The views, opinions, and content of this brief do not necessarily reflect the views, opinions, or policies of the Center for. Mental Health Services (CMHS),
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ISSUE BRIEF SERIES Part 1: Why Use a Trauma -Informed Approach With LGBTQ Youth? The Adopting a Trauma -Informed Approach for LGBTQ Youth brief is a product of the National Resource Center for Mental Health Promotion and Youth Violence Prevention, under funding provided by the Substance Abuse and Mental Health Services Administration (SAMHSA), Cooperative Agreement 5U79SM061516 -02. The views, opinions, and content of this brief do not necessarily reflect the views, opinions, or policies of the Center for Mental Health Services (CMHS), SAMHSA, or the U.S. Department of Health and Human Se rvices (HHS). The National Resource Center for Mental Health Promotion and Youth Violence Prevention is operated by American Institutes for Research (AIR) in collaboration with the Center for School Mental Health, ZERO TO THREE, Community Science, FHI 360, National Indian Child Welfare Association, National Asian American Pacific Islander Mental Health Association, National Latino Behavioral Health Association, National Leadership Council on African American Behavioral Health, and the Council of State Gover nments.
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Part 1: Why Use a Trauma -Informed Approach With LGBTQ Youth? Page i Contents I. Introduction . 1 II. Definitions of Sexual Orientation and Gender Identity . 2 III. Prevalence and Impact of Traumatic Stress in the Lives of LGBTQ Youth 3 What Is Trauma? 3 Types of Trauma 3 Trauma Among LGBTQ Youth . 4 Impact of Trauma on LGBTQ Youth . 6 IV. Trauma -Informed Youth -Serving Systems 8 What Is a Trauma -Informed Approach? 8 Why Adopt a Universal Approach to Addressing Trauma? . 9 Why Is a Trauma -Informed Approach Needed for LGBTQ Youth? 10 V. Conclusion .. 11 References 12
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Part 1: Why Use a Trauma -Informed Approach With LGBTQ Youth? Page 1 I.Introduction fiThere is in every child at every stage a new miracle of vigorous unfolding, which constitutes a new hope and new responsibility for all.fl ŠErik Erikson School -age youth who are lesbian, gay, bisexual, transgender, or questioning their sexual orientation and/or gender identity ( LGBT Q) face unique experiences and challenges in their schools and communities. Many LGBTQ youth are surrounded by loving caregivers, friends, teachers, service providers, and community members whose support helps to foster positive development and resilience in the face of external adversity. However, for far too many LGBTQ youth, traumatic experiences such as discrimination, bullying, violence, and rejection are a daily reality with profound consequences. Historically, youth -serv ing systems have supported youth exposed to trauma without acknowledging, understanding, or addressing the impact of trauma or tailoring responses to address trauma -related needs. This is particularly true among LGBTQ youth, who often move through educatio nal and service environments that, at best, do not understand what they need and at worst, cause harm. As awareness of the prevalence and impact of trauma in the lives of youth has grown, so has the recognition that all educators and service providers have a responsibility to help build environments and relationships that promote resilience, prevent or minimize the effects of trauma, and support healing. This includes identifying and adopting specific strategies for preventing and addressing the trauma amon g LGBTQ youth . Adopting a trauma -informed approach means changing the practices, policies, and culture of a school or agency to ensure an environment that is conducive to health and wellness for all, particularly those exposed to trauma. This brief is the first in a two -part series titled Adopting a Trauma -Informed Approach for LGBTQ Youth, which is designed to help schools and community agencies to (1) understand why adopting a trauma -informed approach for LGBTQ youth is needed; and (2) create trauma -info rmed environments that consider the unique trauma -related needs of LGBTQ youth. Part 1 addresses (1) the prevalence and impact of trauma among LGBTQ youth; (2) what it means to adopt a trauma -informed approach in youth -serving systems ; and (3) why this uni versal approach is needed, particularly for LGBTQ youth. The second brief in the series offers a framework for adopting a trauma -informed approach that includes specific strategies for working with LGBTQ youth; the framework and strategies can be applied t o a variety of youth -serving settings.
