Chat with us, powered by LiveChat LGBTQ Employment Discrimination and it’s effects on Human Development | Abc Paper

Topic: LGBTQ Employment Discrimination and it’s effects on Human Development 

Directions: Approach the issue using a bio-psycho-social framework. You are to analyze and explain the issue using developmental theories/concepts and you are to discuss the application of these concepts in psychotherapy. Thus, you are to describe and explain the issue, summarize, and present relevant research on the topic, demonstrate an ability to apply developmental theories to current problems and psychotherapy, and illustrate understanding of the influence of biopsychosocial factors. You are to incorporate course concepts and support any claims made with research. The paper should be double spaced following APA style. This paper is 7-8 pages.

Please use ONLY the sources provided.

J. WORKPLACE RIGHTS, Vol. 16(1) 107-128, 2011-2012

New Scholar




State University of New York, College at Brockport


Queer people experience poor well-being in many workplaces, yet employ-
ment non-discrimination legislation providing comprehensive federal pro-
tection from employment discrimination based upon sexual orientation has
failed to materialize over the last three decades. Current proposals for a
federal Employment Non-Discrimination Act (ENDA) do not fully protect
lesbian, gay, bisexual, transgender, and queer (LGBTQ) workers, especially
in states that already have better protections. This conceptual article con-
siders the well-being of queer employees within the context of human
rights, the impact of historic queer employment discrimination cases, and
the impact of historic legislative action. Current strategies for protecting
queer employees at the federal level have failed. Suggestions for creating
change in the workplace will be explored.

Lesbian, gay, bisexual, transgender, and queer (described collectively in this
article as LGBTQ or “queer”) people experience discrimination and prejudice in

*This work was originally presented as a paper at the National Women’s Studies Association
Annual Conference, Denver, CO, November 11–14, 2010.


� 2012, Baywood Publishing Co., Inc.


many workplaces (Badgett et al., 2007). Federal employment non-discrimination
legislation providing comprehensive protection from employment discrimination
based upon sexual orientation has failed to materialize over the last three decades.
However, employment protections for queer workers have gained the interest
of key political players. United States President Barack Obama has expressed
support for a federal Employment Non-Discrimination Act (ENDA) and “believes
that our anti-discrimination employment laws should be expanded to include
sexual orientation and gender identity” (White House, 2011).

Jurisdictional protections currently exist in more than 20 states (Human
Rights Campaign [HRC], 2009; Law & Hrabal, 2010), but the setting up of
widespread federal protections has failed to gain widespread support from
policymakers (National Gay and Lesbian Task Force [NGLTF], 2008). As
many as 68% of LGBTQ employees report experiencing employment dis-
crimination (Badgett et al., 2007). Employment non-discrimination legis-
lation would protect the employee from employers who “fail or refuse to hire
or who discharge any individual, or otherwise discriminate against any indi-
vidual with respect to compensation for work and with respect to the terms,
conditions, or privileges of employment of the individual, because of such an
individual’s actual or perceived sexual orientation or gender identity.” Currently,
that protection is extended only to queer employees who happen to live in
jurisdictions that protect them.

The absence of employment non-discrimination legislation in many states
and the absence of other supportive workplace policies for queer individuals
negatively affect the workplace well-being of queer people and constitute a
human rights issue. Social scientists such as Diener (1984) have defined well-
being as a person’s global, subjective experience of satisfaction with his or her
quality of life. Workplace well-being means an individual’s cognitive and affec-
tive sense of personal satisfaction within the workplace (Page, 2005). Well-being
at work matters because work occupies a significant amount of an individual’s
time and energy. Berry (2005: ix) notes that

The very fabric of our life revolves around work. Our entire identity encom-
passes the type of work we are doing—or not doing, for that matter. The
type of food we eat, the neighborhood we live in, the clothes we wear, and
how we socialize—all somehow are related to our work.

This conceptual article considers the well-being of the queer individual in
the workplace, within a human rights framework. The analysis begins by
reviewing historic queer employment discrimination cases that have been
affected by non-discrimination legislation. A review of the social science litera-
ture on workplace well-being follows, and a discussion about how the well-
being of queer individuals may be affected by more supportive workplace
non-discrimination legislation.

108 / GATES


For the purpose of this discussion, well-being at work is defined as an
employee’s subjective experience of quality of life at work (Diener, 1984;
Page, 2005). Well-being in the workplace constitutes a fundamental and basic
human right. Article 23 of the Universal Declaration of Human Rights ([UDHR],
for which see United Nations, 1948) notes that

Everyone has the right to work, to free choice of employment, to just and
favourable conditions of work and to protection against unemployment . . .
the right to just and favourable remuneration ensuring for himself and his
family an existence worthy of human dignity, and supplemented, if necessary,
by other means of social protection.

Yet queer employees are treated differently than the average worker by
being denied their basic human rights in many workplaces. They are denied basic
dignity and respect in the workplace because LGBTQ identity is a devalued and
stigmatized social identity. According to Goffman (1963: 5), the stigmatized
person is treated as “not quite human.” The queer employee possesses attributes
that make her or him different from the norm in her or his social unit (Jones
et al., 1984). Stigmatizing attitudes toward queer individuals are among the last
culturally acceptable behaviors against a minority group in society. Though
stigmatizing attitudes against LGBTQ people are common among people with
conservative faith backgrounds (Adamczyk & Pitt, 2009), stigmatizing attitudes
toward LGBTQ people are found throughout the general public. In a study of
heterosexuals’ use of words such as “fag” and “queer” to refer to one another in an
insulting manner, Burn (2000) found that heterosexual males self-report that
they frequently use terms indicative of LGBTQ stigma to deride one another.
Swim, Pearson, and Johnston (2007: 40-41) found that LGBTQ participants
report daily heterosexist experiences, including “comments about the participant
or about LGBTQ individuals that deal with stereotypes (e.g., gay males are
effeminate or lesbians are “butch”), jokes that involve stereotyping of LGBTQ
individuals or hostility toward them, overt threats of violence or expressions of
hate, and/or a general dislike or stigmatization of LGBTQ individuals.”

Underlying sexual prejudice is homophobia and/or heterosexism. Homophobia
is defined as fear or hostility toward homosexuals (Hudson & Ricketts, 1980).
Heterosexism refers to the societal bias that privileges heterosexual behaviors,
identity, or norms while discrediting the behaviors, identities, and norms of
LGBTQ people (Smith & Ingram, 2004). Herek (2004: 14) comments in a history
of homophobia that, although members of the public may or may not have
stigmatizing perceptions about LGBTQ people, there appears to be a shared
knowledge that LGBTQ desire and identities are very often viewed as “bad,
sick, or inferior to heterosexuality”.

The shared knowledge of cultural stigma affects LGBTQ individuals across
various life domains, including the workplace. For example, a study by Drydakis


(2009) found that, when potential employers were mailed a pair of resumes that
were substantively identical except for a mention in one of them of affiliation
with an LGBTQ organization, gay men faced a significantly lower chance of
receiving an employment interview than heterosexual men. Thus, stigmatization
of LGBTQ individuals may occur at the hiring phase. Several researchers
have found that between 25% and 66% of LGBTQ individuals experience
stigmatization in the workplace (Croteau & Lark, 2009; Croteau & von Destinon,
1994; Irwin, 1999; Levine & Leonard, 1984). LGBTQ experiences in the work-
place include overt, enacted stigma, such as homophobic or heterosexist jokes,
verbal harassment, or physical violence. Actions by employers may include
actions such as denial of promotion, exclusion from a social function, or lack of
provision of benefits such as domestic partner insurance (Irwin, 1999).

LGBTQ identity has been a historically marginalized and stigmatized identity
(Dimauro, 2001; Eartman, 2001; Schultz & Goldsmith, 2001). While the UDHR
was not written specifically to protect the rights of LGBTQ workers, advocating
the rights of queer workers is a logical application of human rights principles.
Because all people “are born free and equal in dignity and rights” (United Nations,
1948), the poor well-being of historically marginalized people is a human rights
issue. The oppression and stigmatization of queer workers is a violation of
their basic dignity and rights.


The queer employee’s struggle for dignity and respect has gone on for many
years. Though various protections, such as amendments to the Civil Rights Act
of 1964 and a separate Employment Non-Discrimination Act (ENDA), have
been proposed by policymakers at the federal level, those policy bills have yet
to pass. The federal movement toward employment protections for LGBTQ
individuals and toward legislation that protects the rights of the LGBTQ
community has often been met with contempt. It is important to consider the
history of how policymakers have addressed, or arguably, not addressed, the issue
of LGBTQ worker rights.

The passage of Title VII of the Civil Rights Act of 1964 brought increased
public attention to the issue of discrimination in the workplace. Employment
discrimination became more of a part of public discourse in the United States.
Title VII prohibits “disparate treatment” on the basis of belonging to a “protected
class” by one’s race, color, religion, sex, or national origin with respect to
compensation for work and with respect to the terms, conditions, or privileges
of employment (Faley et al., 1999). Absent from the Civil Rights Act of 1964
are worker protections based upon sexual orientation and gender identity.
Though some states have since included lesbian, gay, and bisexual as “protected
classes,” discrimination against these workers and harassment of them are
pervasive (Drydakis, 2009; HRC, 2009; Law & Hrabal, 2010; Lewis, 2009;

110 / GATES

Weichselbaumer, 2003). This is due in part to the fact that discrimination can be
difficult to prove and can be subtle (King et al., 2006; McDonald, Ravitch, &
Sumners, 2006). Overtly verbally harassing a fellow employee by calling her or
him “dyke” or “faggot” and/or being physically threatening is easier to prove than
more subtle and more common forms of exclusion, such as giving the queer
employee the “silent treatment” or refusing basic courtesies in the workplace.

To date, the proposed federal protections of the queer employee have failed
to materialize (HRC, 2009; Law & Hrabal, 2010; NGLTF, 2008), and the wide-
spread federal protections that already exist have failed to gain widespread support
from policymakers. The possibility of federal employment protections for the
queer employee in the United States was first raised during the 1970s, five years
after the famous Stonewall riot, an angry rebellion by the LGBTQ community in
New York City against police mistreatment (D’Emilio, 1998). In 1974, Represen-
tatives Bella Abzug (D-NY) and Edward Koch (D-NY), supported by the NGLTF,
first proposed an equality bill, which would have been titled the Equality Act of
1974, a bill that would have banned discrimination based upon sexual orientation,
marital status, and gender in public accommodation, housing, and employment.
Though the initial equality measure proposed by Abzug and Koch failed to pass,
LGBTQ activists were invigorated by the civil rights movement of the 1960s, the
Stonewall rebellion, and the possibility of changing attitudes toward minority
groups in the United States. Abzug reintroduced the bill as the Civil Rights
Amendment of 1975, which would have added protections based upon sexual
or affectional preference to existing civil rights laws. Adding sexual orientation
identity to the Civil Rights Act would have been a significant achievement for
queer rights, as placing sexual orientation under the scope of the Civil Rights Act
would have provided protections to queer workers equal to those provided to other
protected classes (i.e., those protected by their race, color, religion, sex, or national
origin). However, Abzug’s proposed amendment to the Civil Rights Act did not
gain widespread support. Abzug and NGLTF secured co-sponsors for similar
antidiscrimination bills in 1976 and 1977; however, efforts to introduce LGBTQ
employment protection laws were unsuccessful (NGLTF, 2008).

As the political climate of the 1960s and 1970s changed, the prospect of
LGBTQ worker protection from workplace discrimination came swiftly to a
halt during the 1980s and 1990s:

Unforeseen by activist leaders, three social and political dynamics con-
verged during the 1980’s and 1990’s to create a “perfect storm” that swamped
this early optimism: Increasingly, well-organized antipathy towards lesbian,
gay, bisexual, and transgender (LGBT) people because of the rising power of
the religious Christian right; the AIDS crisis, into which a critical mass
of political energy was necessarily diverted; and third, [the takeover of
the federal government, beginning in 1994, by a Republican Party beholden
to social conservatives who opposed equality claims of gay people, women,
racial minorities, and immigrants. (Chapman, 2007: 6)


Efforts to address the problem of employment non-discrimination at the judicial
level through the Supreme Court have been equally unsuccessful. For example,
in Holloway v. Arthur Andersen and Company (1977), the Court rejected a
transgender plaintiff’s claim of sex discrimination under Title VII, stating that
Congress had only the traditional notion of “sex” in mind. A similar rejection
occurred in Desantis v. Pacific Telephone and Telegraph Company (1979) on the
assumption that “sex discrimination applies only to discrimination on the basis
of gender and should not be judicially extended to include sexual preference”
(Holt, 1997; McDonald et al., 2006; Rivera, 1980). Though the Court ruled in
Oncale v. Sundowner Offshore Services, Inc. (1998) that same-sex harassment
is actionable under Title VII, the question of LGBTQ harassment was never
explicitly considered (McDonald et al., 2006; Paetzold, 1999).

Though the years from the 1980s to the present presented a number of chal-
lenges to equal rights in the workplace for the queer community, the 21st century
has brought a number of successes (in additional to further failures) by way of
protections for the queer community. Proposed employment protections for queer
workers shifted from amendments to the Civil Rights Act of 1964 to a separate
Employment Non-Discrimination Act (ENDA). A proposed ENDA would pro-
vide federal protection from employment discrimination based upon sexual orien-
tation (and, in some versions, gender identity). However, these proposed changes
would ultimately have created a “separate, not equal” system for queer employees.
Various versions of ENDA failed to be adopted during this period.

The LGBTQ community has made marginal gains in the last decade, prompted
by a variety of state-level court decisions. A number of jurisdictions, including the
District of Columbia, passed legislation during the the last decade that prohibits
discrimination based upon sexual orientation (Ekeberg & Tumber, 2004). State
sodomy laws were overturned as was the Bowers v. Hardwick (1986) ruling,
which stated that an individual is not afforded sexual privacy according to
the Constitution. In the Supreme Court’s landmark decision, Lawrence v. Texas
(2003), consensual intimacy between two adults is protected under due process
(Chauncey, 2004). Many private-sector, university, municipal, and federal civil
service employees who identify as LGBTQ began to enjoy workplace protection
from discrimination and gained tangible benefits for their partners including
medical insurance, life insurance, bereavement leave, and other benefits (Kovach
& Millspaugh, 1996). However, to date, the federal government in the United
States has failed to recognize the importance of employment protections by
passing federal employment protections for queer employees.


Well-being and happiness in general have been explored by social scientists
and philosophers alike. Well-being has been described as the “ultimate” depen-
dent variable in social science (Helliwell & Putnam, 2005). While human beings

112 / GATES

have not reached a consensus on what constitutes the good life, social scientists
have come to the conclusion that well-being may be based on either meaningful
relationships or material comforts:

The concept of the “good life” varies considerably among individuals.
For some, this ideal state is one of wealth and luxury; for others, it is attained
through meaningful relationships with friends and families. For still others,
the physical comforts of wealth and security are foregone to provide better
lives for those in need. These different kinds of individuals would appear
to be quite different in external circumstances, yet they might all share a
subjective feeling of well-being. (Diener & Lucas, 1999: 213)

Well-being is an overall concept that includes a variety of aspects of satisfaction
and health and refers to both global and context-specific evaluations of the
individual’s life (Sonnentag, 2001). The concept of well-being is elusive for
most social science researchers because there cannot be universal agreement on
its elements.

Despite the individual nature of well-being and the lack of universal defini-
tions of well-being and happiness, the correlates of well-being in the workplace
have been of interest to social science researchers. Work has been said to be one
of the hallmarks of adulthood (Akabas, 1993), and finding meaningful work
and satisfying relationships at work seems to be a major component of happiness
during adulthood (Hall, 1986). Individuals who are employed in meaningful
work tend to be happier than individuals who are not employed (Warr, 1999a).
People who live in countries with high levels of unemployment tend to report
less happiness than those who live in countries with low levels of unemploy-
ment (Warr, 1999a). Though the actual correlates of well-being and happiness
are individually and situationally bound, work is at least one component of a
person’s unique sense of wellness.

