: DCF Pol. Man., Pol. # 2022-02

In policy: The Department of Children and Families (DCF) is committed to promoting safe, affirming, and discrimination-free environments for lesbian, gay, bisexual, transgender, questioning, queer, intersex, asexual, etc. (LGBTQIA+) children, youth, young adults, parents, caregivers, and foster parents working with DCF. The purpose of this policy is to ensure that the services, programs, and placements provided by DCF are safe, affirming, and free from discrimination, harassment, and bullying for all children, youth, and families regardless of sex assigned at birth, gender identity, gender expression, or sexual orientation.

DCF is respectful of how individuals ask to be identified and does not make assumptions about any individual's identity. DCF accepts a child's assertion of their LGBTQIA+ identity and allows youth to use their expressed names and pronouns at any time. DCF addresses youth by their names and pronouns when working with youth and families and throughout the case. A court-ordered name or gender change is not necessary for a youth's expressed name and pronouns to be utilized.

DCF utilizes a youth's name and pronouns consistent with their desired privacy and confidentiality. DCF asks youth about their desires around discussing their names and pronouns with their family and other individuals involved in their life. DCF does not disclose this information without the youth's permission.

Youth in care are allowed to express themselves through clothing, accessories, hairstyles, and other means of expression consistent with their identities. DCF supports gender-neutral practices regarding clothing and physical appearance. For transgender and gender diverse youth in care, DCF connects them to resources that provide gender-affirming clothing, such as binders, packers, body shapers, bras, breast inserts, and similar items in a timely manner.

Supports for LGBTQIA2S+ Youth in Care

Citation: Ann. Laws Ch. 112, § 275; DCF Pol. Man., Pol. # 2022-02, # 2021-01

The term 'sexual orientation and gender identity change efforts' means any practice by a health-care provider that attempts to change of an individual's sexual orientation or gender identity, including, but not limited to, efforts to change behaviors or gender expressions or to eliminate or reduce sexual or romantic attractions or feelings toward individuals of the same sex. A health-care provider shall not engage in sexual orientation and gender identity change efforts with a patient who is younger than age 18.

In policy: DCF connects and provides LGBTQIA+ youth with resources in their community and schools, such as social support groups, books, and other resources that help build social connections and resilience. DCF takes care to ensure department offices have LGBTQIA+-affirming materials and signs posted throughout the office to demonstrate affirmation and support of LGBTQIA+ people. If a child or youth is experiencing bullying or harassment at school, the caseworker and the child or youth's caregivers work together to address the issue with school administrators.

Case management, medical care, and mental health services for youth in care are provided in a manner that is culturally responsive and affirming. LGBTQIA+ children and youth are provided with culturally responsive and affirming case management, medical care, mental health care, and community resources, including gender-affirming care when applicable.


DCF, foster parents, and contracted service providers do not make attempts to convince LGBTQIA+ youth to reject or modify their sexual orientation, gender identity, or gender expression. DCF does not contract with or make referrals to medical providers, mental health providers, service providers, or community and/or faith leaders who attempt to change a youth's sexual orientation, gender identity, or gender expression.

From policy # 2021-01: For children and youth in State custody, DCF ensures that transgender and gender-diverse youth have access to medically necessary care, including psychotherapy, without unnecessary delays, requirements, or barriers. DCF recognizes the importance of early identification of these children and youth along with early access to medical treatment and support. DCF has established policy guidelines and procedures for staff to follow to ensure the medical needs of transgender and gender-diverse children in State custody are addressed in a timely manner.


Medical providers must seek consent from DCF before beginning gender-affirmation medication for youth in State custody. Requests must be reviewed by DCF's regional nurse, child psychiatrist, and medical director. This review is intended to provide consent and to ensure that the youth will have personal, clinical, and medical support and care coordination in their gender-affirmation process. DCF responds to requests for gender-affirmation medication in a timely manner. It is recommended that children and youth in State custody seeking puberty-blocking medication participate in psychotherapy. Youth who are seeking hormone therapy medication are required to participate in psychotherapy for at least 3 months with a frequency of at least two sessions per month prior to making the request.

Placement Considerations

Citation: Code of Regs. Tit. 110, § 7.104; DCF Pol. Man., Pol. # 2022-02

To be licensed as a foster parent, the applicant must demonstrate, to the satisfaction of DCF, the ability to promote the physical, mental, and emotional well-being of a child placed in their care, including supporting and respecting a child's sexual orientation or gender identity.