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Part 1: Why Use a Trauma -Informed Approach With LGBTQ Youth? Page 2 II.Definitions of Sexual Orientation and Gender Identity Gender identity ŠA person™s internal sense of being male, female, or something else. Gender expression ŠHow people express their gender identity, for example, in the way they dress, the length of their hair, the way they act or speak, and in their choice of whether or not to wear make -up. Gender nonconforming ŠPeople who do not follow other people™s ideas or stereotypes about how they should look or act based on the female or male sex they were assigned at birth. Sexual orientation ŠThe desire for intimate emotional and/or sexual relationships with people of the same gender/sex, another gender/sex, or multiple genders/sexes. Lesbian ŠFemale -identified people who are attracted romantically, erotically, and/or emotionally to other female -identified people. Gay ŠIndividuals who are primarily emotionally, physically, and/or sexually attracted to members of the same sex and/or gender. More commonly used when referring to men who are attracted to other men and can be used as an umbrella term to refer to a broad array of sexual orientation identities other than heterosexual. Bisexual ŠA person emotionally, physically, and/or sexually attracted to males/men and females/women . This attraction does not have to be equally split between genders and there may be a preference for one gender over others. Transgender ŠA person whose gender identity/expression is different from that typically associated with their assigned sex at birt h. A transgender person fitransitionsfl to express gender identity through various changes (e.g., wearing clothes, adopting a physical appearance that aligns with their internal sense of gender). Sexual orientation varies and is not dependent on gender ident ity. Questioning ŠIndividuals who are uncertain about their sexual orientation and/or gender identity. Cisgender ŠA person whose gender identity and biological sex assigned at birth align (e.g., a person who was born as male identifies as a man ). Intersex ŠIndividuals born with a reproductive/sexual anatomy that does not fit the typical definitions of male or female; frequently fiassignedfl a gender at birth, which may differ from their gender identity later in life. Two -s pirit ŠAn inclusive term created speci fically by and for Native American communities (American Indians and Alaska Natives) to recognize individuals who (a) express their gender, sexual orientation, and/or sex/gender roles in indigenous, non -Western ways, using tribal terms and concepts and/or (b) define themselves as LGBTQ and I ntersex in a native context. Other terms ŠYouth also may use other terms to describe their sexual orientation and gender identity such as homosexual, queer, gender queer, non -gendered, and asexual. Source s: Green & Peterson , 2004; Poirier, J. M., Francis, K. B., Fisher, S. K., Williams -Washington, K., Goode, T. D., & Jackson, V. H., 2008; Poirier, J. M., Fisher, S. K., Hunt, R. A., & Bearse, M. , 2013.
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Part 1: Why Use a Trauma -Informed Approach With LGBTQ Youth? Page 3 III .Prevalence and Impact of Traumatic Stress in the Lives of LGB TQ Youth What Is Trauma? The term trauma is used to describe an event , series of events, or set of circumstances that is experienced as physically or emotionally harmful or life -threatening, overwhelms one™s ability to cope, and has lasting adverse effect s on a person™s mental, physical, social, emotional, or spiritual well -being (National Child Traumatic Stress Network, n.d.; SAMSHA, 2014a). Whether an event is fitraumaticfl depends not just on the event itself but on our experience of the event. We cannot say that a particular experience, such as witnessing violence , is always traumatic for everyone. How youth respond to potentially traumatic events is influenced by many factors, including their internal coping resources, external supports, and broader community, cultural, and societal factors that shape how they understand a nd respond to these experiences (Brom, Pat -Horenczyk, & Ford, 2009; Layne, Briggs, & Courtois, 2014; Masten, 2014; SAMHSA, 2014a). Traumatic experiences may have short – or long -term effects and can alter how youth view themselves , others, and the world around them by challenging their belief that the world is a safe place and other people can be tr usted . Types of Trauma Trauma tic experiences come in many forms and range from one -time events such as an accident, natural disaster, or single experience of violence to experiences that are chronic or even generational and include abuse, neglect, exposure to family and community violence, and the cumulative and historical impact of poverty, racism, and oppression. Types of Traumatic Experiences Acute trauma: Traumatic events that occur at a particular time and place and are usually short -lived, such as witnessing or experiencing a single act of violence, sudden loss of a loved one, a serious accident, or a natural disaster (The National Child Traumatic Stress Network, n.d.). For LGBTQ youth, this may include single experiences of verbal or physical harassment related to sexual orient ation or gender identity or one -time experiences of large -scale violence like the recent shooting in Orlando, Florida. Chronic trauma: Traumatic experiences that occur repeatedly over long periods of time (The National Child Traumatic Stress Network, n.d.) . Examples include chronic abuse or neglect; ongoing domestic or community violence; chronic bullying; long -term illness; chronic homelessness; forced displacement; chronic exposure to poverty and deprivation; and ongoing experiences of oppression, discrim ination, and isolation such as those related to race, ethnicity, and sexual orientation or gender identity. Complex trauma: Trauma that (1) begins in childhood during key stages of development; (2) continues over time; (3) often occurs within caregiving relationships where a caregiver is either a source of threat or unable to support, nurture, or protect a child from threat; and (4) leads to immediate and long -term difficulties in many areas (Cook et al., 2005). Examples include chronic interpersonal viole nce in the form of physical, emotional, and sexual abuse or witnessing domestic violence as well as ongoing neglect and other forms of violent victimization or loss without adequate adult support to manage these experiences. For LGBTQ youth, potentially traumatic experiences related to sexual orientation or gender identity may include rejection by family members and chronic experiences of harassment, violence, isolation, instability, and lack of secure attachments and support during childhood and adolescenc e.