The social science literature has made significant progress in identifying
correlates of well-being in the workplace. Well-being in the workplace has
(1) individual, (2) interpersonal, and (3) environmental elements (see Figure 1).
I will continue this discussion by examining the three components of work-
place well-being.



Well-being in the workplace is a broad and encompassing construct that is
composed of the various life, work, and nonwork satisfactions enjoyed by the
individual (Danna & Griffin, 1999). There is no model of individual well-being
in the workplace; nor is there any composite of the various conditions within
individuals that make them feel dissatisfied in the workplace (Brodsky, 1976).
However, the social science literature has identified three primary constructs of


individual well-being in the workplace: psychological well-being, subjective
well-being, and health-related well-being (Danna & Griffin, 1999; Page & Vella-
Brodrick, 2009; Warr, 1990). These individual elements of workplace well-being
will be explored below.

Psychological Well-Being

Individual workplace well-being has been conceptually identified by some
researchers as psychologically based. Psychological well-being is composed
of self-acceptance, positive relationships with others, autonomy, environmental
mastery, purpose in life, and the potential for personal growth (Ryff, 1989).
Individuals who are psychologically well in the workplace tend to be optimistic,
have meaningful social relationships, and possess resources that enable them
to work toward goals that they value (Diener et al., 1999). Individuals who have
a high degree of psychological well-being on the job tend to have good overall
mental health, while those with poor general mental health tend to be more
susceptible to work-related stressors (Donaldson-Feilder & Bond, 2004; Jackson
& Saunders, 2006; Page & Vella-Brodrick, 2009).

114 / GATES

Figure 1. Workplace experiences and workplace well-being.

Among people who experience the most threats to their psychological
well-being in the workplace are those who experience workplace discrimination.
A number of recent studies examined the experiences of well-being among
minorities in the workplace. For example, using two national survey datasets,
the National Survey of Black Americans and the Detroit Area Study, Forman
(2003) found that perceived segmentation by race is negatively associated with
African Americans’ psychological well-being. Jackson and Saunders’ (2006)
study of professional African Americans examined whether perceived discrim-
ination and stress related to being the “token” African American (that is,
hired only to create the illusion of inclusion) in the workplace was predictive
with regard to correlates of psychological well-being (mental health, depression,
anxiety, and somaticism [physical pains that have psychological causes]).

Token stress, defined as stress that can result from being the perceived symbolic
representatives of a minority group in a workplace (Jackson, Thoits, & Taylor,
1995; Kanter, 1977), impacts psychological well-being in the workplace. Kanter
(1977) notes, in her theory of proportional representation, that token stress can
arise because tokens feel pressure to overachieve in the workplace in order to
prove themselves, and to pave the way for others from their minority group by
appearing to set a good example. Token status can cause a great deal of stress
in the workplace. For example, King and colleagues (2005) found women’s
token status to be associated with their perceptions of workplace inequity. Other
research findings indicate that token stress and role overload are predictors
of work stress (Jackson & Saunders, 2006).

Perceived discrimination has been found to negatively predict psychological
well-being in a nationwide probability sample (N = 1783) of working immi-
grants (Jasinskaja-Lahti, Liebkind, & Perhoniemi, 2007). In a study of teachers,
academics, and educators, experiences of discrimination in the workplace have
been found to increase anxiety and stress levels, to result in loss of confidence,
and, as a consequence in some extreme cases, to result in suicidal ideation (Irwin,
2002). Though the empirical evidence on the impact of discrimination in the
workplace on an individual’s psychological well-being is limited, the social
science literature suggests that the individual’s experience of well-being may
be psychologically based.

Subjective Well-Being

A closely related component of individual well-being is subjective well-being.
Subjective well-being refers to an individual’s overall experience in life, a
global assessment of the individual’s qualify of life guided by the individual’s
own criteria (Diener, 1984). The components of subjective well-being include
pleasant affect, such as contentment, pride, affection, or happiness; or unpleasant
affect, such as guilt and shame, sadness, depression, envy, and desire to change
one’s life (Diener et al., 1999). Subjective well-being may be experienced within


the domains of work, family, leisure, health, finances, self, or one’s group
(Diener et al., 1999). Subjective well-being and psychological well-being care
closely related constructs; however, there are some differences between psycho-
logical and subjective well-being. Unlike psychological well-being, subjective
well-being is not simply the absence of negative factors, as in many measures
of mental health, but rather the presence of positive factors (Diener, 1984). In
addition, measures of subjective well-being tend to focus on an individual’s
self-reported values, emotions, and evaluations, while measures of psychological
well-being tend to be based upon domains of wellness as defined by psychological
experts (Diener & Lucas, 1999; Diener, Sapyta, & Suh, 1998).

Though subjective well-being in the workplace is not entirely separate from
overall well-being within other life domains, there seems to be some evidence of
a relationship between meaningful employment and subjective well-being. Indi-
viduals who are unemployed show significantly lower levels on standardized
measures of subjective well-being (Helliwell & Putnam, 2005), while individuals
who are employed in meaningful work tend to have feelings of mastery, a sense
of progress toward their goals, and positive social relationships (Diener et al.,
1998). Happiness, satisfaction, morale, and positive affect determine why people
generally experience subjective well-being in the workplace, but the individual’s
own cognitive and affective reactions to workplace experiences ultimately deter-
mine how the individual experiences subjective well-being (Diener, 1984).

Health and Well-Being

A third component of individual well-being in the workplace is the individual’s
personal health. Threats to employees’ subjective and psychological well-being
have been found to negatively affect employees’ health. For example, Evans and
Steptoe (2002) found that job strain not only is correlated with poor psycho-
logical well-being but also results in more absences related to personal illness.
Commonly used indicators of poor health-related well-being in the workplace
are the individual’s psychosomatic complaints and experience of burnout. Symp-
toms of poor health-related well-being in the workplace may range from
headaches, muscle tension, nausea, stomach cramps, or rapid heartbeat (De Dreu,
Dierendonck, & Dijkstra, 2004) to more severe gastrointestinal or cardiac symp-
toms, such as eating problems, heart trouble, and elevated blood pressure
(Kaukiainen et. al., 2001). High rates of absenteeism and turnover can be a sign of
poor individual health-related well-being in the workplace (De Dreu et al., 2004).

Organizations that make proactive efforts to promote wellness among
employees tend to have higher levels of individual health-related well-being
among their employees. Perceived leadership commitment to health and health
support from workmates promote increased health citizenship in the workplace
generally (Mearns & Reader, 2008). While health and wellness are only one
aspect of the individual’s overall well-being in the workplace, with psychological

116 / GATES

and subjective well-being as closely related constructs, there is promising evi-
dence that organizations who support wellness tend to have employees who
have higher levels of individual health-related well-being.



Next in this framework for understanding workplace well-being we come to
the interpersonal aspects of the workplace that support an individual’s wellness.
The opportunity for meaningful interpersonal contact is an important job charac-
teristic that has been associated with well-being in the workplace (Warr, 1999b).
Several interpersonal themes are present in the well-being literature, including
conflict with others, support from others, and identity congruence, which will
be explored below (Bates & Thompson, 2007; De Dreu et al., 2004; Griffith
& Hebl, 2002; Warr, 1999b).

Conflict with Others

While conflict is an almost inevitable component of any productive workplace,
pervasive interpersonal conflict is associated with poor workplace well-being (De
Dreu et al., 2004). Workplaces are complex social settings, marked by both
informal and formal hierarchies, rules, and regulations, and thus interpersonal
discord is likely to occur from time to time (Bates & Thompson, 2007). However,
workplace conflict that is balanced by interpersonal respect promotes employees’
experience of positive workplace well-being (Warr, 1999b).

The presence of significant workplace conflict that results in interpersonal
harassment or violence has an enormously negative effort on workplace well-
being. In extreme cases, workplace conflict may result in physical, verbal, or
sexual harassment, destruction of property, work sabotage, or aggression, which
can be connected to poor workplace well-being (Bates & Thompson, 2007;
Irwin, 2002). In other cases, covert workplace conflict is equally damaging to
employee well-being (Kaukiainen et. al., 2001). Moreover, conflict at …

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A Decade of Microaggression Research and LGBTQ Communities: An

Introduction to the Special Issue

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A Decade of Microaggression Research and LGBTQ
Communities: An Introduction to the Special Issue
Kevin L. Nadal, PhD

John Jay College of Criminal Justice, City University, New York, New York, USA

Though the Supreme Court of the U.S. legalized same-sex
marriage in 2015, heterosexism and transphobia has continued
to manifest through many systems in the US — from lack of
federal protection in employment non-discrimination laws to
polices that prohibit transgender people from using bathroom
and public facilities that match their gender identities.
Heterosexist and transphobic discrimination have also per-
sisted through interpersonal interactions — ranging from
more overt forms (e.g., hate crimes, bullying) to more subtle
forms of discrimination, otherwise known as microaggressions.
Since 2008, there have been hundreds of articles written on
microaggressions, with dozens focusing specifically on experi-
ences of lesbian, gay, bisexual, transgender, and queer (LGBTQ)
people. Qualitative and quantitative studies have revealed that
LGBTQ people who experience microaggressions have
reported negative outcomes like depression, low self-esteem,
and trauma. This special issue aims to further Microaggression
Theory by providing theoretical and empirical papers that
focus on the manifestation and impact of microaggressions
on LGBTQ people. Using an interdisciplinary approach, articles
range in topic from intersectional identities, to health and
psychological outcomes, to advancing research methods.
Future studies regarding microaggressions and LGBTQ people
are discussed- highlighting the influence of the changing land-
scape of heterosexism and transphobia within general society,
as well as new dynamics that have formed and developed
within LGBTQ communities.

Microaggressions; LGBTQ;
heterosexism; transphobia

Over the past decade, there have been many indicators that general American
society had become more accepting of lesbian, gay, bisexual, transgender, and
queer (LGBTQ) people. In 2009, President Obama signed the Matthew
Shepard and James Byrd, Jr. Hate Crimes Act, which officially added sexual
orientation and gender identity as protected classes in federal hate crime law.
That same year, he signed the executive order to put an end to Don’t Ask,
Don’t Tell—allowing LGBTQ soldiers to serve openly in the military. Many
LGBTQ celebrities such as Ellen DeGeneres, George Takei, RuPaul, Ricky
Martin, Wanda Sykes, Laverne Cox, and Chaz Bono openly discussed their

CONTACT Kevin L. Nadal [email protected] John Jay College, CUNY, 524 W. 59th Street, New York, NY
10019, USA.

2019, VOL. 66, NO. 10, 1309–1316

© 2019 Taylor & Francis Group, LLC

sexual orientations and gender identities and continued to be embraced by
mainstream audiences. And in 2015, the Supreme Court of the U.S. legalized
same-sex marriage across the country.

Despite this, heterosexism and transphobia has continued to manifest on
systemic levels—ranging from some states’ anti-transgender laws regarding
the use of bathroom and public facilities to the passing of “religious freedom
laws” that permit anti-LGBTQ discrimination when such behaviors align
with one’s religion (e.g., not baking a cake for a same-sex wedding).
Furthermore, sexual orientation and gender identity are not considered
protected classes in federal employer non-discrimination laws and many
state laws prohibit adoption by same-sex couples. Interpersonally, anti-
LGBTQ discrimination has continued to persist—from anti-LGBTQ bullying
in K–12 institutions to the alarming amount of murders of trans women of
color annually (Nadal, 2018). Over the past decade, researchers have also
examined microaggressions, or subtle forms of discrimination that LGBTQ
people and other historically marginalized groups encounter in their daily
lives (Nadal, Whitman, Davis, Erazo, & Davidoff, 2016).

Conceptualized initially as racial microaggressions by Pierce, Carew,
Pierce-Gonzalez, and Willis (1978) and later reintroduced by Sue et al.
(2007), many scholars have highlighted the many ways that racial discrimi-
nation have manifested in more covert or well-intentioned forms—often by
individuals who were unaware of their biased behaviors. As people of color
had attained more rights and opportunities than in the past, it it had become
less socially acceptable for people to maintain or vocalize racial biases.
Accordingly, microaggression scholars argued that people (particularly
those who belong to dominant identity groups) may no longer participate
in overt or bigoted behavior, but instead may engage in unconscious or
subconscious behavior that may be reflective of their implicit biases (Nadal,
2018; Sue, 2010).

In the past two years, thousands of media articles have been written about
microaggressions through popular outlets such as the New York Times,
Huffington Post, Washington Post, and Buzzfeed (Nadal, 2018, Torino,
Rivera, Capodilupo, Nadal, & Sue, 2018). Hundreds of scholarly articles on
microaggressions, particularly racial microaggressions, emerged at a much
more rapid rate than other previous studies focusing on psychological or
sociological concepts (Wong, Derthick, David, Saw, & Okazaki, 2014).
Microaggression theory had been expanded to include discrimination based
on gender, sexual orientation, gender identity, ability status, religion, ethni-
city, and other identity groups (Nadal, 2013, 2018; Sue, 2010).

Sue and Capodilupo (2008) first described microaggressions based on
sexual orientation (along with microaggressions toward women). Shortly
after, Nadal, Rivera, and Corpus (2010) introduced a taxonomy outlining
microaggressions based on both sexual orientation and gender identity,

1310 K. L. NADAL

hypothesizing themes that were later qualitatively supported. Examples of
these endorsed themes include: (1) use of heterosexist/transphobic terminol-
ogy, (2) endorsement of heteronormativity/ gender binaries, (3) assumption
of sexual pathology, and (4) discomfort or disapproval of LGBTQ identities
or experiences (Nadal et al., 2011; Nadal, Skolnik, & Wong, 2012; Platt &
Lenzen, 2013). Numerous qualitative and quantitative studies have revealed
that LGBTQ people who experience microaggressions have reported negative
outcomes such as depression, low self-esteem, and trauma (Nadal, 2018;
Nadal et al., 2016). Despite this research, some naysayers have argued that
microaggressions are not valid, that people who experience microaggressions
are overly sensitive or paranoid, or that microaggression research is not
scientifically robust. Thus it is crucial to build on the existing research on
microaggressions, to use multiple, robust, and creative methods to document
the existence of microaggressions, and to continue to validate the lived
experiences of LGBTQ people and other groups.

This special issue aims to advance microaggression theory by highlighting
theoretical, quantitative, and qualitative scholarship that focus on the impact
of microaggressions on LGBTQ people. Accordingly, this issue features eight
articles that comprise diverse disciplines, including psychology, education,
social work, public health, human development, epidemiology, and more.
These articles feature theoretical models, new quantitative measures, and
qualitative studies that examine lived experiences of specific LGBTQ sub-
groups. All studies utilize intersectional approaches—considering the ways
that microaggressions manifest due to interactions of sexual orientation and
gender identity with other identities (e.g., race, ethnicity, gender, religion,
immigration status, age)—beginning with Vacarro and Koob (2019), who
presented an intersectional model of microaggressions, highlighting the need
to center intersectional identities when theorizing and studying anti-LGBTQ

Building on a previous literature review of Nadal et al. (2016), Fisher,
Woodford, Gartner, Sterzing, and Victor (2019) conduct a scoping review of
previous quantitative studies on heterosexist microaggressions and other
forms of subtle homophobia. Complementing these previous quantitative
studies, three new scales measuring anti-LGBTQ microaggressions are intro-
duced in this special issue- the Microaggression Experiences at Work Scale
(Resnick & Galupo, 2019) and the Sexual Orientation Microaggressions Scale
(SOMS) and Gender Identity Microaggressions Scale (GIMS; Nadal, 2019).
Because one of the critiques to microaggression research is the lack of robust
quantitative studies, these scales provide opportunities for future empirical
studies to better understand LGBTQ microaggressions as they affect different
groups and in different contexts.

