Introduction

As shown by previous research from North America (USA) and Northern Europe (Sweden), LGBTQ + youth are disproportionally represented in various forms of out-of-home care (Fish et al., 2019; Schindele & Lindroth, 2021). Despite this overrepresentation, clinical social workers often fail to acknowledge and address the specific needs of LGBTQ + youth. Studies conducted in different countries and contexts reveal a lack of competence among social workers in recognizing and meeting the needs of young LGBTQ + people in out-of-home care (Erney & Weber, 2018; Gerassi & Pederson, 2022; Greeno et al., 2022; Kaasbøll et al., 2022; Lindroth, 2021; Mallon, 2019; Mountz et al., 2018).

A recent review show that LGBTQ youth in out-of-home care face barriers to disclosing their sexual orientation or gender identity due to fear of negative consequences, such as exclusion, bullying or stigmatisation from either the professionals or their peers in the care home, where young transgender people are particularly exposed (Schaub et al., 2022). Transgender and non-binary youth in Sweden are more exposed to discrimination and violence than their peers (Public Health Agency of Sweden, 2017), despite the policies that exist to protect them. These findings are similar to research from many parts of the world, and sometimes the discrimination takes place in care settings, such as health care and school (Kearns et al., 2021; Wittlin et al., 2023). This indicates the need for more research and support for trans youth in out-of-home care, as they may face multiple forms of oppression and marginalisation. Transgender and non-binary youth are often not included in studies concerning LGBTQ youth in out-of-home care. For instance, the main identities represented in studies found in a recent review were those of gay youth. The perspectives of lesbian, bisexual, transgender, and non-binary were rare (González Álvarez et al., 2022).

During their youth, 3–4% of young people in Sweden will experience out of home care (Swedish Agency for Technology Assessment and Assessment of Social Services, 2017), and in 2021, approximately 32,500 young people were placed in some form of out-of-home care. The care can be either voluntary under the Social Services Act (SFS 2001:453) or mandatory under the Care of Young Persons (Special Provisions) Act [1990:52]. The out-of- home care is organized in three forms: family or foster homes, residential care homes and secure state care institutions. In this study, we focus on clinical social workers that care for youth in residential care homes. In 2021, approximately 6,000 young persons were placed at residential care homes, homes that are usually separated by binary gender, with some exceptions for mixed-gender homes (National Board of Health and Welfare, 2022). Grounded in the definition of sexual and reproductive health and rights (SRHR), proposed by the Guttmacher-Lancet Commission (Starrs et al., 2018), Sweden has a national strategy for SRHR that asserts that care givers (public or private) hold a particular responsibility in working towards everyone’s right to attain a good sexual and reproductive health (Public Health Agency of Sweden, 2020). The action plan that builds on the strategy emphasizes the role of the social services as a crucial actor in achieving this goal, notably by highlighting the importance of addressing SRHR in various contexts, such as out-of-home care, and for specific groups such as youth and LHBTQ + people (Public Health Agency of Sweden, 2023).

Significant health disparities between young people in out-of-home care and those not in care have been presented, based on the combined analysis of two separate surveys on sexual health among 16–29-year-olds in Sweden (Schindele & Lindroth, 2021). These findings indicate that young people in out-of-home care, regardless of gender identity or sexual orientation, are more vulnerable and at risk for sexual ill-health. A clinical social work approach that affirms and supports SRHR among young people in out-of-home care is thus needed (Lindroth & Andersson, 2021; Schindele and Lindroth, 2021). However, in a study of websites of residential care homes and secure state care institutions for young people in Sweden, the care givers did not address the needs and experiences of LGBTQ + youth (Carlström et al., 2023). Of the approximately 1,000 existing residential care homes, only 20 stated that they worked with or had competence in LGBTQ + issues.

Previous research has shown that LGBTQ youth in out-of-home care benefit from professionals’ support (González-Álvarez et al., 2023). In interviews with staff working in transitional apartments for trans youth experiencing homelessness, staff describe how they attempt to provide a safe, inclusive, respectful and protective environment (Nadan et al., 2024). There is however a lack of studies on social workers’ experiences of working with LGBTQ youth in general (Kaasbøll et al., 2022), and of working with transgender and non-binary youth in particular. Therefore, this study aims to investigate the practices and challenges of clinical social workers at residential care homes when working with gender identity and sexual health issues among young transgender and non-binary youth.

Methods

Design, Setting and Recruitment

To gain a deeper understanding of an under-researched field, a qualitative exploratory approach was adopted (Robson & McCartan, 2016). Verbal contact was made with unit managers at four residential care homes, who were asked to invite their professional staff to participate in interviews. Three managers agreed to cooperate and distributed our study information among the staff. They then provided us with contact details of those willing to participate in the study.