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Part 1: Why Use a Trauma -Informed Approach With LGBTQ Youth? Page 4 Historical trauma: The collective and cumulative trauma experienced by a particular group across generations. Examples of historical trauma include violent colonization and assimilation policies; slavery; segregation; racism; homophobia; and discrimination and oppression. The negative effects of these experiences continue to impact the affected communities in the present in ways that may include struggles with violence, suicide, substance abuse, and other risk -taking behaviors; feelings of low self -worth or aggression; and a mistrust of systems, including education and behavioral health (The National Child Traumatic Stress Network, 2013a; The National Child Traumatic Stress Network, 2013b; The National Child Traumatic Stress Network, 2014). Racial trauma: Potentially traumati c experiences related to race may include (1) direct experiences of racial harassment including threats of harm or injury and being humiliated; (2) witnessing racial violence toward others such as hate crimes or violence by law enforcement; and (3) experiencing discrimination and institutional racism. Racial trauma includes fimicroaggressionsfl Šbrief, everyday verbal or behavioral exchanges that intentionally or unintentionally communicate hostile, derogatory, or negative racial messages or insults (Bryant -Davis & Ocampo, 2005; Carter, 2007; Sue et al., 2007). Examples include racial slurs; being followed in a store; communications that convey rudeness and demean a person™s racial identity; or exchanges that negate or deny thoughts, feelings, or the experienti al reality of a person of color. Among LGBTQ youth of color, trauma may be related to both racial or cultural identity and gender identity/expression. Trauma Among LGBTQ Youth fiIt™s very easy to look at me and tell I™m Gay and it makes me feel afraid to walk around knowing there are people here in my hometown that hate me . . .fl ŠHuman Rights Campaign (2012) Rates of childhood trauma are alarmingly high, and experiences of violent trauma are particularly common. In the United States, more than two -thirds of children report experiencing a traumatic event by age 16 , such as a serious accident, natural disaster, or experiencing or witnessing violence (Copeland, Keeler, Angold, & Costello, 2007). Approximately 2 out of 3 children and youth ages 17 a nd younger were exposed to some form of violent victimization at home or in the community in the past year; 50% had more than one exposure (Finkelhor, Turner, Shattuck, & Hamby, 2015). Among LGBTQ youth, rates of exposure to potentially traumatic events are even higher than for their heterosexual peers (Coker, Austin, & Schuster, 2010; Kosciw, Greytak, Giga, Villenas, & Danischewski , 2016; Kosciw, Greytak, Palmer, & Boesen, 2014). LGTBQ youth often face adversity related to their sexual orientation or gend er identity that includes bullying, harassment, and violent victimization, and experiences of stigma, discrimination, and social isolation (Institute of Medicine, 2011 ; Kosciw et al., 2014; Koscow et al., 2016 ). Systemic discrimination plays out in many forms, large and small. Pervasive fimicroaggressionsfl related to gender identity/expression include using the term figayfl to describe something negative, derogatory looks or comments about someone™s gender identity or expression, or being told not to fiflauntfl one™s sexuality. Beyond these daily insults is the very real threat of violence toward LGBTQ individuals and groups that can be seen across the United States. More than half of LGBT people are concerned about being the victim of a hate crime ( Marzullo & Li bman , 2009). Despite federal legislation, sexual orientation is the third highest motivator of hate crimes, and sexual orientation crimes are often more personal and violent in nature (Marzullo & Libman, 2009). Although the number of attacks on gay institu tions have decreased, we have only to look at the Orlando nightclub shooting to imagine what an adolescent or teen who is preparing to come out is feeling given the level of violence toward individuals and groups of sexual minority youth.