The remaining studies provide understanding of the various ways that
microaggressions may impact diverse subgroups of LGBTQ people in unique


ways. First, Arayasirikul and Wilson (2019) provide insight to the myriad
ways that transgender women encounter microaggressions and how these
experiences influence their stress levels and overall processes. Second,
Winberg et al. (2019) use quantitative methods to examine how heterosexist
language negatively impacts LGBTQ college students’ substance use beha-
viors. Finally, Munro, Travers, and Woodford (2019) conducted focus groups
to reveal how LGBTQ youth experience microaggressions, while Lomash,
Brown, and Galupo (2019) used a qualitative method to underscore three
main themes of microaggressions faced by LGBTQ people of different reli-
gious backgrounds.

Reflections and future directions

One of the ways that the study of LGBTQ microaggressions has evolved since
our initial conceptualizations are the ways that new language and identities have
been introduced and integrated into our understandings of gender and sexuality.
Specifically, in recent years, there has been an increase in literature on the
concept of gender nonconformity—citing the multiple ways that people may
identity along the gender spectrum or beyond the gender binary. No longer do
people simply identify as men or women, nor are transgender people expected to
transition according to a binary; individuals proudly claim their identities as
genderqueer, genderfluid, agender, and bigender, among others. Similarly,
regarding sexual orientation identity, no longer do people identify only as gay,
lesbian, bisexual, or heterosexual; they also identify as queer, pansexual, asexual,
demisexual, and many other terms. With this, it is crucial for scholars of queer
and transgender studies to validate and integrate these lived experiences and to
prevent microaggressions that may occur toward individuals with these identi-
ties. Though the general population (and some LGBTQ individuals themselves)
may be reluctant to understand or accept new identities or terminology, rejecting
these individuals and communities would be similar to the ways that hetero-
sexuals do/did not accept gay and lesbian people; that gay and lesbian people did/
do not understand accept bisexual people; or gay, lesbian, and bisexual people
did/do not understand transgender people. In this way, enacting any biases
toward these groups would be considered microaggressions themselves.

One future direction for research would be the study of microaggres-
sions that occur within LGBTQ communities. Previous studies highlighted
some of the ways these occur; for instance, in one study, lesbians described
microaggressions they experienced from bisexual women, and bisexual
women described microaggressions from lesbians (Nadal et al., 2011).
Transgender people (especially transgender women) are cognizant of
microaggressions they encounter from cisgender men, and LGBTQ people
with disabilities have identified both systemic and interpersonal microag-
gressions within the LGBTQ community (Nadal, 2013). LGBTQ people of

1312 K. L. NADAL

color can identify the many types of racial microaggressions they encoun-
ter with LGBTQ communities, with examples of exclusion or lack of
representation, bias through dating, and exoticization (Nadal, Erazo,
Shulman, Han, & Deutsch, 2017).

Relatedly, noted in many of these studies (e.g., Lomash et al., 2019; Nadal,
2019) are the disproportionate overrepresentations of White LGBTQ samples
and underrepresentation of LGBTQ communities of color (e.g., particularly
Black Americans and indigenous people). While this is a trend that matches
LGBTQ research in general, it is critical to make more intentional efforts to
represent communities of color in order to fully understand how race,
ethnicity, and other intersectional identities impact LGBTQ people’s lived
experiences. In this regard, it must be noted that there are very few studies
that collect data on ability status, further marginalizing and erasing people
with disabilities—especially LGBTQ people with disabilities.

One other way to further empirically support microaggression theory
(particularly studies involving LGBTQ communities) is to conduct experi-
mental, epidemiological, and mixed methodological designs with large sam-
ples. While multiple quantitative and qualitative methods have been
employed—using online surveys to in-person focus groups—measuring
microaggressions in these ways can assist in telling a more complete story
about how microaggressions impact LGBTQ people’s lives. As such, there is
a need for funding opportunities that focus on LGBTQ communities, with
specific intents to recruit underrepresented LGBTQ populations (e.g., people
of color, transgender and genderqueer people, people with disabilities). And
because there are limitations to the types of federal or government funding
goes to LGBTQ research, it is important for foundations and LGBTQ phi-
lanthropists to consider ways to advance our communities.

Finally, LGBTQ-led organizations and support systems are important in
assisting LGBTQ people in navigating and fighting against microaggressions.
For instance, GLSEN has brought to light the many obstacles that LGBTQ
youth face in primary and secondary school systems (Greytak, Kosciw,
Villenas, & Giga, 2016), while the LGBTQ Scholars of Color Network was
founded with the mission of advancing LGBTQ communities of color in
academia (Nadal, 2016). Organizations such as the National Coalition of
Anti-Violence Programs (NCAVP) annually documents the experiences of
LGBTQ survivors of hate violence (Waters, 2017), while Lambda Legal (2010,
2015) documents how systemic oppression against LGBTQ people still per-
sists—citing discrimination in health care, legal settings, or other systems.
The thousands of LGBTQ-affirming organizations that exist across the world
are necessary in continuing to validate the existence of LGBTQ people,
particularly highlighting their resilience in navigating microaggressions,
overt discrimination, violence, and systemic oppression.


In conclusion, I believe this special issue on LGBTQ people and micro-
aggressions advances the science and practice in microaggression theory, and
I hope it provides provocation for more critical models and studies to
emerge. In order to truly advocate for equity for LGBTQ communities
(and the decrease or erasure of systemic and interpersonal discrimination),
scholars, activists, community leaders, public servants, practitioners, and
others must first acknowledge how microaggressions impact LGBTQ people’s
lives and then work together to instill change on systemic and group levels.


Special thank you to the team of peer reviewers who assisted in this process, including Steph
Anderson, Rebecca Campon, Kim Case, Melissa Corpus, Kristin Davidoff, Cirleen DeBlare,
Tanya Erazo, Lourdes Follins, Alexis Forbes, Carlton Green, Cara Jacobson, Marc Johnston
Guerrero, Mira Krishnan, Omar Martinez, Anthony Ocampo, Nic Rider, María Scharron-del
Rio, Richard Shin, Avy Skolnik, Charlotte Tate, and Gina Torino. They represent many
academic and clinical specialties, sexual orientations, gender identities, racial and ethnic
identities, and other backgrounds, and their collective perspectives were invaluable in ensur-
ing this special issue was an inclusive success.

Disclosure statement

No potential conflict of interest was reported by the author.


Arayasirkul, S., & Wilson, E. C. (2019). Spilling the T on trans-misogyny and microaggres-
sions: An intersectional oppression and social process among trans women. Journal of
Homosexuality. doi: 10.1080/00918369.2018.1542203

Fisher, C. M., Woodford, M. R., Gartner, R. E., Sterzing, P. R., & Victor, B. G. (2019).
Advancing research on LGBTQ microaggressions: A psychometric scoping review of
measures. Journal of Homosexuality. doi: 10.1080/00918369.2018.1539581

Greytak, E. A., Kosciw, J. G., Villenas, C., & Giga, N. M. (2016). From teasing to torment:
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Lambda Legal. (2010). When health care isn’t caring: Lambda legal’s survey of discrimination
against LGBT people and people with HIV. New York, NY: Author. Retrieved from https://

Lambda Legal. (2015). Protected and served? New York, NY: Author. Retrieved from https://www.

Lomash, E. F., Brown, T. D., & Galupo, M. P. (2019). “A whole bunch of love the sinner hate
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Munro, L., Travers, R., & Woodford, M. R. (2019). Overlooked and invisible: Everyday
experiences of microaggressions for LGBTQ adolescents. Journal of Homosexuality.
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Nadal, K. L. (2013). That’s so gay! Microaggressions and the lesbian, gay, bisexual, and
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Nadal, K. L. (2016). The intersection of queer theory and empirical methods: Visions for
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Nadal, K. L. (2018). Microaggressions and traumatic stress: Theory, research, and clinical
practice. Washington, DC: American Psychological Association.

Nadal, K. L. (2019). Measuring LGBTQ microaggressions: The sexual orientation microag-
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Nadal, K. L., Erazo, T., Shulman, J., Han, H., & Deutsch, T. (2017). Caught at the intersec-
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Nadal, K. L., Issa, M., Leon, J., Meterko, V., Wideman, M., & Wong, Y. (2011). Sexual
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Resnick, C. A., & Galupo, M. P. (2019). Assessing experiences with LGBT microaggressions
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1316 K. L. NADAL

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Reflections and future directions
Disclosure statement

See discussions, stats, and author profiles for this publication at:

LGBTQ Student Achievement and Educational Attainment

Chapter · April 2015

DOI: 10.3102/978-0-935302-36-3_7




3 authors:

George Wimberly

American Educational Research Association



Lindsey Wilkinson

Portland State University



Jennifer Pearson

Wichita State University



All content following this page was uploaded by George Wimberly on 07 August 2019.

The user has requested enhancement of the downloaded file.

LGBTQ Issues in Education:
Advancing a Research Agenda

ch00-frontmatter.qxp 4/7/15 3:53 PM Page i

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LGBTQ Issues in Education:
Advancing a Research Agenda

Edited by
George L. Wimberly

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The American Educational Research Association (AERA) publishes books and journals based
on the highest standards of professional review to ensure their quality, accuracy, and
objectivity. Findings and conclusions in publications are those of the authors and do not reflect
the position or policies of the Association, its Council, or its officers.

© 2015 American Educational Research Association

Published by the American Educational Research Association
1430 K St., NW, Suite 1200
Washington, DC 20005
Printed in the United States of America

All rights reserved. No part of this publication may be reproduced or distributed in any form
or by any means, including, but not limited to, the process of scanning and digitization, or
stored in a database or retrieval system, without the prior written permission of the publisher.

Library of Congress Cataloging-in-Publication Data

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Table of Contents
Preface v
Acknowledgments vii
1 Introduction and Overview 1

George L. Wimberly
2 LGBTQ Education Research in Historical Context 23

Karen Graves
3 Sociolegal Contexts of LGBTQ Issues in Education 43

Catherine A. Lugg and Madelaine Adelman
4 Schools and Children in LGBTQ Families 75

Ryan J. Watson and Stephen T. Russell
5 K–12 Students in Schools 89

Mollie Blackburn and C. J. Pascoe
6 Bullying and K–12 Students 105

Dorothy L. Espelage
7 LGBTQ Student Achievement and Educational Attainment 121

George L. Wimberly, Lindsey Wilkinson, and Jennifer Pearson
8 Higher Education 141

Kristen A. Renn
9 School Workers 161

Jackie M. Blount
10 Use of Large-Scale Data Sets and LGBTQ Education 175

George L. Wimberly
11 Challenges to Doing Research on LGBTQ Issues in Education

and Important Research Needs 219
George L. Wimberly and Juan Battle

12 Conclusion and Recommendations for Further Research 237
George L. Wimberly

Name Index 253
Subject Index 255
Workshop Participant Roster 271
About the Contributors 273

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Chapter 1

Introduction and Overview
George L. Wimberly

In an increasingly diverse society, educators and policy makers face thechallenge of fostering educational environments that are inclusive and wel-coming to all students and teachers. Schools and teachers must consider
whether the educational context facilitates learning for all youth, including
those who are lesbian, gay, bisexual, transgendered, queer (LGBTQ), or ques-
tioning their sexual identity, as well as children of sexual-minority parents. In
a pluralistic society, school administrators must also consider whether teachers,
aides, or other staff who themselves may identify as LGBTQ are hindered in
the workplace because of discriminatory policies, practices, or comments.

The enhanced social status of LGBTQ people and the increased visibility
of LGBTQ issues across societal and cultural domains are affecting how we
understand schools and educational issues. Changes in family structures and
dynamics have led to an increased relevance and awareness of LGBTQ issues
in schools or educational contexts. Several states and the District of Columbia
have laws permitting same-sex marriage, and many communities recognize
same-sex relationships with expanded property rights and legal protections to
legitimize these relationships and households. Findings from the 2010 U.S.
Census estimate that over 600,000 households are led by same-sex couples,
and it is estimated that one quarter of these households are raising children
(O’Connell & Feliz, 2011). These changes in family demographics and structure
bring LGBTQ issues to the forefront in our nation’s schools.

K–12 schools and colleges have had to respond to the increased visibility
of LGBTQ youth and young adults as well as LGBTQ faculty and staff on
their campuses. Thus, in a school context there may be children who have
LGBTQ parents, students who identify as LGBTQ or engage in same-sex
sexual behavior, parents of LGBTQ students, and faculty, staff, school admin-
istrators, and other adults in the school context who are directly or indirectly
affected by LGBTQ issues and concerns. This opens up a new realm of issues
and thinking for the overall population of students, teachers, and others in the
school who interact in an LGBTQ context.

The increased visibility of LGBTQ people in schools and in education is
changing how we think about school curriculum issues, sexuality, definitions
of family, and attitudes toward these issues. It is expanding how we conceptu-


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alize, develop, and use education research on LGBTQ issues and topics.
School leaders, teachers, parents, and policy makers need information and
knowledge to understand the social, psychological, structural, and school cli-
mate factors that affect LGBTQ students and others at the individual level
(micro level) and to understand how LGBTQ issues affect the school curriculum
and structure (macro level). Findings and discussions from scholarly education
research can help schools expand to serve all students and become places for
learning about and exploring LGBTQ people and their communities.

Recognizing the presence of LGBTQ people and issues in an educational
context has been an evolving and dynamic process. For many decades much
of the education research on LGBTQ issues related to mental health factors
such as youth depression, social isolation, homelessness, and teen suicide
(D’Augelli, 2002; D’Augelli, Hershberger, & Pilkington, 2001; Savin-Williams,
2001). Early research studies depict LGBTQ teachers as social deviants or as
immoral, arguing that students need to be protected from these educators
(Blount, 2005; Graves, 2009). However, an emerging body of literature and
education research uses multiple theoretical and conceptual frameworks and
conventional research methods to explain and help us understand the LGBTQ
experience in our nation’s schools.

Information and findings from education research studies can describe
and explain the school experiences of LGBTQ youth and their peer relation-
ships across a broad range of topics such as school/campus climate, parent
involvement, student achievement, and other essential elements that affect
students in schools. Particularly at the high school level, recent education
research is shedding light on some of the challenges that LGBTQ youth
face. This research suggests that in comparison with their non-LGBTQ peers,
LGBTQ students may be more likely to be victims of bullying and harass-
ment, have lower levels of academic achievement, have less school engage-
ment, suffer emotional distress and social isolation, and experience social
and psychological adjustment problems. In some communities local high
schools and community organizations are addressing the needs of LGBTQ
youth and working within schools to ensure that these students have a safe,
vibrant, and rich school experience. However, much of this research is
limited to a small number of campuses and communities, resulting in large
gaps in knowledge about LGBTQ youth and students, particularly among
racial and ethnic minorities, low-income students, and those living in small
towns and rural areas.

College and university campuses have been at the forefront of giving voice
to the issues and challenges faced by LGBTQ students. Campus organizations
provide social support and psychological counseling, and campus advocacy

2 introduction and overview

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organizations and policies protect LGBTQ students, faculty, and staff. Colleges
provide a platform for researchers to study students’ current and past experi-
ences, attitudes toward LGBTQ issues, and perceptions related to education.
Beyond the campus experience, colleges and universities are now investing in
academic centers and research to increase our knowledge and understanding
of LGBTQ people, topics, and communities.

This report seeks to give voice to the research, to expand our understanding
of LGBTQ issues, and to foster scientific and scholarly inquiry that draws
upon solid theoretical models and methods. It provides a synthesis of what we
know from research on LGBTQ issues, considers the key methods used to
gather the information, and discusses essential elements for understanding
how research can contribute to the overall discovery and knowledge of LGBTQ
issues that are affecting students and youth, school faculty and staff, school
curriculum and areas of study, and the overall educational experience. Through-
out this report the authors review key LGBTQ research, examine areas for fu-
ture research, consider issues important to advancing scholarship, and offer
recommendations for investing in research, data, and training of researchers
in this important arena of inquiry.

