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

Date: January 2023

Rights of LGBTQIA2S+ Youth in Foster Care

Citation: Child Welfare Practice Guidance for LGBTQ+ Youth

In policy: The North Carolina Division of Social Services is committed to being respectful of the dignity of all youth and families and to keeping children and youth safe while meeting their unique needs, regardless of sexual orientation, gender identity, or gender expression (SOGIE). This includes children and youth with open child welfare cases at any stage of the child welfare services continuum.

The purpose of this guidance document is to ensure that youth who identify as lesbian, gay, bisexual, transgender, queer, or questioning (LGBTQ+) and gender nonconforming (GNC) involved in the child welfare system have equal access to services that are affirming and supportive, including housing, medical and mental health care, and opportunities that promote positive youth development and are emotionally and physically safe.

County child welfare agencies must provide all youth with respectful, fair, and equal treatment and access to services, irrespective of the youth's actual or perceived SOGIE. County child welfare agencies must promote positive development by demonstrating respect for all children and youth, reinforcing respect for differences, encouraging the development of healthy self-esteem, and helping children and youth manage stigma sometimes associated with difference. Agency staff must do the following:

  • Not harass any youth based on the youth's actual or perceived SOGIE.
  • Protect youth from harassment based on the youth's actual or perceived SOGIE.
  • Provide services and placements that are safe, affirming, and supportive of youth, irrespective of their actual or perceived SOGIE.

When working with LGBTQ+ youth, agency staff and foster and kinship providers should use respectful language and behaviors, such as the following:

  • Avoid making assumptions about the SOGIE of youth.
  • Use gender-neutral language when communicating with youth and avoid language that presumes all youth are heterosexual, cisgender, or gender conforming.
  • Defer to youth about the language they use to describe their SOGIE and generally utilize terms in the glossary.
  • If youth use an unfamiliar term, respectfully ask what the term means to them.
  • Use the name and pronouns the transgender or GNC youth specifies when interacting with the youth, regardless of the name on the youth's identity documents or legal documents associated with any court proceedings.
  • Respectfully ask if they are unsure of the pronouns a youth uses.

County child welfare agencies should do the following:

  • Permit youth to dress and present themselves in a manner consistent with their gender identity and individual expression.
  • Make and enforce the same grooming rules and restrictions, including rules regarding hair, makeup, shaving, etc., for all youth, regardless of SOGIE status.
  • Permit transgender and GNC youth to use the approved forms of personal grooming consistent with their gender identity.
  • Permit youth to use money allocated for clothing and grooming items to select or purchase items that they want and are comfortable with regarding their gender expression.

Supports for LGBTQIA2S+ Youth in Care

Citation: Child Welfare Practice Guidance for LGBTQ+ Youth

When working with LGBTQ+ children and youth, child welfare workers should do the following:

  • Offer developmentally appropriate approaches that affirm identity.
  • Evaluate identity development and exploration.
  • Identify and work to reduce sources of distress for LGBTQ+ children and youth.
  • Engage parents, guardians, and caregivers.
  • Consider school and community interventions.
  • Use LGBTQ+-inclusive language related to family and relationship status.

County child welfare agencies should make good-faith efforts to do the following:

  • Refer LGBTQ+ youth for medical and mental health services from LGBTQ+-competent providers.
  • Provide access to providers who can have inclusive and affirming conversations regarding sexual health.
  • Provide access for transgender youth to receive a full medical assessment by qualified medical personnel who adhere to the relevant medical standards of care.
  • Provide transgender youth access to necessary transition-related treatment, as determined by qualified medical personnel familiar with the relevant standards of care.

If, prior to entering foster care, a transgender youth has been receiving transgender-related medical care, such as hormone therapy or supportive counseling, the agency must work with service providers to develop a strategy for hormone replacement therapy to continue as prescribed by an attending medical provider.

In accordance with accepted health-care practices, which recognize that attempting to change a person's sexual orientation or gender identity utilizing methods such as conversion therapy, is harmful, the agency should not employ or contract with medical or mental health providers who attempt to change a youth's sexual orientation or gender identity.