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Part 1: Why Use a Trauma -Informed Approach With LGBTQ Youth? Page 6 For too many LGBTQ youth, experiences of discrimination and rejection extend to families and communities (Human Rights Campaign, 2012) : 33% of LGBTQ youth said their family is not accepting of LGBTQ people.About half said they had an adult in their family they could turn to for help if worried or sad,compared to 79% of non-LGBTQ youth.Among LGBTQ youth experiencing homelessness, 43% were forced from their homes due to conflictsrelated to sexual orientation or gender identity; 32% have experienced physical, emotional, or sexualabuse at home related to their sexual orientation or gender identity.Nearly half of LGBTQ youth did not feel that they fit in in their communities.4 in 10 said that the community in which they live is not accepting of LGBTQ people.Impact of Trauma on LGBTQ Youth fiI™ve been so viciously tortured in public school that I now have severe anxiety and can no longer cope with the panic attacks and thoughts that plague me while I™m there.fl ŠCisgender male student , 11 th grade, Wisconsin , 2013 National School Climate Survey (Kosciw et al. , 2014 ) Resilience Šthe capacity to positively adapt to adversity Šdevelops over time through interactions between individual characteristics and external circumstances ( Center the Devel oping Child at Harvard University , 2015) . How youth respond to a traumatic event is influenced by individual factors such as age, gender, history of exposure, level of internal resources and skills for coping, and environmental factors such as the nature of the event, level of support, and parental responses. Combined environmental and individual characteristics that help children achieve positive outcomes in the face of adversity include (1) the availability of at least one stable, caring, and su pportive relationship with an adult ; (2) a sense of mastery over lif e circumstances; (3) s trong executive func tion and self -regulation skills; and (4) affirming faith or cultural traditions ( National Scientific Council on the Devel oping Child, 2015). Many youth, including LGBTQ youth, have the internal resources and external supports to develop in healthy ways and positively adapt to adversity. Most youth exposed to trauma do not develop significant mental health issues (American Psychological Association, 2008). However, LGBTQ youth are more likely than their heterosexual peers to face challenges that can compromise resilience such as greater risk of exposure to traumatic stress, absence of adult support or affirming communities, and lack of control over ex ternal circumstances and responses. Experiences of discrimination, violence, and lack of support or rejection by caregivers, peers, and communities place LGBTQ youth at increased risk for depression, posttraumatic stress disorder, suicide -related behaviors , substance abuse, HIV, and relationship difficulties (Bostwick et al., 2014; Horvath, Remafedi, Fisher, & Walrath , 2012 ; Institute of Medicine, 2011; Lazear & Gamache, 2012; Roberts et al., 2012 ). Suicide and LGBTQ Youth (Sources : Suicide Prevention and Resource Center, 2008; Haas et al. , 2011) Lesbian, gay, and bisexual (LGB) youth are nearly 1.5 to 3 times more likely to have reportedsuicidalideation than non-LGB youth.High school students who identify as LGBT are 2 to 7 times more likely to have reported attemptingsuicide than non-LGBT youth.