Background on AERA’s Initiative
This report derives from an initiative of the American Educational Research As-
sociation (AERA) undertaken to examine LGBTQ issues in education, the state
of the knowledge, and promising directions for future research. The AERA
study gathered information on the state of research on LGBTQ issues in education
through multiple processes: (a) an extensive literature search and review, (b) a
broad-based Call for Ideas to the education research community to invite input
and suggestions, and (c) an intensive small research workshop of scholars.
Literature Search
AERA staff initiated an extensive literature search and review through e-mail
and the AERA website, calling on the education research community for input
and ideas on LGBTQ issues in education. This search produced over 400
entries, which showed the breadth of topics and areas of research examining
LGBTQ issues in education. This information was supplemented with other
literature collected by AERA staff and a literature list generated by the Queer
Studies Special Interest Group (SIG). Throughout the development and prepa-
ration of this report, AERA continued to add and update the literature list and
organize it in a useful format for researchers, practitioners, and educators. The
literature collection in itself is an accessible, important product of the project.

introduction and overview 3

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Call for Ideas
The Call for Ideas on Scholarly Knowledge on LGBTQ Issues in Education
was posted on the AERA website, disseminated across AERA divisions and rel-
evant SIGs, and distributed widely to other associations, research societies, and
organizations in the social sciences and humanities that directly and indirectly
link to scholars in relevant research areas. The AERA call asked researchers to
provide citations to significant findings and studies, respond to specific questions
about the state of knowledge on LGBTQ issues, identify theoretical perspectives,
and discuss methodological concerns in this research. This call resulted in about
100 responses, which contributed to identifying the range of germane knowledge
and to the development of this report.
Research Workshop
In the fall of 2010 AERA held a Workshop on LGBTQ Issues in Education Re-
search that brought together scholars in education research and other fields to
examine LGBTQ research as it relates to education, identify research on LGBTQ
issues across a broad perspective, determine gaps in the research, and discuss
what future research agendas might address. The goal of the workshop was to
bring scholars from multiple disciplines together to provide a state-of-the-art
examination of LGBTQ research as it relates to education as a learning envi-
ronment as well as to the health and well-being of those who study or work in
educational settings.

The workshop participants included researchers who study and work with
LGBTQ populations or in related areas. These scholars discussed from the
vantage of their expertise the state of the knowledge, important issues unstudied
or understudied, and promising trajectories for future research. They also ad-
dressed methodological and conceptual challenges to the research and devel-
oped an illustrative map of promising research directions and discussed po-
tential funding considerations, data needs, and other resource needs important
to advancing this work. Research was examined on substantive topics such as
LGBTQ issues in the school context, research on educators and school leaders,
the family, K –12 schools and schooling issues, international and cultural con-
texts, and indicators and demographics for LGBTQ populations.

In advance of the workshop, participants each contributed to the literature
list through memoranda that focused on salient studies and findings and provided
important citations to research. These memoranda highlighted work within
participants’ particular research domains and expertise. The memos also served
as catalysts for the workshop conversation and helped to emphasize issues ad-
dressed in the broad-based call from the education research community. The

4 introduction and overview

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discussions and memos from the workshop, the literature collection, and the
Call for Ideas all contributed to the development of this report.

Use of the Term LGBTQ
The term LGBTQ is often associated with lesbian, gay, bisexual, transgender,
and queer individuals and their communities. In this report the authors use the
LGBTQ term as a general categorization of the individuals, groups, issues,
behaviors, and identities that are discussed. But one finding that emerges from
this literature is that gender expression, sexual behavior, attraction, and identity
are each separate and distinct domains. Throughout the literature, each com-
ponent of the term LGBTQ has multiple definitions, has been adopted by
some groups and not by others, has changed and evolved overtime, and is
deemed appropriate for some situations but unsuitable in others. For example,
some women describe themselves as “lesbian” and others prefer the term “gay
women” (Moore, 2011). Some people may engage in same-sex sexual behavior,
yet reject the label gay or bisexual. The Centers for Disease Control uses the
term “men who have sex with men” to capture men who self-identify as
straight or heterosexual yet engage in sexual activity with men. Some use the
label “queer,” once thought of as derogatory, to associate with queer theory or
a queer lifestyle; others designate the “Q” as “questioning.”

Gender expression or transgender issues— the “T” in LGBTQ— remain a
somewhat new and understudied area in education research. A few researchers
are just beginning to explore and examine the school experiences of those who
express their gender outside traditional masculine and feminine roles (Beemyn
& Rankin, 2011; Wentling, Schilt, Windsor, & Lucal, 2008). We are just beginning
to have some understanding or some limited research on how those who are
transgender or who express gender differently experience school, interact in so-
ciety, and understand their sexuality. A person’s gender expression as female,
male, or other expression may be different from their sexual expression. We are
just starting to learn about some of the experiences that transgender people have
on university campuses, but this research is very limited. Even more limited is
the literature on alternate gender expression among children and young adults
(Kosciw, Greytak, Bartkiewicz, Boesen, & Palmer, 2012; Kosciw, Greytak,
Diaz, & Bartkiewicz, 2010; Kosciw, Greytak, Palmer, & Boesen, 2014). Although
many researchers include the “T” in a general description of the population, few
actually disaggregate the experiences of this group in any way that is generalizable
to a wider population. This opens the door to much-needed future research, par-
ticularly in a school or educational context.

introduction and overview 5

ch01.qxp 4/7/15 3:53 PM Page 5

Each of the LGBTQ components and definitions can reflect cultural, polit-
ical, and social agendas that describe specific issues, individuals, and groups
but also can be misaligned with the values, beliefs, and attitudes of others
who may have similar identity, attraction, gender expression, or same-sex be-
havior. Thus, there is not a universal term that necessarily captures everyone.
The authors in this report choose to use LGBTQ to describe the population in
an all-encompassing sense. However, when referencing the literature or when
talking about a particular group such as gay or transgender people or those
who have same-sex attraction, the authors use the more specific term and
limit the use of acronyms.

Theories and Conceptual Frameworks Used to Study LGBTQ Issues
Theory provides a lens to frame an issue or argument, define key concepts,
and ultimately make sense of research findings and results. Scholars of LGBTQ
issues in education draw upon the concepts and tenets of multiple theoretical
perspectives to develop research questions that address behaviors, individual
identity (or identities), group interactions, cultural factors, and the social land-
scapes that shape LGBTQ issues in an educational context. Some of the studies
in this report represent several theoretical perspectives and show how they are
applied to education research issues that affect the LGBTQ community. Among
the theoretical lenses used to examine LGBTQ topics are heteronormative
perspectives, which frame research in terms of the traditional male-female re-
lationship; queer theory, which seeks to dismantle categorical notions; and
intersectionality, which brings in different elements of multiple frameworks.

The next section offers further explanation of theoretical models to help
the reader understand the research presented and discussed throughout this re-
port. Each of the theories discussed is much more complex and broad than as
presented here. Readers seeking a deeper understanding of the theories them-
selves should consult the cited literature. Following this review of theory, we
then discuss some of the research methods that scholars and researchers use
to collect information and analyze data on LGBTQ issues.
The Heteronormative Theoretical Perspective
Much of the education research on LGBTQ issues is framed using a hetero-
normative theoretical perspective. This research starts with the notion that tra-
ditional male-female relationships are the norm or standard that shapes and
dominates social institutions such as the family, politics, religion, public health,
and education (Mayo, 2007; Renn, 2010). This perspective organizes identities
into categories that are hierarchical binaries, such as male-female and hetero-

6 introduction and overview

ch01.qxp 4/7/15 3:53 PM Page 6

sexual-homosexual, with the male heterosexual perspective prevailing as the
most powerful and superior perspective. It is this binary dominance that creates
the standard by which all other areas are judged. This theoretical perspective
supports patriarchy and male dominance throughout society. Within the het-
eronormative structure, other notions of gender, marriage, or sexuality are not
an option and are viewed as deviant or criminal (Carpenter & Lee, 2010).

Most schools function as heteronormative institutions, which overwhelm-
ingly maintain that opposite-sex relationships, coupled with male dominance
and female submission, represent the natural and standard manner of behaving
and interacting. Many scholars translate heteronormative perspectives as de-
rivatives of masculine identity theories and masculine domination (Pascoe,
2007; Sears, 1998, 2005). The heteronormative structuralist framework and
traditional attitude are pervasive throughout K–12 schools and in higher edu-
cation. As early as preschool, students are socialized to adhere to and accept
the strict cultural and moral norms surrounding heteronormativity. Children
are often taught gender-based stereotypes such as boys’ being strong and ag-
gressive and girls’ being meek, nurturing, and mild mannered.

Beyond social interactions among students, heteronormativity is reflected
in school curricula that present only a heterosexual perspective, in different
dress code standards for boys and girls, in students’ and teachers’ expressions
of homophobia, and often in sports and school clubs where homophobia and
transsexual phobia are used as a weapon or threat to compel students to
conform (Kosciw et al., 2010, 2012; Lipkin, 2001; Pascoe, 2007). Research
shows a general prevalence of homophobia within schools that is often wide-
spread and supported by faculty and the general environment (G. W. Smith,
1998; Walters & Hayes, 1998). Students who deviate from the norm are often
ostracized, isolated, or otherwise ignored in the school.

The heteronormative perspective regulates much of how sexuality is con-
ceived and discussed in schools, as well as how LGBTQ topics are studied. It
is through heteronormative discursive practices that LGBTQ lives are mar-
ginalized socially and politically and, as a result, are invisible in some social
spaces, including schools. Prior to 1990 the heteronormative perspective dom-
inated education research on LGBTQ issues, as much of this work focused on
pathological topics surrounding LGBTQ students’ mental health and psycho-
logical well-being (D’Augelli,1996; Tierney & Dilley, 1998). Depression,
anxiety, and youth suicide were prevalent in this research.

Until the 1970s many K–12 schools did not teach anything related to sexu-
ality beyond a health education curriculum. Students learned about the “birds
and the bees,” focusing exclusively on the traditional reproductive process
(Irvine, 2004). Family dynamics were centered around heterosexual norms of

introduction and overview 7

ch01.qxp 4/7/15 3:53 PM Page 7

marriage and child-rearing, and any deviations were seen as perverted and
often scorned (Foucault, 1990). However, sex education evolved as lifestyles,
cultural norms, and family dynamics changed, reproductive health topics ex-
panded, and diverse groups of students entered our schools. The onset of
AIDS in the 1980s demanded that schools address sex education and discuss
sexuality with an ever-growing and changing student population. Some of
this research is the subject of the current report. Heteronormative perspectives
were still the most common: Abstinence-only sex education promoting male-
female relationships, heterosexual marriage, and traditional family structures
dominated many schools’ curricula. But world events precipitated greater vis-
ibility of LGBTQ students, teachers, and issues affecting schools, and led re-
searchers to produce a body a knowledge addressing LGBTQ issues.
Queer Theory
At the opposite end of the theoretical continuum, queer theory supports an in-
dividual’s self-identification and full self-expression, challenging the hetero-
normative perspective by dismantling all categories of cultural norms and val-
ues, class distinctions, racial and gender thinking, preconceived notions of
family, and the traditional structure of the institutions that support heteronor-
mative roles (Sullivan, 2003). Queer theory is not a specialized theory; rather,
it is a perspective or way of thinking that is defined by action. Instead of re-
placing the traditional categories with alternatives, queer theory dismantles
the categories altogether. Where heteronormative perspective creates categorical
binaries within gender, race, class, and sexuality, queer theory is fluid and as-
sumes no group hierarchy or connections. Queer theory holds that under a
heteronormative framework the LGBTQ person is deemed as powerless; thus,
it is only through eliminating categories that LGBTQ people can truly gain
power or voice.

Queer theoretical frameworks can help us understand lesbian, gay, bisexual,
and transgender experiences. It also provides the opposing argument to the
heteronormative idea that gender and sexuality are fixed and/or natural char-
acteristics. A queer theoretical framework is based on the notions that people
can live as a gender different from the one they were born into, can refuse to
identify as either male or female, can engage in sexual relationships with both
men and women, and can reject the gay or straight classification. This per-
spective moves beyond ideas of gender and sexuality …

LGBTQ employment discrimination: Half of
states offer no protections
Miller, Susan . USA Today (Online) ; Arlington [Arlington]08 Oct 2019.

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LGBTQ employment discrimination: Half of states offer no protections

Systemic inequalities for LGBTQ professionals in STEM
by E. A. Cech, and T. J. Waidzunas
Volume 7(3):eabe0933
January 15, 2021
Copyright © 2021 The Authors, some rights reserved; exclusive licensee American Association for the Advancement of Science. No claim to original U.S. Government Works. Distributed under a Creative Commons Attribution NonCommercial License 4.0 (CC BY-NC).

Fig. 1 Career opportunities and resources, by LGBTQ status.
E. A. Cech, and T. J. Waidzunas Sci Adv 2021;7:eabe0933
Copyright © 2021 The Authors, some rights reserved; exclusive licensee American Association for the Advancement of Science. No claim to original U.S. Government Works. Distributed under a Creative Commons Attribution NonCommercial License 4.0 (CC BY-NC).

Career opportunities and resources, by LGBTQ status. Predicted means by LGBTQ status, holding constant variation by demographics, employment and job characteristics, and professional society. Scale ranges from 1 (strongly disagree) to 5 (strongly agree), with higher numbers representing stronger agreement. Error bars represent 95% CIs. N = 25,324.

Fig. 2 Professional devaluation, by LGBTQ status.
E. A. Cech, and T. J. Waidzunas Sci Adv 2021;7:eabe0933
Copyright © 2021 The Authors, some rights reserved; exclusive licensee American Association for the Advancement of Science. No claim to original U.S. Government Works. Distributed under a Creative Commons Attribution NonCommercial License 4.0 (CC BY-NC).

Professional devaluation, by LGBTQ status. Predicted means by LGBTQ status, holding constant variation by demographics, employment and job characteristics, and professional society. Scale ranges from 1 (strongly disagree) to 5 (strongly agree), with higher numbers representing stronger agreement. Error bars represent 95% CIs. N = 25,324.

Fig. 3 Social exclusion by colleagues, by LGBTQ status.
E. A. Cech, and T. J. Waidzunas Sci Adv 2021;7:eabe0933
Copyright © 2021 The Authors, some rights reserved; exclusive licensee American Association for the Advancement of Science. No claim to original U.S. Government Works. Distributed under a Creative Commons Attribution NonCommercial License 4.0 (CC BY-NC).

Social exclusion by colleagues, by LGBTQ status. Predicted means for each category, holding constant variation by demographics, employment and job characteristics, and professional society. Scale ranges from 1 (strongly disagree) to 5 (strongly agree), with higher number representing stronger agreement. Error bars represent 95% CIs. N = 25,324.

Fig. 4 Percent experiencing harassment, by LGBTQ status.
E. A. Cech, and T. J. Waidzunas Sci Adv 2021;7:eabe0933
Copyright © 2021 The Authors, some rights reserved; exclusive licensee American Association for the Advancement of Science. No claim to original U.S. Government Works. Distributed under a Creative Commons Attribution NonCommercial License 4.0 (CC BY-NC).

Percent experiencing harassment, by LGBTQ status. Predicted percentages for each category, holding constant variation by demographics, employment and job characteristics, and professional society. Scale represents percent of respondents in each category who experienced harassment at work at least once in the past year. Error bars represent 95% CIs. N = 25,324.

Fig. 5 Health and wellness difficulties, by LGBTQ status.
E. A. Cech, and T. J. Waidzunas Sci Adv 2021;7:eabe0933
Copyright © 2021 The Authors, some rights reserved; exclusive licensee American Association for the Advancement of Science. No claim to original U.S. Government Works. Distributed under a Creative Commons Attribution NonCommercial License 4.0 (CC BY-NC).

Health and wellness difficulties, by LGBTQ status. Predicted means for each category, holding constant variation by demographics, employment and job characteristics, and professional society. Scale ranges from 1 (never) to 5 (very often in the last year), with higher numbers representing more frequent incidence of each symptom. Error bars represent 95% CIs. N = 25,324.