Participants and Data Collection

Eight persons (aged 26–58, six identified as women, and two as men) working at three different residential care homes for young people (three worked in homes for girls, five in homes for boys) in the south of Sweden were interviewed. They worked in different municipalities and had various educational backgrounds, such as social pedagogy, behavioural science and treatment pedagogy. Some of these educations constitute university degrees, while some are shorter professional courses in Sweden. The interviewees’ experience working in residential care homes years ranged from a few months to eight years. Their clinical social work included clinical treatment, everyday care and relationship strengthening counselling within the context of residential care homes. For an overview of participants, see Table 1.

Table 1 Overview of participants
Full size table

The interviews were conducted in the autumn of 2022, with each lasting approximately one hour and held either at the participant’s workplace or digitally. A semi-structured interview guide was used, and it consisted of a few open-ended questions about education in, and actual experiences of, work related to gender identity, sexual orientation and sexual experiences, and improvement areas related to this work. The interviewer (initials EH) has a background working in residential care homes for young people and shared this information with the participants at the beginning of the interview. All interviews were recorded, transcribed verbatim and stored in a single Word-file.

Analysis

The analysis process was guided by reflexive thematic analysis, which involves identifying and examining categories and components that emerge from the data and relating them to theoretical perspectives and previous research in the field (Braun & Clarke, 2006). After transcription, the interviews were read repeatedly, and themes were identified through an overall coding in the Word-file. Then, a more focused coding was conducted where categories were created and populated with content, and patterns were identified. Lastly, representative quotes were used to illustrate and report the findings. The analysis revealed four themes that capture how social work professionals at residential care homes work with issues regarding gender identity and sexual health among transgender and non-binary youth, and what institutional barriers they experience in this clinical social work: (i) Knowledge being a personal matter; (ii) Heteronormativity and binarity creating consequences; (iii) Handling discrimination and harassments; and (iv) Creating a trustful alliance. We found no clear distinctions in the results, related to participant gender, age or education. Quotes are therefore substantiated by a fictional name only.

Ethical Aspects

The project and its aims were explained to the interviewees both verbally and in writing. They were informed that participation was voluntary and that they could leave the project at any time without giving any reason. The results section does not reveal any sensitive personal information or identify any individual. The Swedish Ethical Review Authority approved the project (2022- 01636-01); and the research ethics principles of the Humanities and Social Sciences Research Council from1990 were followed (Swedish Research Council, 2012).

Results

Knowledge Being a Personal Matter

The interviewees emphasize that they have had little or no training (either in their professional education or later) on LGBTQ + issues. They claim that their own interest in the topic has been their main motivation, not workplace policy or work descriptions. This is also true for participants working in one of the three residential care homes that had undergone a LGBTQ certification process. Regarding getting LGBTQ competence during her professional education, Kristin conveys, ‘Not that much during the training, but I find this really interesting. […] I have taken an interest myself, so I have kind of read up on it.’ Josef, who agreed to participate in the study mainly because he wanted to learn more and to reflect on LGBTQ issues, reflects:

This is a subject I would like to know more about. I try to read, watch documentaries, interviews and other stuff on YouTube, and ask people I know. Because I want to know what I’m talking about. I want to know how to work with it, how to treat people, and every person is a unique individual and have their own…want to be treated individually.

That LGBT competence stems from the individual, not the organization, has been seen in previous studies. Furthermore, social workers who work to include sexological issues in their daily work often do so based on their own motivation and interest, rather than based on their organisation’s expectations (Combs & Taussig, 2021; Hall et al., 2019). Gruber (2013) found that knowledge and engagement in sexuality and gender identity in Swedish residential care homes were more related to the professional’s personal commitment than the workplace policy. Our findings are consistent with Gruber’s, despite being conducted ten years later. According to several interviewees, the staff at the residential care homes often have less knowledge about LGBTQ issues than the youth who live there; and they learn from them. Kristin explains:

We don’t know that much, but it’s like… if one wants to do a gender correctional treatment, how do they do that? I know as little as they do; oftentimes they know more. But, of course, if someone has a question, you help them look it up.

While the level of knowledge among the interviewees is described as low, by them, they show a positive attitude to learning more and supporting the youth to increase their knowledge. Overall, the interviewees have an SRHR- affirmative approach. However, their self-perceived lack of knowledge often makes them afraid of discussing topics related to sexuality and gender identity. William shares his insecurity that makes him avoid addressing these issues: ‘And then I am also so damn afraid to say the wrong thing and step on somebody’s toes… then, you kind of… feel a bit insecure and maybe take a step back.’ This reluctance to talk to young people in state care about sensitive issues has been observed before. For instance, Överlien (2004) noted that professionals in secure state care institutions remained silent instead of having conversations with girls about sexual violence, a topic that they were unsure how to address and handle. Areskoug-Josefsson et al. (2019) argue that professionals may shy away from addressing SRHR issues because they lack education in this field and do not feel confident to deal with them. Another factor that complicates conversations about SRHR in general, or in this case sexuality and gender identity specifically, is the lack of supportive routines or guidelines, either at the organisational or the national level. This is a common concern among all interviewees. For example, Wilma states:

Regarding that, I think we should have a template for… like how “this is the basis for what the youth should bring with them from their stay here,” and maybe then it would be easier to bring it up […] I think I am reconsidering things as I am talking about this. That it is really unclear for me how I and my workplace are working with these issues.