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Part 1: Why Use a T rauma -Informed Approach With LGBTQ Youth? Page 7 Family acceptance or rejection is a particularly impactful mediating factor for healthy development and well -being among LGBTQ youth. According to the Family Acceptance Project, lesbian, gay, and bisexual ( LGB) youth who come from highly rejecting families are more than eight times as likely to have attempted suicide as LGB peers with little to no f amily rejection (SAMHSA, 2014b). The risk of family rejection also further jeopardizes support networks for LGBTQ youth , which can lead to unstable support networks and other traumas such as homelessness or out -of-home care (Durso & Gates, 2012; Kenney, Fisher, Grandin, Hanson, & Winn, 2012 ; Poirier, Murphy, Shelton, & Costello, 2013). The top causes of homelessness among LGBTQ youth include (1) family rejection resulting from sexual orientation or gender identity; (2) physical, emotional, or sexual abuse; (3) aging out of the foster care system; and (4) financial and emotional neglect (Durso & Gates, 2012). LGBTQ you th are overrepresented in the child welfare and homeless service systems (Gates, 2011; Ray, 2006; Wilson, Cooper, Kastanis, & Nazhad, 2014). They are also at higher risk for negative outcomes in both of these systems. LGBTQ youth are at higher risk for bei ng treated poorly by the foster care system when compared with their heterosexual counterparts (Wilson et al., 2014). While homeless, LGBTQ youth are also at greater risk for traumatic experiences including exchanging sex for basic needs, which often resul ts in sexual assault; being bullied and victimized; and dropping out of school (Cray, Miller, & Durso, 2013; Kenney et al., 2012 ). Subpopulations of LGBTQ youth face particular challenges based on the degree and type of trauma exposure. For example, transgender youth are more likely to be diagnosed with a mental health issue such as depression or anxiety or engage in suicidal or self -harm behaviors (Reisner et al., 2015). Youth exposed to multiple layers of harassment are also at greater risk for negative o utcomes. LGBTQ youth of color who are harassed in school based on sexual orientation and race are more likely to miss school and had significantly lower grade point averages (Diaz & Kosciw, 2009). LGBTQ youth who have experienced ongoing discrimination, rejection, and violence are more likely to view the world and other people as unsafe. Those who have been repeatedly hurt by others may come to believe that people cannot be trusted. Youth who are further traumatized within schools or service settings that d o not recognize, understand, or address their needs face increasingly negative outcomes. For example, LGBTQ youth who experience unsupportive conditions in schools are more likely to (1) have higher rates of absenteeism; (2) have been disciplined at school; (3) have lower grade point averages; (4) drop out of school; (5) have higher rates of depression and anxiety; and (6) have lower self -esteem (Kim, 2009; Kosciw, Greytak, Bartkiewicz, Boesen, & Palmer, 2012; Kosciw et al., 2014; Koscow et al., 2016). Scho ol victimization in adolescents is linked to young adult mental health issues and increased risk for STDs and HIV (Russell, Ryan, Toomey, Diaz, & Sanchez, 2011). Effects of Chronic Exposure to Trauma When children are exposed to chronic interpersonal trauma from an early age, the impact on brain development becomes increasingly profound , leading to a host of future challenges ( Cloitre et al., 2009; Cohen , Perel, DeBellis, Friedman, & Putnam , 2002; National Scientific Council on the Developing Child, 20 05/2014; National Scientific Council on the Developing Child 2010a ; Perry, 2001; Perry & Pollard 199 8; DeBellis & Zisk, 2014 ). The effects of chronic trauma include increased medical and mental health problems; learning difficulties; difficulty planning and anticipating; problems with boundaries; difficulties with peers; self -destructive or self -injurious behaviors; oppositional behavior; difficulty managing rules and limits; learning difficulties and poor academic performance; and low self -esteem, shame, and guilt ( Cook et al., 2005; D™ Andrea, Ford, Stolbach, Spinnazzola, & van der Kolk, 20 12; Fairbank & Fairbank, 2009; Finkelhor, Ormrod, & Turner, 2009; National Sci entific Council on the Developing Child, 2010b; Shonkoff, 2012 ). Trauma that goes unrecognized and unaddressed in childhood has long -term individual and societal implications. Th e groundbreaking Adverse Child hood Experiences (ACE) Study highlights the significant connection between childhood exposure to potentially traumatic events (e.g.,
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Part 1: Why Use a Trauma -Informed Approach With LGBTQ Youth? Page 8 physical or sexual abuse, witnessin g violence) and challenges in adulthood including high -risk behaviors like smoking and unprotected sex; mental illness; chronic physica l illnesses such as heart disease, obesity, autoimmune disorders, and cancer; and heightened risk of early death (Felitti et al., 1998 ; Felitti & Anda, 2010 ). IV.Trauma -Informed Youth -Serving Systems What Is a Trauma -Informed Approach ? Growing awareness of t rauma and its impact on children and youth has challenged all who serve youth to consider the role they play in addressing this public health issue. Supporting youth exposed to trauma can take many forms ranging from providing therapeutic interventions tha t address trauma -related symptoms to adopting systemic approaches to ensure that entire organizations or schools are equipped to recognize and respond to trauma ( Magruder , Kassam -Adam s, Thoresen, & Olff, 2016 ). Consensus is growing that, in addition to evi dence -based treatment for PTSD and other trauma -related responses, universal approaches are needed to address the magnitude of violent