Fig. 6 Intentions to leave STEM, by LGBTQ status.
E. A. Cech, and T. J. Waidzunas Sci Adv 2021;7:eabe0933
Copyright © 2021 The Authors, some rights reserved; exclusive licensee American Association for the Advancement of Science. No claim to original U.S. Government Works. Distributed under a Creative Commons Attribution NonCommercial License 4.0 (CC BY-NC).

Intentions to leave STEM, by LGBTQ status. Predicted means for each category, holding constant variation by demographics, employment and job characteristics, and professional society. Scale on the “Thought About Leaving STEM Job” measure ranges from 1 (strongly disagree) to 5 (strongly agree), with higher number representing stronger agreement. Scale on “Plans to Leave STEM Profession” measure ranges from 1 (spending rest of their career in their profession) to 5 (spending less than 5 years in their profession). Error bars represent 95% CIs. N = 25,324.

Other Recent Work

New Research on Sexual Orientation and Gender Identity Discrimination: Effect on State
Policy on Charges Filed at the EEOC


Baumle, Amanda K.
Badgett, M.V. Lee
Boutcher, Steven

Publication Date

Data Availability
The data associated with this publication are not available for this reason: Licensing

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University of California

Home Page

New Research on Sexual Orientation and Gender Identity
Discrimination: Effect of State Policy on Charges Filed at
the EEOC
Amanda K. Baumlea, M. V. Lee Badgettb, and Steven Boutcherc

aDepartment of Sociology, University of Houston, Houston, Texas, USA; bDepartment of Economics,
University of Massachusetts Amherst, Amherst Center, Massachusetts, USA; cLaw & Society Association, University of
Massachusetts Amherst, Amherst Center, Massachusetts, USA

In 2013, the Equal Employment Opportunity Commission (EEOC) began allowing
anyone who believed that they experienced sexual orientation or gender identity (SOGI)
discrimination to file charges of sex discrimination under Title VII of the Civil Rights
Act. Very little is known about the impact of the EEOC’s decision and whether it has
enhanced protections for LGBT people. In this brief report, we present preliminary
findings on trends and patterns in charge filing, paying particular attention to differences
that emerge in charges filed in states with and without SOGI employment
nondiscrimination laws. Differences in the characteristics of charging parties, allegations,
and charge outcomes suggest that legal protections operating at the state level shape the
experiences and disputing behaviors of LGBT individuals in pursuing Title VII remedies.

KEYWORDS: Employment discrimination, sexual orientation, gender identity

Studies from a variety of social science disciplines have found that lesbian, gay, bisexual,
and transgender people face employment discrimination in the United States (e.g.
Badgett, 2001; Baumle & Poston, 2011; Klawitter, 2015; Pew Research Center, 2013;
Schilt, 2006; Tilcsik, 2011). Other than President Obama’s 2014 Executive Order
forbidding sexual orientation and gender identity (SOGI) discrimination by federal
contractors, federal law has no explicit ban on SOGI discrimination in employment in the
private sector. Only twenty-one states plus the District of Columbia outlaw SOGI
employment discrimination, and one other outlaws sexual orientation discrimination.

However, in 2013 the Equal Employment Opportunity Commission (EEOC) began
allowing anyone who believed that they experienced SOGI-based discrimination to file
charges of sex discrimination under Title VII of the Civil Rights Act, arguing that
discrimination against LGBT employees is rooted in gender stereotypes and other sex-
based considerations. Aside from anecdotal evidence from specific cases, very little is
known about the impact of the EEOC’s decision and whether it has enhanced protections
for LGBT people. This paper presents preliminary findings on trends and patterns in
charge filing that come from a larger ongoing study of how federal policy has influenced
employment discrimination disputes involving LGBT people. Given the variation in
state-level nondiscrimination laws, we focus on examining how characteristics of

charging parties, the charge allegations, and charge outcomes vary between states with
SOGI protection and those without such laws.

We might expect state-level laws to be related to differences in charge patterns for
several reasons. Herek (2007) observes that sexual stigma is reinforced and perpetuated
through institutional and ideological practices. This “heterosexism” operates through
institutions to generate disadvantage for sexual minorities, irrespective of the presence or
absence of individual discrimination. Further, Herek notes that heterosexism operating
through institutions such as the law serves to legitimate individual level prejudice. Within
the employment context, therefore, LGBT individuals are disadvantaged due to both
individual acts of discrimination and the ideological and institutional practices that
uphold heteronormativity through the legal system and sociopolitical environment in
which individuals are nested.

The scientific premise of this study was to test the proposition that legal protections
operating at the state level are associated with the experiences and disputing behaviors of
LGBT individuals who pursue Title VII remedies. Despite the availability of legal
recourse at the federal level, we expect that variations in heterosexism, which was
operationalized by state-level variation in the presence or absence of SOGI
nondiscrimination laws, would be associated with the types of disputes that arise and are
pursued. In this brief report, we describe the differences associated with Title VII SOGI
charges filed in states with and without nondiscrimination laws.


This study uses data from the Equal Employment Opportunity Commission, the agency
that enforces federal civil rights laws. Discrimination charges may be filed with the
EEOC directly or with one of the state or local Fair Employment Practices Agencies
(FEPA) that have agreements with the EEOC to share the processing of charges. In this
paper, we report preliminary findings from a quantitative dataset of all charges filed
between 2012 and 2016 by individuals located in any of the 50 states or Washington,
D.C. that allege SOGI discrimination. The 9,121 charges in our dataset, therefore,
comprise the total population of charges. The EEOC data are highly confidential and are
not publicly available, but can be used for research purposes if the researcher is detailed
to the EEOC through the Intergovernmental Personnel Act (“IPA”) to conduct research
on SOGI discrimination with these data.

In this preliminary analysis, we examine the overall trends in filing over time and the
relationship between individual and charge characteristics with state-level
nondiscrimination laws. Our primary independent variable was the presence or absence
of a SOGI or SO nondiscrimination law at the time of filing; during this timeframe, 22
states and D.C. prohibited discrimination.1 We examined the relationship between this

independent variable and several dependent variables including individual characteristics
of the charging parties, charge allegations, and charge outcomes.

Characteristics of charging parties

We first examined demographic characteristics of the charging parties. FEPAs are less
likely to have recorded complete demographic data on charging parties, thus we specify
in our results the proportion of charges with valid responses on demographic
characteristics. We include the variable of sex, measured as male or female; race,
including White, Black, Asian, Hawaiian/Pacific Islander, and Native American; and
Hispanic ethnicity. Race and ethnicity are not mutually exclusive, meaning an individual
could identify as both Black and Hispanic.

Charge allegations

We then examined characteristics of the charges, including other bases of discrimination
and issues alleged; for these variables, we include the total 9,121 charges in the dataset.
Along with a SOGI claim, charging parties might allege discrimination based on another
protected category, such as race, disability, or retaliation.

We also examined the specific discriminatory employer practice, or issue, alleged by the
charging party, such as termination, unequal compensation, or harassment. A particular
issue can be difficult to link to only one basis, given that an issue such as harassment
could be tied to multiple stigmatized characteristics (e.g. sexual orientation and race).
Accordingly, we report issues contained in a charge of discrimination that includes at
least one allegation of SOGI discrimination.

Charge outcomes

Finally, we examined whether a charge received a favorable outcome resulting in the
charging party receiving a monetary or nonmonetary benefit. For this subset of charges,
we look only at the 7,851 charges that have been closed, meaning that they have been
resolved. Monetary benefits include items such as back pay, fringe benefits, punitive
damages, or attorney’s fees; nonmonetary benefits include items like policy changes,
training, or accommodations.


This present analysis reports univariate and bivariate descriptive statistics for the entire
population of charges. As reflected by Figure 1, there was a sharp increase in the number
of charges in 2013 – the year when the EEOC began to formally accept SOGI charges.

(Some charges filed in 2012 may have had a SOGI charge added later.) As expected with
a change in federal policy, most of these charges were filed with EEOC offices, but there
was also an increase in charges filed with state FEPAs during this period. The increase in
charges occurred for both sexual orientation and gender identity discrimination (Figure
2). These data reflect a rapid increase in LGBT individuals invoking federal
nondiscrimination law during the three years following the EEOC’s policy change.

Figure 1. Number of federal sexual orientation and gender discrimination charges filed
with the Equal Employment Opportunity Commission and Fair Employment Practice
Agencies, 2012–2016.

Figure 2. Number of federal sexual orientation (SO) and gender identity (GI)
discrimination charges filed, 2012–2016.

Notably, the greatest increase in charges was seen in states without SOGI laws, where
charges grew from 126 filed in 2012 to 1,213 in 2016, a 10-fold increase in filing (Figure
3). In states with nondiscrimination policies, charge filings increased more modestly,
doubling from 508 filed in 2012 to 1,063 in 2016. Further, although charging parties may
file their federal complaint with either an EEOC or FEPA office, the charge data reveal a
division of labor between states with SOGI nondiscrimination laws and those without
such laws. In states with nondiscrimination laws, the state FEPAs handled 63% of SOGI
charges, whereas in states without SOGI protection the EEOC offices handled
approximately 80% of SOGI charges.

Figure 3. Number of federal sexual orientation and gender discrimination charges filed
with the Equal Employment Opportunity Commission (EEOC) and Fair Employment
Practice Agencies (FEPA), by state nondiscrimination law, 2012–2016.

Characteristics of charging parties

Demographic data on charging parties show distinct patterns by race and sex.
Approximately 16% of charges contain no information on the sex of the charging party.
For those charges with available data, more are filed by men (55%) than by women
(45%). Men particularly dominate charges of discrimination based on sexual orientation,
with 58% of these charges being filed by men in contrast to only 42% filed by women;
approximately 14% of sexual orientation charges have no data on sex. For gender
identity, in contrast, women comprise a greater proportion of charges at 63% with men at
37%; approximately 25% of gender identity charges have missing data on sex. There is
very little difference in filing by sex between states with SOGI laws and those without
such laws, with approximately 56% of charges in SOGI states filed by men compared to
55% in non-SOGI states.

Approximately 41% of charges are missing data on the race/ethnicity of the charging
party, mostly from FEPAs. For those with data on race/ethnicity, approximately 52% are
White, 43% are Black, and 10% are Hispanic (Table 1). For charges based on sexual
orientation, 50% are White, 44% Black, and 10% Hispanic. For gender identity, 55% of
charging parties are White, 39% Black, and 7% Hispanic. Differences emerge in the race
of charging parties in non-SOGI states compared to SOGI states. A greater proportion of
charging parties in non-SOGI states are Black, at 47%, compared to 38% in SOGI states.
Also, 11% of charging parties are Hispanic in non-SOGI states and 9% in SOGI states.

Table 1. Race and ethnicity of charging parties in Federal SOGI charges, 2012–2016 (percent of total valid

Race SOGI States Non-SOGI States Total

Black/African American 37.6% 46.6% 43.2%

Hawaiian/Pacific Islander 1.5% * 0.7%

American Indian/Alaska Native 3.1% 2.0% 2.4%

Asian 4.1% 1.0% 2.1%

White 53.7% 50.3% 51.6%

Hispanic 9.0% 10.6% 9.9%

* Cell size is not reported because it falls below the EEOC’s cut-off of 30 charges.

Charge allegations

Charging parties often allege employment discrimination based on more than one
protected category. The most common alleged bases of discrimination besides sexual
orientation or gender identity were other gender bases (55%), followed by retaliation
(42%), race (17%), and disability (14%) (Table 2). Other gender bases include other
discrimination based on sex (i.e. being male or female, pregnancy; or equal pay). Both
retaliation (46% vs. 39%) and gender (59% vs. 52%) bases were included in a greater
proportion of charges in states without SOGI nondiscrimination laws than in those with
laws. In addition, a slightly larger proportion of charges included a race basis in states
without SOGI protection (19% vs. 16%).

* Some charges allege several bases, resulting in values summing to more than 100%.

** The other basis category includes many listed bases that have only a small number of charges,
such as genetic information. Most of the other alleged bases in the “other” category are not bases
that are protected by civil rights laws, such as ancestry or abortion.

The most common issues alleged in SOGI charges were discharge2 (54%), harassment
(47%), terms and conditions3 (29%), discipline (15%), and sexual harassment (14%)
(Table 3). In states without SOGI laws, in contrast to those with such laws, a greater
proportion of charges included allegations of harassment (52% vs. 41%) and discharge
(58% vs. 51%). In addition, charges in states without SOGI laws had a slightly higher
proportion of constructive discharge (11% vs. 8%) issues alleged, meaning that the
employee quit due to an intolerable work environment. In states with SOGI protection,
terms and conditions (31% vs. 27%) and sexual harassment (15% vs. 13%) were the only
issues that emerged as comprising a slightly greater proportion of charges than in non-
SOGI states.

Table 2. Other bases of discrimination in Federal SOGI charges, 2012–2016 (percent of all charges).

Basis SOGI

Non-SOGI States Total

Gender 51.9% 58.9% 55.3%

Race/Color 15.6% 18.7% 17.1%

Religion 3.9% 4.7% 4.3%


6.1% 5.2% 5.7%

Age 8.1% 6.7% 7.4%

Retaliation 38.7% 45.5% 42.0%

Disability 13.5% 14.8% 14.2%


14.6% 4.5% 9.7%

Table 3. Issues alleged in Federal SOGI charges, 2012–2016 (percent of charges citing

Issue SOGI

Non-SOGI States Total

Benefits 3.0% 2.4% 2.7%

Constr. Discharge 7.9% 11.1% 9.5%

Demotion 2.9% 2.9% 2.9%

Discharge 50.9% 57.9% 54.3%

Discipline 14.1% 15.4% 14.7%

Harassment 41.4% 52.4% 46.7%

Hiring 5.4% 5.2% 5.3%

Intimidation 5.4% 6.3% 5.8%

Layoffs 1.0% 0.9% 0.9%

Promotion 6.1% 6.2% 6.2%


14.6% 12.5% 13.6%

Suspension 4.9% 5.1% 5.0%

Terms/Conditions 31.0% 27.1% 29.1%

Wages 4.9% 5.1% 5.0%

Other Issue** 32.4% 16.8% 24.8%

* Some charges allege several issues, resulting in values summing to more than 100%.

**The other issue category includes many listed issues that are reported in a small number of
charges, such as apprenticeship, assignments, or severance pay. The largest category within other

is the EEOC’s own “other” issue code.

Charge outcomes

We are also able to ascertain whether a benefit accrued to the charging party during the
EEOC or FEPA’s handling of the case. Overall, approximately 15% of closed SOGI
charges resulted in a benefit. Benefits were slightly more likely in states without SOGI
protections at 17% of closed charges, whereas 13% of closed charges incurred a benefit
in states with SOGI protection.


Our preliminary findings reflect trends associated with the emergence of a federally
protected category based on sexual orientation and gender identity that vary based on the
presence or absence of a nondiscrimination law at the state level. People in states without
a SOGI nondiscrimination law appear to have benefitted greatly, with the largest increase
in charges filed with the EEOC offices occurring in these states.

Our findings also provide evidence that legal and sociopolitical context are likely shaping
the discriminatory experiences and disputing behaviors of LGBT individuals. A greater
proportion of charges in states without SOGI laws alleged more serious issues of
discrimination, including harassment and discharge, and contained retaliation as a basis.
The prevalence of harassment in SOGI discrimination charges was a full 10 percentage
points higher in sates without SOGI laws.

In addition, our findings suggest that legal context plays a role in the experience of
discrimination and/or disputing behaviors for those with other stigmatized identities,
particularly race. Given that approximately 12% of the U.S. population is Black, it is
notable that over 40% of SOGI charges are filed by individuals who identify as Black.
The disproportionate number of SOGI charges filed by Black individuals could indicate
differences in the legal consciousness of this group, given that past research on race
discrimination suggests that African Americans are more likely to perceive
discrimination and enter into the dispute process (Hirsh & Lyons, 2010). In states without
SOGI laws, a higher proportion of SOGI charges were filed by Black individuals and a
slightly higher proportion included charges of race discrimination. This is likely at least
partially attributable to the higher proportion of Black residents within southern states,
which lack nondiscrimination laws. It is also possible that the intersectionality of

individual characteristics could operate differently within states with a negative
sociopolitical environment.