County child welfare agencies must provide all youth in agency custody with access to educational, recreational, and other programming and activities that are appropriate to their age or developmental levels.

County child welfare agencies should do the following:

  • Connect LGBTQ+ and GNC youth to LGBTQ+ community supports and encourage them to participate in LGBTQ+ community activities.
  • Provide support to families to increase acceptance of their LGBTQ+ and GNC youth, regardless of whether return home is possible.
  • Ensure youth have access to informational material and other age-appropriate media regarding LGBTQ+ and GNC youth, adults and communities.

County child welfare agencies should work with educational partners to ensure all LGBTQ+ and GNC youth in the custody of the child welfare agency are safe in their educational settings and inquire whether these youth feel safe and secure in their communities, in transit to services, and when with providers or on community outings. In addition, county child welfare agencies should ensure transgender youth are referred to services to address name or gender-marker changes, if desired.

Placement Considerations

Citation: Child Welfare Practice Guidance for LGBTQ+ Youth

Children and youth in child welfare custody have substantive due process rights under the 14th Amendment, including rights to personal security and reasonable safe-living conditions; freedom from psychological harm, physical harm, and psychological deterioration; adequate care, including the provision of certain services; and a reasonably suitable placement.

Caregiver Qualifications

Citation: Child Welfare Practice Guidance for LGBTQ+ Youth

County child welfare agencies should ensure all staff receive training on providing competent, nondiscriminatory, and respectful treatment of LGBTQ+ and GNC youth, utilizing resources available through the Statewide Training Partnership and other sources.


Citation: Child Welfare Practice Guidance for LGBTQ+ Youth

This glossary of LGBTQ+ terminology comes from Equality North Carolina and Lambda Legal. These terms and definitions are always evolving and often mean different things to different people. For that reason, the following is not an all-inclusive or all-encompassing glossary of language used within the LGBTQ+ community:

  • 'Bisexual' describes a person who is attracted to both men and women.
  • 'Cisgender' describes a person whose gender identity aligns with the sex assigned to them at birth.
  • 'Discrimination' is any act, policy, or practice that, regardless of intent, has the effect of subjecting any youth to differential treatment because of that youth's actual or perceived sexual orientation, gender identity, or gender expression.
  • 'Gay' describes a person who primarily is attracted to individuals of the same gender. While historically used to refer specifically to men, it is often used to refer to women attracted to other women as well.
  • 'Gender expression' describes how individuals communicate their gender to others. People express and interpret gender through hairstyles, clothing, physical expression and mannerisms, physical alterations of their body, and/or by choosing a name that reflects their gender identity.
  • 'Gender identity' refers to a person's internal identification or self-image as male, female, something in between, or outside the male/female binary.
  • 'Gender nonconforming' (GNC) describes a person who does not subscribe to gender expression or roles imposed by society.
  • 'Harassment' is an act that includes, but is not limited to, name-calling; disrespectful gestures, jokes, or comments; inappropriate touching; threats of physical or emotional acts or negative consequences (including religious condemnation); physical abuse; sexual abuse, including unwanted sex acts, touching, pantomime, and threats; and emotional abuse, such as shunning or isolation. Attempting to change a youth's sexual orientation or gender identity is also a form of harassment.
  • 'Heterosexual' describes a person who is attracted to people of a different gender.
  • 'Lesbian' describes a woman who is attracted to other women.
  • 'Nonbinary' describes a person whose gender is not male or female.
  • 'Queer' describes a person who identifies themselves with a flexible and inclusive view of gender and/or sexuality.
  • 'Sex' or 'gender' is a person's actual or perceived sex or gender as defined by a person's gender identity.
  • 'Sexual orientation' is an attraction to others that is shaped at an early age (usually by about age 10).
  • 'Transgender' describes a person whose gender identity differs from the sex they were assigned or presumed at birth. A transgender man is a person who was assigned female at birth but identifies as and is living as a man. A transgender woman is a person who was assigned male at birth but identifies as and is living as a woman.