trauma affecting youth. Interventions to address trauma must target the individual and the larger context in which suppor t is offered (DeCandia & Guarino, 2015; Magruder et al., 2016). Adopting a trauma -informed approach in youth -serving systems includes four key elements : (1) realizing the prevalence of trauma in the lives of the children and youth being served; (2) recognizing the impact of trauma on you th, staff, and communities; (3) responding in ways that are informed by an understanding of trauma and what is needed to support recov ery and resilience; and (4) resisting engaging in practices that are re -traumatizing for youth (SAMHSA, 2014 a). Often this requires changes to the practices, policies, and culture of an entire school or agency. Changes to policy and practice in a trauma -i nformed organization or school may include (a) providing regular staff training on trauma and its impact; (b) reducing practices that may trigger or re -traumatize ; (c) creating physical and emotional safety in relationships and in the environment; (d) cons idering trauma in all assessment protocol s and behavior or treatment plans ; and (e) ensuring youth voice, choice, and empowerment (Guarino , Soares, Konnath, Clervil, & Bassuk , 2009; Hopper ,Bassuk, & Olivet , 2010; SAMHSA, 2014 a; Guarino, 2014 ). Finally, a trauma -informed approach takes into account the secondary impact that working with trauma survivors has on educators and service providers and includes practices to create a culture that supports staff resilience and care .Guiding Principles of a Trauma -Informed Approach A trauma -informed approach is driven by a set of core principles that reflect the fundamental attitudes, values, and beliefs needed to provide adequate support for all youth exposed to trauma, including LGBTQ youth. Here we outline guiding principles of a trauma -informed approach that are applicable across youth -serving settings. Core principles inform all aspects of daily practice agency – or school -wide. In a trauma -informed organization or school, all aspects of a service or education delivery system Šfrom how the workforce is trained to what procedures and policies are adopted Šare grounded in an understanding of trauma and its impact and designed to promote healing and resilience.
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Part 1: Why Use a Trauma -Informed Approach With LGBTQ Youth? Page 9 Guiding Principles of a Trauma -Informed Approach in Youth -Serving Settings (C ole, Eisner, Gregory, & Ristuccia, 2013; Guarino et al., 2009; SAMHSA, 2014a) Understand trauma and its impact All staff in a school or agency share a common understanding of trauma and its impact on youth, families, and providers/educators and a joint mission to create environments that acknowledge and address trauma™s impact and support healing and resilience. Believe that healing happens in relationships The school or agency demonstrates the belief that establishing safe, authentic, and positive relationships can be corrective and restorative to survivors of trauma and build resilience for all. This includes relationships among and between staff, youth, and families Ensure physical and emotional safety The school or agency is committed to establishing a safe physical and emotional learning and service environment where basic needs are met, safety measures are in place, and staff responses are consistent, predictable, and respectful. Support choice, control, and empowerment The school or agency supports youth choice and control whenever possible within the school or service environment and looks for ways to empower youth by building skills that enhance sense of control and mastery. This focus on choice, control, and empowerment extends to families and st aff. Strive for cultural competence The school or agency strives for cultural competence in all aspects of education or service delivery. This includes respecting diversity within the school or agency; considering the relationship between culture, traumat ic experiences, safety, healing, and resilience; and using approaches that align with the cultural and linguistic backgrounds of youth, families, and the broader community. View youth holistically The school or agency understands the interrelated nature of life experiences, including traumatic events and emotional, physical, relational, and spiritual health and academic success and looks to build youth skills in all areas. Use a collaborative approach The school or agency uses a collaborative approach wi th youth and families and among staff. This includes sharing power and decision making across all levels of the school or agency and seeing youth and families as partners. Why Adopt a Universal Approach to Addressing Trauma? There are several key reasons why youth -serving systems such as education, child welfare, behavioral health, and juvenile justice are adopting a universal approach to addressing trauma: 1. Rates of childhoo d trauma are high. A significant number of youth have been or continue t o be exposed to traumatic experiences that can have a significant impact on health, well -being, be havior, and learning. Among LGBTQ youth, rates of exposure to trauma are even higher than in the general population. 2. There is increas ed ris k of doing harm when trauma responses are overlooked. Youth who have experienced prolonged trauma have developed survival skills to manage their experiences that can be confusing and easily misunderstood by school or agency staff. Traumatized children and youth may be difficult to redirect, seem emotionally out of control, avoid taking responsibility, engage in risk -taking behaviors, and appear oppositional and disruptive or disconnected and indifferent. Without understanding the connection between trauma a nd current behaviors, school staff and social service
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