Our findings support Herek’s (2007) proposition that social stigma is reflected and
reinforced through heterosexism in institutions and ideological practices, including the
law. In states with a nondiscrimination law, LGBT individuals have operated in both
workplace and legal environments that provide protection against discriminatory
employment practices. This could result in LGBT individuals in these states encountering
different types of discriminatory practices than those residing in states without any
protection; in particular, they might face less overt discrimination than individuals in
states without nondiscrimination laws. In contrast, those LGBT individuals in states
without nondiscrimination laws could encounter a more negative sociopolitical
environment, facing greater social stigma that results in more egregious types of
discrimination. Further, their embeddedness within such an environment can foster
skepticism of the legal system and a hesitancy to use it to seek redress. Thus, while we
see an increase in charges in both states with and without SOGI laws, states with
nondiscrimination laws have higher charge rates than states without such laws.

Our preliminary results suggest that a more visible federal enforcement of Title VII laws,
or an explicit nondiscrimination law, could result in more favorable workplace
environments for LGBT individuals residing in states without state-level protection. This
report, however, presents only descriptive statistics regarding the relationship between
state context and charging patterns, so future research employing multilevel modeling is
needed to examine the relationship between charging patterns and both individual and
state-level characteristics, as well as the interactions between the two.


We thank Ron Edwards, Kelly Trindel, Mo Willow, Patrick Davis, and the U.S. Equal
Employment Opportunity Commission for access to the data. We thank the U.S.
Department of Labor for their support. This workforce product was funded by a grant
awarded by the U.S. Department of Labor’s Employment and Training Administration.
The product was created by the recipient and does not necessarily reflect the official
position of the U.S. Department of Labor. The Department of Labor makes no
guarantees, warranties, or assurances of any kind, express or implied, with respect to such
information, including any information on linked sites and including, but not limited to,
accuracy of the information or its completeness, timeliness, usefulness, adequacy,
continued availability, or ownership. This product is copyrighted by the institution that
created it.


1. States with a nondiscrimination law during this period were California, Colorado,
Connecticut, Delaware, District of Columbia, Hawaii, Illinois, Iowa, Maine, Maryland,
Massachusetts, Minnesota, Nevada, New Hampshire (sexual orientation only until 2018),
New Jersey, New Mexico, New York, Oregon, Rhode Island, Utah, Vermont,
Washington, and Wisconsin (sexual orientation only).

2. “Discharge” indicates termination from employment by the employer.

3. “Terms and conditions” includes the employment conditions agreed upon between the
employer and employee, such as job title, starting date, job responsibilities, training, and
dress code.


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Additional information


This work was supported by the U.S. Department of Labor: [Grant Number EO-30272-17-6O-5-

Characteristics of charging parties
Charge allegations
Charge outcomes

Characteristics of charging parties
Charge allegations
Charge outcomes

Additional information

Ramifications Ramifications

Volume 1
Issue 1 Issue 1 – Fall 2019 Article 4


The Impact of Discrimination Against The LGBTQ Community. The Impact of Discrimination Against The LGBTQ Community.

Hazir Coleman
West Chester University, [email protected]

Follow this and additional works at:

Part of the Gender, Race, Sexuality, and Ethnicity in Communication Commons

Recommended Citation Recommended Citation
Coleman, Hazir (2019) “The Impact of Discrimination Against The LGBTQ Community.,” Ramifications: Vol.
1 : Iss. 1 , Article 4.
Available at:

This Article is brought to you for free and open access by Digital Commons @ West Chester University. It has been
accepted for inclusion in Ramifications by an authorized editor of Digital Commons @ West Chester University. For
more information, please contact [email protected]

mailto:[email protected]

One of the things that society does to marginalize certain groups of people is to ignore

them and pretend that they are invisible. In the United States, this has happened to Indigenous

peoples, to people of African descent, and the homeless. Today it is happening to people who are

lesbian, gay, bisexual, transgender, or queer (LGBTQ). It happens in most societies all around

the world, where LGBTQ people are not even spoken about. Most of the time, especially in

schools, the only reference heard to gay people is when one student calls another a ‘faggot’.

Name-calling is bad, but social invisibility and silence can be even more detrimental, because

they have the effect of denying someone’s humanity. If some LGBTQ people insist on making

their presence known, the dominant culture reacts with hostility. Shunning and name-calling can

escalate to physical violence. The effects are long term and pernicious. The message is clear:

Stay in the closet and out of our sight. The irony is that, even when LGBTQ individuals try to

blend in, they are often targeted anyway. This persistent discrimination against the LGBTQ

community causes disruption of individuals’ well being, be faced with unfortunate adversity, and

have a negative effect on society as a whole.

Negative attitudes toward LGBTQ students in school put them at an increased risk for

violence and ill health, as compared to heterosexual students. In 2015, a nationwide study by the

Centers for Disease Control found that LGBTQ students were nearly three times more likely than

straight students to stay home from school due to of safety concerns. 34% reported being bullied

on school property and 10% were threatened or injured with a weapon on school property. 28%

were bullied electronically. The study went on to link exposure to violence to negative effects on

the mental health of these students. “Nearly one-third (29%) of LGBTQ youth had attempted


Coleman: The Impact of Discrimination Against The LGBTQ Community

Published by Digital Commons @ West Chester University, 2019

suicide at least once in the prior year compared to 6% of heterosexual youth” (“LGBT Youth |

Lesbian, Gay, Bisexual, and Transgender Health | CDC”, 2017).

Unfortunately, school is not the first place where LGBTQ youth experience discrimination.

For many, it begins at home, often the instant they speak openly about their sexual orientation.

Coming out can be traumatic, with half of LGBTQ teens experiencing a negative reaction from

parents. Of those, 30% are subjected to physical violence and 26% end up being thrown out of

their homes. In the U.S., approximately 40% of all homeless youth are LGBTQ (Friedman,

2014). Growing up on the street or in shelters makes it even more likely that these kids will not

attend school regularly, starting a downward spiral that makes it very difficult for them to

become productive adults.

That being said, there are many LGBTQ people who grow into adulthood, find good jobs and

partners, and try to live their lives enjoying the same rights and liberties as their fellow

Americans. Being good citizens does not necessarily mean they will be accepted, however. 42%

will be discriminated against at work, leading them to have “higher levels of psychological

distress and health-related problems” than workers who do not experience discrimination. Even

worse, it is estimated that up to 25% of LGBTQ people are the victims of hate crimes. Those

who survive a hate crime—and many do not—have significant health problems in the aftermath,

including depression, anger, anxiety, and post-traumatic stress disorder (Friedman, 2014).

Many gay people experience discrimination in legal matters, such as when they try to adopt

a child or buy property, and this occurs even though the country now has equal marriage and fair

housing laws. Then there are the straight people who seek exemption from laws designed to

prohibit discrimination of LGBTQ people. For example, in December, the Supreme Court heard

a case involving the owner of a Colorado bakery who did not want to make a wedding cake for a


Ramifications, Vol. 1 [2019], Iss. 1, Art. 4

gay couple on the ground that his religious faith should exempt him from laws designed to

ensure equal treatment for everyone (Liptak, 2017). Last July, President Donald Trump

announced that he would rescind the rule allowing transgender people to serve in the military. He

did this over the objections of senior military officers and in spite of the fact that about 15,000

transgender persons are currently serving with no problems (Tozzi & Greenfield, 2017).

An article by Jennifer Calfas on the cost of employment discrimination with a subtopic

of the next frontier on the animadversion of the LGBT (lesbians, gay, bisexual and transgender)

community describes how after years of struggle, LGBT advocates celebrated the Supreme Court

decision to legalize the same-sex marriage. As far as making a pejorative decision, in over 28

states, it became legal to remove someone from office just because of their gender identity. This

is because the national anti-discrimination law was not there to protect the LGBT laborers from

any state caprices. The equality Act was introduced by Rep. David Ceciliani so as to cover

current issues of discrimination. The Supreme Court ruling was just the start. Advocates of the

LGBT were avid to focus their energy on ending discrimination of the LGBT individuals in a

workplace. In 2014, President Barack Obama signed an order to allow protection of the LGBT

federal workers. The discrimination of workers due to their sexual identity falls under the VII of

civil Rights Act. All the states had their own different view about the LGBT anti-discrimination

law. The human right campaign has worked with several organizations to help them implement

the Anti-discrimination Act. These campaigns jumped from 61% to 91%. This is an indication of

how vital is to end the LGBTQ discrimination in the workplace. Therefore the laws and policies

are vital for the LGBTQ equality, but remain insufficient.

These ongoing attempts to erode the civil rights of LGBTQ people have a negative

impact beyond the victims; they cast a stigma on the entire LGBTQ community, as well as their


Coleman: The Impact of Discrimination Against The LGBTQ Community

Published by Digital Commons @ West Chester University, 2019

families and friends. Just knowing that the society holds negative attitudes about your sexual

orientation, regardless of whether you experience direct hostility, can erode your mental health

and your ability to develop coping skills and healthy relationships. It is more difficult to be open

with others about yourself and your life when you fear you won’t be accepted. This increases

stress, limits social supports, and leads to overall poor quality of life (“Stigma and

Discrimination | Gay and Bisexual Men’s Health | CDC”, 2017).

In fact, if one looks at the big picture, the entire society suffers because it tolerates

discrimination against LGBTQ people. Bullying is a good example. First, it should be said that

some kids who are bullied and called names like “faggot” and “fairy” are not even gay. They

simply have a mannerism that is stereotyped as being gay, such as a boy with a high voice.

Regardless of the victim’s sexual orientation, any bullying incident can be as traumatic for those

who witness it as it is for the victim. There is evidence that bystanders who witness bullying

experience fear for themselves, the victim, and other bystanders. If they don’t help the victim,

they feel guilty afterward. Many experience anxiety, fearing that they will be the next targets. A

chain reaction takes place, affecting siblings, parents, teachers, and others who know about the

bullying and worry about its effects. From an economic perspective, society ultimately bears the

burden of increased medical costs associated with bullying, including the cost of mental health

services and lost productivity (Gordon, 2017).

Faced with persistent, negative images and messages about their sexual orientation, some

gay people come to hold these views themselves. They believe that they are inferior, or even

evil, because they are not heterosexual. This condition was originally referred to as internalized

homophobia, but now it is also known by what some psychiatrists consider to be a more precise

term, internalized heterosexism. Heterosexism is preferred because it more accurately describes


Ramifications, Vol. 1 [2019], Iss. 1, Art. 4

the attitude as favoring heterosexual orientation, while homophobia describes fearing

homosexual orientation. In truth, those who discriminate against LGBTQ persons are less likely

to be fearful and more likely to be hateful. Whichever term is used, the basic concept is that

LGBTQ people gradually start to agree with the opinions of their oppressors. This has serious

negative effects on the gay person’s mental health. As one psychologist who has researched this

phenomenon, Gordon Allport, noted, “One’s reputation, whether false or true, cannot be

hammered, hammered, hammered, into one’s head without doing something to one’s character”

(Herek, 1998, p. 160).

In addition to internalizing heterosexism, many LGBTQ people also have to cope with

the stresses that arise from discrimination based on sex, race, ethnicity, and gender identity.

Herek (1998) points out that, unlike straight people who are members of “stigmatized ethnic

minority groups, most homosexually oriented persons are not exposed to self-protecting,

supportive attitudes in their families.” Instead, LGBTQ people, regardless of race, are “most

often raised by heterosexual parents and socialized as heterosexuals in environments that

frequently promote anti-homosexual attitudes” (p. 162).

For many people of color, being LGBTQ presents challenges that sometimes feel

overwhelming. One source of traditional support for young Latinos and African-Americans,

religious affiliation, may be less available to those who are LGBTQ. Barnes & Meyer (2012)

point out that in the United States’ religious culture is generally associated with better mental

health. While this is not true for every single religious group, people as a whole who are

religious have “less depression and greater life satisfaction, personal happiness, and

psychological well-being” (p. 505).


Coleman: The Impact of Discrimination Against The LGBTQ Community

Published by Digital Commons @ West Chester University, 2019

Unfortunately for gay people, if you are religious you may actually have a greater degree of

internalized heterosexism than if you were non observant. This is because most religions are

what psychologists call “non-affirming” of homosexuality. In fact, the three largest churches in

America, the Roman Catholic Church, the Southern Baptist Convention, and the United

Methodist Church, all have formal policies that either condemn being gay or require a gay person

to be celibate in order to participate. Gay people cannot be married in these churches, nor can

they be ordained (Barnes & Meyer, 2012). Many independent and Pentecostal churches have

similar policies. Imagine growing up in a non-affirming church, and when you realize you are

LGBTQ, grappling with the secret knowledge that, if they knew the real you, your fellow

worshippers would think you were bound for hell. To come out as LGBTQ in an environment

like that, you would either have to be very brave or very foolish. It is not surprising that some

gay people choose to stay silent and keep their true selves hidden.

But the costs of silence and hiding are too great. There is evidence that, for gay men at least,

mental health improves after they come out (Scott, 2016). So for this writer, the pressing

question is, what can be done to make life better for LGBTQ people, particularly youth, who are

marginalized and suffering as a result? To quote a well-known activist organization, “We’re

here! We’re queer! Get used to it!” (“Queer Nation NY History”, 2018).

There are a number of constructive actions that can improve the lives and outcomes for

LGBTQ people. They are easy to take and likely to have significant results. The Centers for

Disease Control suggests several actions that schools can take, one of which is to create LGBTQ

support groups such as gay-straight alliances. Studies show that LGBTQ students experience

fewer threats of violence, fewer missed days of school, and fewer suicide attempts when they are

part of a gay-straight alliance (“LGBT Youth | Lesbian, Gay, Bisexual, and Transgender Health |


Ramifications, Vol. 1 [2019], Iss. 1, Art. 4

CDC”, 2017). Schools should also provide training for teachers and staff in how to create safe

spaces for all students, including those who are LGBTQ. There is a very good organization

called GLSEN (pronounced ‘glisten’), which stands for Gay, Lesbian and Straight Education

Network. It provides resources and research for schools that want to join them in their mission

“to create safe and affirming schools for all, regardless of sexual orientation, gender identity, or

gender expression” (“Championing LGBTQ issues in K-12 education since 1990”, 2018).

GLSEN also provides resources and organizing help to youth who are LGBTQ and want to join

others in advocating for more inclusive social policies and practices. One of the organization’s

major campaigns is the annual Day of Silence, which takes place this year on Friday, April 27.

The nationwide event is designed to make people aware of “the silencing effects of anti-LGBTQ

name-calling, bullying and harassment in schools” (“Day of Silence – Friday, April 27, 2018”,

2018). Students, both LGBTQ and straight, take a vow of silence for the day to encourage

classmates, teachers, and school administrators to address the problem of anti-LGBTQ

behaviors. It would be great if we could observe the Day of Silence at West Chester University

Homosexual people have been stigmatized over the years due to their sexual identity. The

reason is why? In explaining homophobia, the community usually thinks that the sexual

orientation manifested in form of homophobia (the aversion to homosexual or gay individuals or

even their culture or lifestyle and behavior based on the aversion). It can also be known as the

irrational fear of homosexuality. Heterosexism, on the other hand, is used to describe

homosexuality and sexism. These explain the ideological system, which denigrates, stigmatize

and denies any time of non-heterosexuality kind of identity, behavior, community and

relationship. It relates the homosexual behavior to sexism, racism and antisemitism and placed

under the dual process of attack and invisibility. If an individual is found in engaging in any


Coleman: The Impact of Discrimination Against The LGBTQ Community

Published by Digital Commons @ West Chester University, 2019

visible homosexual behavior, he/she is subjected to brutal attack by the entire society. (Herek,


Given the amount of academic research and evidence that is endorsed by reputable

institutions such as the Centers for Disease Control, plus the acknowledgment from major news

organizations and national nonprofit advocacy groups, it is quite clear that anti-LGBTQ

discrimination has negative effects for gay people, their families and friends, and the entire

society. For people of color who are LGBTQ, life can be especially challenging due to a number

of the customs and religious traditions of our communities. In private spaces, such as individual

homes, people are free to avoid associating with those who are LGBTQ. That is discriminatory,

but in a free society, people get to make those decisions. However, in public spaces—especially

schools where young people are forming their own values and identities—discrimination against

anyone, including LGBTQ people, has no place. This paper has presented convincing evidence

as to why that argument is sound.


