Supporting LGBTQ+ youth as they head back to school

A Q&A with UCLA Health experts on mental health and well-being.
The past two years have wreaked havoc on youth mental health, especially among LGBTQ+ adolescents, according to The Trevor Project. Isolation, disruption to routine, lack of sleep, physical activity and healthy eating habits, plus more screen time have all contributed.

As students head back to school in person, Nupur Agrawal, MD, MPH, assistant professor of Internal Medicine and Pediatrics at UCLA and Liz Ollen, PhD, licensed clinical psychologist and clinical director of the EMPWR Program at UCLA, provide tips and resources for families and caregivers helping teens navigate the changes.

It has been difficult for many folks to reengage into society in ways they did prior to the pandemic – students included. Is there guidance on how adolescents can ease back into social situations at school?

Dr. Ollen: People have had such a wide variety of experiences as they’ve tried to reintegrate and get back into a more normal swing of things. We see commonly that teens especially, but adults as well, experience a lot of anxiety going back into these social situations.

For parents and caregivers, they can try to support their youth by being validating and compassionate, and giving them some tools to manage the anxiety. We know that avoiding the anxiety potentially can make it worse in the long run. We also want to be careful not to tell parents or caregivers to overly accommodate the anxiety, but to instead have the tools to manage the anxiety. That might look like some simple emotion regulation.

Consider connecting them with a therapist, if it seems like the anxiety is interfering with their day-to-day life.

What are the best ways for adolescents to take care of their mental health?

Dr. Ollen: There are many foundational building blocks that parents and caregivers can emphasize that are sometimes overlooked – things like good sleep, hygiene, nutrition and exercise.

I think that parents and caregivers also have a very important role in caring for their own mental health and well-being as a model for youth to see. If they're getting a message from their parents that mental health is really important, but then they're seeing that their parents don't take care of themselves, that's hard for kids to reconcile and understand.

Parents are usually pretty tuned in, but in terms of facilitating social support and connection, we know that open communication is important to well-being and especially as we're still moving through parts of this pandemic and youth are trying to navigate where they can connect socially.

Is there guidance on how an adolescent can inform their family/peers on what pronouns to use?

Dr. Agrawal: The ask to use certain pronouns is often accompanied by a conversation about gender identity. It’s definitely a very sensitive and personal experience on how people engage with their loved ones and immediate network when having these conversations. It’s great when people introduce themselves by saying, “Hey my name is ______, and I use _______ pronouns.” This creates an inclusive environment and prevents anyone from feeling obligated to explain or clarify their gender identity or pronouns if they don’t feel comfortable doing so.

My guidance for schools is to incorporate pronouns into introductions at the start of the year. It just normalizes the fact that we are all diverse and may use different pronouns than what someone might expect or anticipate.

People should be having conversations about gender identity and their gender journey with people that they feel safe with and not necessarily because they feel like they have to.

If adolescents are not sure how to navigate the conversation, talking to their pediatrician or therapist can be a great place to discuss next steps. The biggest thing is to recognize that they are not alone and that it’s okay to reach out for support.

What if an adolescent feels unsafe coming out?

Dr. Ollen: It's really crucial to follow the lead of the LGBTQ+ person. Let them decide if and when, where and how they come out.

It's not a one-time event, it’s a constant coming-out experience. Anytime that a teen gets asked, “Do you have a boyfriend or girlfriend?” is a constant navigation for folks.

I think protecting the confidentiality of LGBTQ+ youth is a really important affirming practice for anyone who interacts with youth, whether that's a parent or caregiver, teacher, coach or a therapist. Listen without judgment or without a specific agenda, for example, convincing a youth to share with others before they're ready.

What if an adolescent is getting bullied at school?

Dr. Ollen: Bullying is a problem for a lot of students, but the LGBTQ+ youth in particular, are often targeted and experience a lot of stigma. One thing that parents and caregivers can do across the board, regardless of whether they know their child is LGBTQ+, is to be aware of what bullying signs to look out for: changes in behavior, new problem behaviors at school, drops in grades and school avoidance.