In policy: DCF ensures that all placement settings for children, youth, and young adults are safe and affirming. DCF actively recruits, screens, and assesses foster families for their ability and willingness to support and affirm LGBTQIA+ children placed in their care, including recruiting foster families that identify as LGBTQIA+. DCF provides education and training to all foster families on supporting and affirming a child's identity. DCF matches children to foster families who can best meet their needs and maintains an electronic record of affirming placements that can best support the needs of LGBTQIA+ children. Children are placed consistent with their gender identity unless they express a safety or privacy concern. DCF is committed to recruiting affirming foster families from varied backgrounds and experiences.


Children and youth have the right to use restrooms, changing facilities, or other gender-differentiated facilities that correspond to their gender identity or that are gender neutral, as they prefer. DCF works with placements and programs to ensure that children and youth have appropriate privacy. Youth may also use a separate, noncommunal facility if they prefer.

DCF ensures that placements for children, including foster homes, group homes, and residential programs, are safe and affirming for LGBTQIA+ children and youth. DCF identifies safe and affirming placements in the electronic record and matches LGBTQIA+ children and youth with placements that are safe and affirming. Children and youth are placed consistent with their gender identity unless there is a safety or privacy concern expressed by the individual child or youth who is to be placed.

Caregiver Qualifications

Citation: DCF Pol. Man., Pol. # 2022-02

To meet the needs of LGBTQIA+ individuals, DCF provides culturally responsive training for all employees and foster parents on an ongoing basis. Training includes communicating effectively and professionally with children and families regarding LGBTQIA+ issues and identities.


Citation: DCF Pol. Man., Pol. # 2022-02; # 2021-01

The terms used in this policy are defined as follows:

  • 'Chosen names' refer to the use of a name that may differ from a person's legal name.
  • 'Gender pronouns' refer to the set of third-person pronouns that an individual prefers that others use to identify that person's gender (or lack thereof).
  • 'Gender diverse' is a term used to describe people with gender behaviors, appearances, or identities that differ from the cultural norms ascribed to their sex assigned at birth. Gender diverse individuals may refer to themselves with many different terms, such as transgender, nonbinary, genderqueer, gender nonconforming, and gender fluid, amongst others. Gender diversity is used to acknowledge and include the vast diversity of gender identities that exists.
  • 'Gender dysphoria' is a medical condition characterized by discomfort or distress caused by a discrepancy between a person's gender identity and their sex assigned at birth, including discomfort or distress with their physical sex characteristics and/or the associated gender role.
  • 'Gender expansive' is an umbrella term used to describe people who expand notions of gender expression and identity beyond what is perceived as the expected gender norms for their society or context. Some gender-expansive people identify with being either male or female, some identify as neither, and others identify as a mix of both. Gender-expansive people include those with transgender and nonbinary identities as well as those whose gender in some way is seen to be stretching society's notions of gender.
  • 'Gender expression' is the external way a person expresses gender, such as with clothing, hair, mannerisms, activities, or social roles.
  • 'Gender identity' is a person's deep internal sense of being female, male, a combination of both, somewhere in between, or neither.
  • 'Gender affirmation' is a process of reflection; acceptance; and, for some, medical treatment to align their gender expression with their gender identity. It may include legal affirmation, medical affirmation, and/or social affirmation. Some individuals who identify as gender diverse may feel affirmed in their gender identity without pursuing medical or surgical interventions.
  • 'Gender-affirming hormone therapy' consists of hormonal medications administered to transgender and gender-diverse individuals for the purpose of aligning their secondary sexual characteristics with their gender identity. This process is also known as medical affirmation.
  • 'Intersex' is an umbrella term that refers to people who have one or more of a range of variations in sex characteristics that fall outside of conceptions of male or female bodies.
  • 'Puberty blockers' refer to a group of medications that prevent puberty from occurring. They also may be called puberty inhibitors, puberty suppressants, or hormone suppressors. These medications inhibit puberty by blocking the hormones (testosterone and estrogen primarily) that lead to puberty-related changes of the body, such as menstrual periods and breast development/growth or voice-deepening and facial hair growth.
  • 'Sex' is an assignment that is made at birth, usually male or female, and that is typically based on external genital anatomy.
  • 'Sexual orientation' is a person's emotional, romantic, or sexual attraction to people of the same sex, different sex, or any sex.
  • 'Transgender' is a term used to describe an individual whose gender identity is different from their sex assigned at birth and generally remains persistent, consistent, and insistent over time.