Ramifications, Vol. 1 [2019], Iss. 1, Art. 4


Barnes, D., & Meyer, I. (2012). Religious affiliation, internalized homophobia, and mental health

in lesbians, gay men, and bisexuals. American Journal Of Orthopsychiatry, 82(4), 505-


Championing LGBTQ issues in K-12 education since 1990. (2018). GLSEN. Retrieved 1 January

2018, from

Day of Silence – Friday, April 27, 2018. (2018). GLSEN. Retrieved 1 January 2018, from

Friedman, M. (2014). The Psychological Impact of LGBT Discrimination. Psychology Today.

Retrieved from


Gordon, S. (2017). How Bystanders Are Wounded by Bullying. Verywell. Retrieved 1 January

2018, from


Herek, G. (1998). Stigma and Sexual Orientation: Understanding Prejudice against Lesbians,

Gay Men and Bisexuals (Psychological Perspectives on Lesbian & Gay Issues) (1st ed.,

pp. 160-186). Los Angeles: Sage.

LGBT Youth | Lesbian, Gay, Bisexual, and Transgender Health | CDC. (2017).

Retrieved 25 December 2017, from


Coleman: The Impact of Discrimination Against The LGBTQ Community

Published by Digital Commons @ West Chester University, 2019

Liptak, A. (2017). Justices Sharply Divided in Gay Rights Case. New York Times. Retrieved



Queer Nation NY History. (2018). Queer Nation NY. Retrieved 1 January 2018, from http://

Scott, R. (2016). The Relationship of Sexual Orientation and Depression (Ph.D.). University of


Stigma and Discrimination | Gay and Bisexual Men’s Health | CDC. (2017). Retrieved

25 December 2017, from

Tozzi, M., & Greenfield, M. (2017). Here’s How Many Trans People Serve in the U.S. Military,

and What Their Care Costs. Retrieved 31 December 2017, from



Ramifications, Vol. 1 [2019], Iss. 1, Art. 4

The Impact of Discrimination Against The LGBTQ Community.
Recommended Citation


Vol.:(0123456789)1 3

Adolescent Research Review (2020) 5:187–211


LGBTQI+ Youth and Mental Health: A Systematic Review of Qualitative

Clare Wilson1 · Laura A. Cariola1

Received: 26 September 2018 / Accepted: 7 May 2019 / Published online: 21 May 2019
© The Author(s) 2019

Due to increased levels of stigma, discrimination and victimization Lesbian, Gay, Bisexual, Transgender, Queer, Question-
ing or Intersex (LGBTQI+) youth face particular challenges in society. With the intention of better understanding the chal-
lenges and issues that LGBTQI+ youth are experiencing, this systematic review explored qualitative studies with a focus
on mental health services and the requisite social support service policies and programs for LGBTQI+ youth. Qualitative
research systematically examines the expressed thoughts and feelings of the research participants, and through reflective
analysis of the themes and links discussed, can provide rich and nuanced understanding. A synthesis of the included studies
identified five core themes: (1) Isolation, rejection, phobia, need for support; (2) Marginalization; (3) Depression, self-harm
and suicidality; (4) Policy and environment; and (5) Connectedness. Key results suggest that community, school, and family
resources to support resilience will optimize LGBTQI+ mental health. This systematic review of qualitative research pro-
vides a source of rich information to inform the provision of services and policies that will address the disparity into mental
health statistics for the LGBTQI+ population.

Keywords LGBTQI+ · Youth · Mental health · Systematic review · Qualitative research


Young people experience many challenges in adolescence.
Anxiety, depression and suicide are reported as causes of
youth morbidity and mortality across the world (Adelson
et al. 2016). Empirical studies suggest that youth who iden-
tify as Lesbian, Gay, Bisexual, Transgender, Queer, Ques-
tioning or Intersex (LGBTQI+) can find themselves faced
with greater challenges, compared to youth of heterosexual
orientation, as they navigate the heteronormative educational
and societal institutions where children and youth spend
much of their early lives (Almeida et al. 2009; Fergusson
et  al. 1999; Hafeez et  al. 2017; Russell and Fish 2016).
Online and community services, such as RainbowYOUTH
(RainbowYOUTH 2018) and InsideOUT (InsideOUT 2018)

in New Zealand and their international equivalents, are
available to youth, but the provision of a positive school
climate where LGBTQI+ youth can feel physically, emo-
tionally and socially safe is vital for them to thrive during
their adolescence and early adulthood. Research into men-
tal health disparities and challenges for LGBTQI+ youth
to date has a predominantly quantitative focus, and several
systematic reviews provide an overview of quantitative data
available on issues faced by Sexual and Gender Minority
Youth (SGMY) (e.g. Brown et al. 2016; McDonald 2018).
Surprisingly, there are fewer qualitative studies that contrib-
ute to an in-depth understanding of the challenges and issues
that LGBTQI+ youth are facing by exploring the views and
opinions of those affected. This systematic review aims to
identify and obtain a comprehensive overview of qualitative
studies by appraising, critically reviewing and synthesizing
qualitatively derived evidence-based results and main emer-
gent themes sourced from current literature. Special atten-
tion is given to the provision of mental health services and
the requisite social support service policies and programs
for LGBTQI+ youth.

* Clare Wilson
[email protected]

Laura A. Cariola
[email protected]

1 Clinical Psychology, Old Medical School,
University of Edinburgh, Teviot Place, Doorway 6,
Edinburgh EH8 9AG, UK

188 Adolescent Research Review (2020) 5:187–211

1 3

LGBTQI+ Mental Health

LGBTQI+ youth are one of the most vulnerable groups in
society due to their increased risk of mental health problems.
Statistics for the LGBTQI+ population estimate that New
Zealand has 8% non-heterosexual youth (Clark et al. 2013),
the U.S. has 7-8% LGB youth (lesbian, gay or bisexual)
(Wilson et al. 2014), and the U.K. has 4.1% of LGB young
people aged 16–24 (Office for National Statistics 2016).
Although LGBTQI+ represents only a small proportion of
the total youth population, they are at increased risk, com-
pared to heterosexual youth, of experiencing hostile environ-
ments at home and in wider society, and are subject to direct
and indirect discrimination, harassment, disadvantage and
inequality with detrimental consequences for mental health
(Hudson-Sharp and Metcalf 2016).

In fact, the 2012 survey completed as part of the Youth
2000 Survey Series, Young People Attracted to the Same Sex
or Both Sexes Report (Lucassen et al. 2014), stated that sex-
ual and gender minority youth were more than three times
as likely to express symptoms of depression and more than
twice as likely to have self-harmed than their heterosexual
peers. One in five had attempted suicide, with almost half
of the respondents having thought about a suicide attempt.
41% of sexual and gender minority youth had been to see
a professional for emotional support in the last 12 months,
compared to 16.6% of their non-LGBTQI+ peers. The Youth
2000 Survey (Lucassen et al. 2014) also identifies a greater
risk of alcohol or drug use in LGBTQI+ youth. During the
same period, in Scotland, 40% of LGBT youth considered
themselves to have a mental health condition in comparison
to 25% of non-sexual and gender minority youth, and bully-
ing was identified as a key factor in distress among respond-
ents (Mental Health Foundation 2016).

In particular, evidence suggests that sexual and gen-
der minority youth have different risk factors and markers
(Silenzio et al. 2007) and that these unique risks combined
with general life stressors have the phenomenological out-
come of higher levels of self-harm, suicidality and impul-
sivity (Liu and Mustanski 2012). These risk factors extend
over the lifespan, with four times greater risk of suicide
for SGM men, and both men and women being 1.5 times
more likely to suffer from anxiety, depression and substance
misuse (King et al. 2008). Evidence from Mental health of
the non-heterosexual population of England, a 2011 study
(Chakraborty et al. 2011) concludes that gay men and les-
bian women have higher levels of psychological distress than
heterosexuals and that discrimination may be a significant
factor affecting mental health for the LGBTQI+ population.

Minority stress theory (Meyer 2003) suggests that the
increased prevalence of mental health issues experienced
by LGBTQI+ youth is due to the increased level of social

stress, including stigma, discrimination, prejudice and vic-
timization. Adolescence is a critical neurological devel-
opment stage, with heightened effects of stress on mental
health, important memory system development and a time
of increased sensitivity to drug use (Fuhrmann et al. 2015).
At this crucial time, feeling discriminated against by edu-
cational, medical or religious institutions, or internalizing
feelings of victimization due to homophobia, transphobia or
biphobia can result in significant psychological challenges
for sexual and gender minority youth (Russell and Fish
2016). Evidence has consistently identified that issues such
as marginalization, isolation, exclusion and bullying create
social stress for sexual and gender minority youth (Gross-
man et al. 2009; Hafeez et al. 2017). Additionally, lack of
access to understanding adults, safe places and change room
facilities creates a psychological burden. However, as Bryan
and Maycock (2017) point out, this can create a patholo-
gizing phenomenon, which paradoxically may stigmatize
well-adjusted and happy LGBTQI+ youth who are manag-
ing their lives in psychological comfort.

Particularly, stigma and shame create personal barriers
for at-risk youth, preventing those affected from accessing
services (Brown et al. 2016). McDermott (2015) suggests
that embarrassment, shame and fear of stigmatization are
reasons for sexual and gender minority youth to avoid seek-
ing support from mental health services. Young LGBTQI+
people who are homeless, rural, or who are substance-users
face additional barriers to seeking help (Brown et al. 2016).
If support from adults or professionals is inaccessible, an
alternative is for LGBTQI+ youth to find peer support and
information on internet-based forums (McDermott et  al.
2015; McDermott et al. 2008).

Family acceptance also has been identified as a salient
influence on the mental health of sexual and gender minor-
ity youth (Sitkin and Murota 2017). Parental attachment, as
described by Mohr and Fassinger (2003), is characterized by
sensitivity and responsiveness to a young person’s needs. If
sexual and gender minority youth feel accepted and valued
as individuals, there is an increased likelihood to disclose
non-heteronormative status to family, and “come out,” or “be
out,” the colloquial terms for being able to openly express
LGBTQI+ orientation (Ryan et al. 2010). However, there is
a disproportionate number of homeless LGBTQI+ youth,
signifying that familial rejection is a significant factor for
compromised mental health (Russell and Fish 2016). Durso
and Gates (2012, p. 4) published results of a national USA
online survey and found that “nearly seven in ten (68%) of
their LGBT homeless clients have experienced family rejec-
tion and more than half of clients (54%) had experienced
abuse in their family.”

Adolescence is a developmental time frame within which
youth explore their sexuality and for LGBTQI+ youth it will
often be the time when they develop understanding of their

189Adolescent Research Review (2020) 5:187–211

1 3

own sexual and gender orientation. Within the realm of early
family relational psychology, Bowlby (1962/1982) discusses
changing attachments during the time of adolescence, with
a subsequent shift in attachment to peers and social groups
other than the family, and to institutions such as school, uni-
versities, religious or political groups. Acceptance by these
alternative attachment groups is a strong protective factor
for sexual and gender minority youth (Higa et al. 2014). The
wider ecology of LGBTQI+ youth has a significant effect
on their mental health and well-being and feelings of social
connectedness to adults gives sexual and gender minority
youth resilience in the face of adversity, particularly at the
vulnerable developmental stage when they are establishing
their sense of personal identity (Difulvio 2011).

Key Themes in Quantitative Research

The vast majority of quantitative literature on LGBTQI+
focuses on the impact of isolation, marginalization and
discrimination against sexual and gender minority youth
in relation to mental health outcomes, and the identifica-
tion of risk and protective factors. For example, there is a
robust pattern of results that demonstrated sexual and gen-
der minority youth experience significantly higher levels of
suicidality, depression, and substance misuse than hetero-
sexual youth, which highlights the severity and prevalence
of differences between sexual and gender minority youth and
heterosexual youth (King et al. 2008; Lucassen et al. 2017).
These results also identified higher rates of violence and
victimization associated with higher levels of hopelessness
and attempted suicide in sexual and gender minority youth,
and also a greater potential for psychosocial problems (e.g.
drug and alcohol use or abuse, risky sexual behaviors, eat-
ing disorders, and mood disorders) than reported by their
heterosexual or cisgender peers. The relationship between
peer victimization and sexual orientation, gender identity
or expression associated with poor mental health outcomes
(e.g. depression, traumatic stress, and suicidality, as well as
alcohol and substance abuse) and educational outcomes (e.g.
diminished school belonging, disruptions in educational
trajectories) has been also confirmed in another systematic
review (Collier et al. 2013). In particular, bisexual individu-
als have been shown to experience more psychological dis-
tress, compared to homosexual and heterosexual peers due
to experiences of victimization, peer judgments and family
rejection (King et al. 2008; Pompili et al. 2014).

Quantitative research has also focused on identifying risk
and protective factors for mental health in LGBTQI+ youth,
which has resulted in setting directions for prevention, inter-
vention and treatment, as well as influencing laws and poli-
cies, and making advances in fostering improved mental
health (Russell and Fish 2016). For example, the role of
family acceptance as a protective factor in LGBTQI+ youth

and young adults has been shown to be a predictor for posi-
tive mental health outcomes (e.g. greater self-esteem, social
support, general health) and a protector against depression,
substance abuse and suicidality (Bouris et al. 2010; Ryan
et al. 2010). As such, family programs that motivate and
empower parents, caregivers and other family members,
have been recognized as a promising framework for commu-
nity interventions that emphasize a strengths-based approach
concentrating on the effects of positive parent–child relation-
ships, rather than focusing on negative parent–child relation-
ships and influences where a child’s sexual orientation and
gender identity may be seen as a “deficit.” Further support-
ing these findings are those of a recent systematic review
of literature (McDonald 2018), who identified that higher
levels of social support were associated with positive self-
esteem whereas lack of social support was associated with
higher levels of depression, anxiety, shame and self-esteem,
alcohol and drug misuse, as well as risky sexual behavior.
In particular family or significant adults providing support
for young LGBTQI+ is a protective factor. Family and car-
egiver acceptance and a sense of belonging to a peer group
were identified as moderators of resilience, and thus, sug-
gests McDonald, can be utilized in communities to support
mental health outcomes.

In relation to accessing and engaging with mental health
care, Brown and colleagues’ systematic review (2016) iden-
tified barriers and facilitators among youth from different
minority groups, including but not exclusively LGBTQI+ ,
who had distinct needs that must be recognized by mental
health services in order to improve their experiences with
mental health care. In particular, findings demonstrated
that barriers to access are more often identified (e.g. lack
of awareness of services, stigma and shame around seeking
help, issues around confidentiality, trust and anonymity),
however, facilitators to support engagement with provid-
ers (e.g. community and educational programs to increase
awareness of services and attitudes toward mental health ser-
vices) have remained widely underexplored, and thus require
further attention in future research. With regards to edu-
cational programs aimed at increasing LGBTQI+ wellbe-
ing, safe school interventions and supportive environments
such as “gay-straight alliances,” sometimes referred to as the
“gender and sexuality alliances,” (GSAs) have been shown to
have a positive effect in reduction of stigma in schools, with
significantly better psychological outcomes (e.g. improve-
ment in academic performance, feeling more comfortable
in their sexual identity and empowerment), social outcomes
(e.g. positive sexual diversity climates, greater sense of
connectedness to their school), and also physical outcomes
(e.g. lower levels of youths’ self-reports of homophobic vic-
timization, fear of safety, and hearing homophobic remarks)
(Black et al. 2012; Marx and Kettrey 2016). This study also
showed that the empowering of youth to be activists and

190 Adolescent Research Review (2020) 5:187–211

1 3

to form their own peer supports may mediate the negative
effects of marginalization and the poor mental health out-
comes, including depression and suicidality.