Keeping an open dialogue with youth will help facilitate this topic and many others. Try to have a collaborative conversation with the youth about how to address it, given the severity. Oftentimes parents want to march down to the school and do something about it, but the youth might not want that.

It’s important to be thoughtful about what the youth’s perspective is and how it might affect them day-to-day and how they want to be supported in having it addressed.

What are some ways LGBTQ+ youth can build community at school?

Dr. Ollen: There are certainly some ways that LGBTQ+ youth can be empowered to cultivate their community at school, but I think it's also crucial to think of this additional layer of considering the ways in which schools can foster a safe space for LGBTQ+ youth.

If a school system doesn't do the foundational work to create an affirming LGBTQ+ climate, youth are going to struggle more to build their community and be connected and engaged at school.

In regards to the things students can do, they can seek out LGBTQ+ clubs or organizations, and identify a supportive adult or teacher to connect with that they feel safe with. A lot of teachers will have safe space or rainbow stickers that make them identifiable.

When we’re trying to think about how youth build their community, a lot of it tends to be around social justice and advocacy efforts. It’s important to remember that these activities can be pretty emotionally draining. And while they do create a lot of community building, it’s also important to encourage students to find spaces where they feel affirmed and supported that are not necessarily in an advocacy role. Coed sports activities might be a place that could be affirming but are not necessarily LGBTQ+ specific, places where teens can just kind of hang out and just be teens.

I think parents also have a role in helping youth build community in the sense that they can be a resource and advocate at school on behalf of their LGBTQ+ child or adolescent.

How should families and caregivers approach talking about sex?

Dr. Ollen: We know that schools overwhelmingly do a poor job of sex education at baseline. Very few schools, even in really affirming states, do a good job of providing LGBTQ+ affirming and inclusive sex ed. Unfortunately, this conversation falls on parents and caregiver’s shoulders as an extra burden, and especially because we know that LGBTQ+ youth are not getting the information that they need.

It's important that families educate themselves and not rely on their child to be their personal source of information for all things LGBTQ+ in general, but also when it comes to sex ed.

LGBTQ+ youth getting affirming and inclusive sex ed has many great health outcomes that reduces the harmful impact of stigma. Make sure that the content doesn't use gendered language and that the examples are of healthy non-heterosexual relationships too.

Sub-content should explicitly address the needs of LGBTQ+ youth in regards to HIV and Sexually Transmitted Infections (STI/STD) and pregnancy prevention, because we know that our LGBTQ+ youth are also getting pregnant and getting other people pregnant.

Dr. Agrawal: Speaking of sex ed, I encourage parents to strongly consider getting their children the Human Papillomavirus infection (HPV) vaccine because it’s our only cancer preventing vaccine. If kids get the vaccine before the age of 15, they only need two shots instead of three; this also ensures most kids are getting vaccinated prior to their initial sexual contact, so they are protected before they are exposed to any risk.

I encourage parents to talk with their child’s pediatrician about any concerns they have regarding the vaccine because that conversation can be potentially life-saving for their child down the road.

How should families and caregivers discuss substance use?

Dr. Ollen: We know that the LGBTQ+ youth substance use rates may be higher because of all of the stigma, discrimination and oppression that they may experience. When having these conversations with youth, try to be straightforward and not condescending. A lot of times parents try to use scare tactics, which tend not to be very effective.

Parents should express an interest in what their teen's goals are regarding the choices that they want to make around substance use. Many young people are pretty level headed and cautious and want to make good choices. Having a foundation of communication and an open dialogue with your teen is going to make all of these things easier to talk about.

Where can gender diverse adolescents learn more about affirming care?

Dr. Agrawal: For starters, the Gender Health Program website can be very helpful.

There are plenty of resources available for families needing more support. The Gender Health Program and the EMPWR program hold Resilience Groups for teens and caregivers, which can help youth and their families build skills and learn more about stress management.

Outside of UCLA, groups such as Transforming Family, Gender Spectrum, PFLAG, and Colors offer support as well.


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