The Current Study

The existing quantitative studies provide a rich picture of
trends based on statistical indications of sexual and gen-
der minority youth who experience adverse outcomes in a
heteronormative society. In contrast to quantitative stud-
ies, qualitative approaches to the analysis of data repre-
sent an important perspective for advancing the literature
by obtaining an in-depth awareness of LGBTQI+ youth
and their experiences of engaging in mental health and
social support services and programs. As such, qualitative
research provides insight into the thoughts and feelings of
the research participants, and through reflective analysis
by the researcher of the themes and links discussed, can
provide meaning and understanding (Sutton and Austin
2015). One of the reasons participants may voluntarily
engage in this type of research is the implicit chance that
the evidence will inform change by giving them a voice,
hence both personal and political empowerment (Clark
2010). The key aim is to provide a comprehensive under-
standing of nuances of human experience through analysis
and interpretation of texts and images (McLeod 2010).

Qualitative research has also been traditionally excluded
from systematic reviews but it has been recognized that qual-
itative research provides valuable insight to inform policies
and practice (Thomas and Harden 2008). In particular, with
the current focus on public and individual opportunity to be
involved in the development and provision of LGBT ser-
vices (Gillespie et al. 2002; Ministry of Youth Development
2015; Stonewall Scotland 2018), there is international rec-
ognition of the importance of client-centered, consultative
and inclusive policy development informed by the voices of
services users and consumers of services. The inclusion of
service user voices draws on the notion of being given the
power in respect to “having a voice,” and conversely, the
notion of “silence” sometimes associated with feminism but
equally ascribable to any marginalized or minority popu-
lation (Hadfield and Haw 2001). Notably, experiences of
youth are also often marginalized or they are spoken for
by the parents or carers, and youth, if they do speak out,
often assume that their voices will not be heard or respected
as valid contributions in decision-making processes. There
should be specific efforts to include youth in meaningful
ways to voice their opinion in relation to matters that are of
concern to them, without resulting in further inequalities.
A Canadian paper, Promoting LGBT health and wellbeing
through inclusive policy development, which also draws on
literature from Australia, the UK and the USA, asserts that

the marginalized LGBTQI+ community must be “explicitly
included in policy development for a more inclusive form of
health promotion” (Mulé et al. 2009, p. 2). Because youth
have authentic, legitimate experiences of the problems they
encounter, qualitative research involving them will improve
policies and future research (McLaughlin 2015). Hence, hav-
ing the voice of young LGBTQI+ people available through
qualitative research is imperative if we are to address the
ecological, social, and pedagogical issues and ultimately
the human rights of this marginalized group (Mockler and
Groundwater-Smith 2015; UNICEF 1990).

The focus of this systematic review is to provide a com-
prehensive overview by collating and critically appraising
the existing evidence-base of qualitative research studies
of the last ten years (2008–2018), a decade that has seen
a global increase in acceptance towards LGBT (Flores and
Park 2018), which sought to provide a youth voice in regards
to mental health challenges and experiences for LGBTQI+
people. This 10-year period has seen international changes
in same-sex marriage laws, gay parenting rights, and gender
reassignment as a protected characteristic (Stonewall Scot-
land 2018). In particular, this review aimed to identify and
map themes from across the different types of qualitative
research being undertaken, as well as identifying gaps in
knowledge, to inform community-based LGBTQI+ service
provision with a focus on ecological measures needed to
support young LGBTQI+ people.


Search Strategy and Eligibility Criteria

For this literature search, several clinical psychology data-
bases were identified to best represent the diverse fields of
study relevant to this review, including ASSIA, CINAHL
focus on qualitative studies published in the last decade
characterized with marked changes of LGBTQI+ legisla-
tion, all database searches were limited to articles written in
the English language, and published between January 2008
and April 2018. The search focused on international research
articles appearing in peer-reviewed journals. Following the
initial database search, a Google search and a manual back
literature search were conducted in June 2018. The search
strategy aimed to identify qualitative research literature on
LGBTQI+ youth with particular attention to mental health
issues, using Boolean operators and variations of the fol-
lowing keywords: qualitative, LGBT*, youth, young people,
adolescent, teenager and mental health.

To identify relevant articles for this systematic review,
inclusion and exclusion criteria were applied. Identified

191Adolescent Research Review (2020) 5:187–211

1 3

journal articles had to fulfill further inclusion criteria: (1)
published between 2008 and 2018, (2) published in English
language peer-reviewed journals, (3) focus on mental health
of LGBTQI+ , (4) participants aged 12 to 24 years (using
the New Zealand Government definition of youth age range
being 12 to 24 years inclusively (Ministry of Youth Affairs
2002), (5) use of a qualitative methodology to the analy-
sis of data. Journal articles were excluded if: (1) the study
focus was on a specific, non-generalizable intervention or
socio-economic population demographic, (2) the study had
a medical perspective or focus on sexual health or practices,
(3) the methodology did not include a qualitative methodol-
ogy. All studies were evaluated according to these inclusion
and exclusion criteria, and only studies that met the criteria
were included in this systematic review. Studies that did not
meet these inclusion criteria were discarded.

To identify relevant studies for this review, the inclusion
and exclusion criteria were applied using a three-stage selec-
tion process (Meade and Richardson 1997): (a) looking only
at the title, (b) looking at the abstract to identify its relevance
to the research question and methodology, and (c) looking at
the whole article. In cases where the researcher was not sure
whether the paper was relevant and met inclusion criteria,
the item was retained for the next screening stage.

Based on the outlined literature search strategy, 873
studies were initially identified. At this stage an additional
manual search of Google using the same search terms and
a manual back literature search of the articles included to
date identified a further 21 articles. After duplicate removal
and a title review of these studies, 676 were excluded and
52 were determined to meet inclusion criteria. Following
another exclusion process, a total of 34 research articles
were selected as having satisfied the eligibility criteria. A
detailed overview of the search stages can be seen in the
PRISMA Flow Diagram (see Fig. 1). The 34 articles include
seven mixed methods studies where the results of the quali-
tative thematic analysis was deemed to add valuable data.

Data Extraction

Data of the included studies were extracted using a stand-
ardized format for systematic reviews of qualitative studies
(NICE 2012a). Characteristics identified from each of the 34
studies included research questions, methods, sample size
and quality assessment. The extracted data were aggregated
clearly and structured in a data extraction table (see Tables 1,
2, 3, 4 and 5). To synthesize the findings of the studies, find-
ings were extracted from the studies and grouped into the-
matic categories. Subsequently, patterns were sought across
the findings to provide a more comprehensive understanding
of the issues of concern to LGBTQI+ population using men-
tal health services addressed in the studies.

Quality Assessment

Quality assessment of the retrieved journal articles was per-
formed using the NICE guidelines quality appraisal check-
list for qualitative studies (NICE 2012b). Following these
guidelines, assessment identifies the research question and
the robustness of the methodology in relation to key findings
and a valid conclusion. Six main domains are assessed: theo-
retical approach, study design, data collection, trustworthi-
ness, analysis and ethics. A seventh overall assessment looks
at the relevance of the study and grants an overall rating;
“++” where all or most of the checklist criteria have been
fulfilled, and where they have not, conclusions are highly
unlikely to alter; “+” where some of the checklist criteria
have been fulfilled, and conclusions are unlikely to alter;
or a rating of “-” where few or no criteria are fulfilled. The
seven mixed methods studies included in this systematic
review had quality assessment performed only on the quali-
tative data methodology results of the research. In relation
to the qualitative assessment of this systematic review, one
reviewer initially assessed the quality of the included stud-
ies and subsequently, the quality assessment was verified by
another reviewer.

Fig. 1 PRISMA flow chart

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ccupational therapy’s
scope of practice intersects
with numerous concerns
of lesbian, gay, bisexual,
transgender, queer, and

questioning (LGBTQ+) communities.
This population faces disproportionately
high rates of disability, eating disorders,
substance abuse, mental illness, suicidal
ideation, sexually transmitted infec-
tions, and other serious health concerns
(Fenway Institute, 2013; Pandjiris &
Kosciewcz, 2017). Additionally, LGBTQ+
individuals are less likely than others to
have access to quality health care. The
barriers to accessing health care services
include financial problems because of
employment discrimination (Grant et
al., 2011), lack of health insurance, and a

widespread lack of cultural competence
education among health care providers.
Many LGBTQ+ individuals have reported
negative interactions because of cultural
insensitivity among clinicians. Many avoid
seeking necessary health care services for
fear of receiving inadequate or insensitive
care, which exacerbates the health dis-
parities they often face (Fenway Institute,
2013). LGBTQ+ patients also frequently
find themselves educating health care
practitioners on their medical needs
because of a lack of provider education on
LGBTQ+ health issues (Shimkin, 2015).

This article provides some background
on LGBTQ+ clients’ occupational needs.

Self-expression through appearance can be
of great importance to LGBTQ+ people,
especially transgender individuals. Cloth-
ing, hair, and makeup are merely superfi-
cial and unimportant for some people; for
others, appearance as a means of identity
expression is paramount and should not be
taken lightly.

For transgender people, dressing may
include items that alter the appearance of
primary or secondary sex characteristics,
such as a gaff (a compressive undergarment
that minimizes the appearance of the penis
and testes) or a binder (a compressive
undergarment that flattens the chest).
Although medical necessity may dictate
what clients can wear, clinicians should
keep in mind that identity-confirming
clothing may be extremely important for
individuals who express their identity
through appearance.

The safety and availability of public
restrooms can have a serious effect on toi-
leting for transgender people. The lack of
safe public restrooms results in high rates
of dehydration, urinary tract infections,
and kidney infections for many (Herman,
2013). When working with a client with

Jadyn Sharber

Fern Silverman

Brianna Brim

Lauren Sponseller

Brooke Kruemmling













Addressing LGBTQ+ Issues With
Occupational Therapy Clients


restroom concerns, talk with them about
planning trips in the community around
a safe and viable toileting schedule, tak-
ing into consideration the availability of
safe public restrooms.

Sex is an important topic to be able
to discuss with all clients. Establish-
ing a therapeutic relationship with
clients is an important step toward
effectively communicating about
their sexual orientation and activity,
which is why LGBTQ+ cultural com-
petence is important for therapeutic
use of self, communication, and client
outcomes. After hip or knee replace-
ment surgery, for example, a limited
number of sex practices are safe for
new joints; unfortunately, guides for
safe sex after joint replacements are
often designed for heterosexual couples
only. LGBTQ+ inclusive guidelines for
safe sex with a new hip or knee joint
can be found at

Health management and maintenance
may be affected by LGBTQ+ identities.
In addition to the barriers to qual-
ity health care services cited above,
some transgender individuals choose
to undergo hormone therapy, which
involves scheduled, self-administered
hormone treatments. Hormone therapy
affects metabolism and nutritional needs,
yet many nutritionists lack LGBTQ+
health training (Pandjiris & Kosciewcz,
2017). You may help LGBTQ+ clients by
discussing information about LGBTQ+
issues with nutritionists and encouraging
them to seek further information.

Schools are also important settings
for occupational therapy practitioners to
help provide education about LGBTQ+
issues. In addition to navigating the com-
plexities of public restroom safety, many
transgender youth face the additional
challenges of gendered school uniforms,
locker rooms, and bullying in school.
These issues are especially difficult for
young people to face when parents and
school staff are unsupportive. Occupa-
tional therapy practitioners who work in
schools can help by bringing LGBTQ+
cultural competency trainings to staff and
students, helping to incorporate infor-
mation and understanding into curricula
and classroom conversations.

What Occupational Therapy
Practitioners and Educators
Can Do
Many resources are available to help
health care practitioners and educa-
tors improve their LGBTQ+ cultural
competence. In-person cultural compe-
tency trainings (also known as diversity
trainings, sensitivity trainings, or LGBT
trainings) designed for health care set-
tings and schools are available in many
areas. Additionally, the National LGBT
Health Education Center (www.lgbtheal- offers clinicians free
online interactive learning modules and
webinars, as well as many other helpful
resources. Practitioners and educators
are encouraged to seek this education
and to invite trainers to their workplace
to help all staff improve their LGBTQ+
cultural competence.

Other ways to make practices and
communities more LGBTQ+ friendly
include the following:

Inclusive Paperwork
Paperwork that allows clients to declare
a first name that may be different from
their legal name, pronouns, gender iden-
tity, gender assigned at birth (physiolog-
ical sex), and sexual orientation enables
all clients to disclose as much or as little
information about their identities as
they see fit. The Fenway Institute patient
forms are excellent examples of what
inclusive paperwork can look like, and
can be found at

Q Cards
If you are unable to change the paper-
work used at your practice, using Q Cards
is recommended. Q Cards, designed to fit
in a wallet, allow clients to discretely tell
health care providers about their sexual
orientation, gender identity, and other
important sensitive information. Practi-
tioners can keep some in their clinics and
make them available to clients. For more
information, visit www.qcardproject.

Environmental Cues
Practitioners can help foster an inclusive
atmosphere through signage and symbols
in their workplaces, such as brochures on
LGBTQ+ health topics; signs regarding
non-discriminatory policies, including
sexual orientation and gender identity;
and symbols of LGBTQ+ safety, such as

a rainbow flag or a sticker that indicates
all are welcome. A small sign can make a
big difference in how safe your LGBTQ+
clients feel in your office.

One of the defining traits of occupational
therapy practitioners is our commitment
to respecting and treating every client as
a whole person. Practitioners should rec-
ognize that identity and orientation are
considerable pieces of the whole. Because
sexual orientation and gender identity
affect all occupations, occupational
therapy practitioners who are educated
on health disparities and the culture of
LGBTQ+ communities are best equipped
to serve these clients effectively.

Fenway Institute. (2013). Asking patients questions

about sexual orientation and gender identity in
clinical settings: A study in four health centers.
Retrieved from

Grant, J. M., Mottet, L. A., Tanis, J., Harrison, J.,
Herman, J. L., & Keisling, M. (2011). Injustice
at every turn: A report of the national transgender
discrimination survey. Washington, DC: National
Gay and Lesbian Task Force and the National
Center for Transgender Equality.

Herman, J. L. (2013). Gendered restrooms and
minority stress: The public regulation of gender
and its impact on transgender people’s lives.
Journal of Public Management & Social Policy,
19(1), 65–80.

Pandjiris, A., & Kosciewcz, J. (2017). Exploring the
complexities of treating trans and gender noncon-
forming patients and their use of disordered eating
to manage body dissatisfaction. Lecture presented
at the meeting of Philadelphia Trans Health
Conference, Philadelphia.

Shimkin, G. (2015). The Q Card: Empowering queer
youth in healthcare. Retrieved from http://www.

Jadyn Sharber, MSOTR, is a recent graduate of Salus
University, in Elkins Park, Pennsylvania, and has developed a
website with resources on LGBTQ+ concerns that relate to
occupational therapy practice, at

Fern Silverman, EdD, OTR/L, is an Associate Professor and
the Director of the doctoral program in occupational therapy
at Salus University.

Brianna Brim, MOTR/L, CPAM, CLIPP, is an Assistant Profes-
sor and Academic Fieldwork Coordinator at Salus University.

Lauren Sponseller, PhD, OTD, MSOTR/L, MEd, is the Director
of the Master’s Program in Occupational Therapy, Chair of the
Occupational Therapy Department, and Assistant Professor in
Occupational Therapy at Salus University.

Brooke Kruemmling, PhD, COMS, is the National Leadership
Consortium for Sensory Disabilities Project Co-Director, Assis-
tant Provost, and Assistant Professor at Salus University,


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