A lack of established routines and guidelines can lead to ambiguity and inconsistency in the work, and the young person’s support may depend on the individual social worker’s comfort level with discussing issues related to sexuality and gender identity. This also indicate that the young person must initiate dialogue, and relatedly; the LGBTQ certification that one of the residential care homes had appears to have had little impact on the social worker’s actual work. Some interviewees emphasise the importance of professionals raising issues of sexuality and gender identity, even if they feel insecure, and that they can learn that one is allowed to make mistakes. Kristin exemplifies:

Most of them (youth) want to talk about this, and they are more likely afraid to bring it up themselves. So, it can be a good thing that we bring it up. I have never noticed that anyone would get angry that I accidentally called someone he even though they want to be called she. It’s just like “Sorry, I forgot.” I think it’s more a fear of how it might turn out. You just have to talk about it and show respect for one another.

Similarly, Josef also stresses the importance of having the courage to talk about topics that the social worker might perceive as sensitive and uncomfortable. He recalls a meeting with a transgender youth that had just arrived at the care home:

I cut right to the chase and explained “I don’t know that much about this issue, so I’m sorry if I sometime later, if I ever say the wrong thing or something that offends you – tell me, because I am pretty clumsy like that.” And then she laughed and said, “I can explain it to you.” And luckily, she was very talkative and told me her life story, how she ended up there, when she realized and what made her realize.

A common challenge that the interviewees refer to is how to avoid offending the youth by using incorrect pronouns, for example. This challenge also emerges in the context of the interviews, as the interviewees often slip up and use incorrect pronouns when referring to the trans people they have worked with. They sometimes correct themselves, but not always. This is not interpreted as malicious, but rather as a reflection of their lack of experience with an inclusive and trans-affirmative vocabulary.

Some of the interviewees emphasise that they treat transgender youth the same as other young people. Anna explains, ‘No, for me it’s nothing weird… you are how you want to be. So, I have not had any problems with it. I hope I have radiated that too. Josef elaborates similarly: ‘If someone comes out, for me it’s not such a big deal. […] I handle that just like any other client, I would say. It’s normal, I think.’ Both Anna’s and Josef’s statements can be understood as an effort to normalize and to adopt a gender inclusive approach. However, they can also be interpreted as unreflective, as they ignore that transgender people live in a heteronormative society where they are treated as deviant and different. The attitude of the professionals can be interpreted as kindness and a reluctance to treat anyone differently; but it can also entail a risk of invisibility and, in the worst case, a denial of transgender people’s actual vulnerability. In a study conducted in the USA, transgender people who had previously been placed in family homes were interviewed (Mountz et al., 2018). Similar to what the interviewees in our study display, the youth reported a lack of professional competence that caused them to, for example, be addressed by an incorrect pronoun or not having their gender identity recognised.

Heteronormativity and Binarity Creating Consequences

Several interviewees discussed the pros and cons of having gender-segregated or gender-inclusive residential care homes. For example, Joseph thinks it depends on the context and the background of each young person:

Let’s say if a girl has been subjected to rape, or if there is a girl that had honour-related violence in the home or something similar, something that can be related to a potential problem, then, this person might have problem with men or boys specifically. And then perhaps you should be at one [ward] that is only for girls, I think, with female staff, but then later be transferred to a mixed residential home. But when it comes to youth or kids or adults with other types of issues, family issues or issues related to drugs or depression or whatnot, then I think it should be mixed.

All the interviewees agree that the binary segregation poses challenges in meeting the needs of transgender and non-binary youth, and they readily share their experiences. For example, they often rely on social services to inform them about a young person’s pronouns and gender-affirming treatment status before placement. However, this information is not always provided. Kristin illustrates:

Of almost all the ones we’ve had placed, the other youth [in the care facility] have had no idea that they are biologically born a girl. It’s not something they have chosen to tell anyone other than the ones that become really close. It’s not always something that we in the staff are informed of before, because it shouldn’t matter. Then, the youth has chosen to tell us. There are things that are good for us to know, for example that we need to buy menstrual hygiene products and other things that we mightn’t think we need to have here.

Kristin’s somewhat ambivalent statement suggests that there are both advantages and disadvantages of professionals not knowing a young person’s gender identity. On the one hand, not knowing or paying attention to that a person has undergone a gender-affirming treatment can be a way of protecting the individual and treating them fairly. On the other hand, it can mean erasing their gender identity and the experience of having undergone a gender-affirming treatment. If the staff at the care home are informed before the placement, the young person does not have to disclose their gender identity to the professionals. In relation to information sharing, Hyde et al. (2016) have highlighted the importance of carefully considering how information regarding youth in contact with the social services and sexuality is shared between professionals. If done poorly, the young person may lose faith in the professionals. Our findings indicate that this also applies for gender identity.

Most interviewees report that youth often end up in the wrong care homes because of their gender identity. They communicate that social services placing the young people in care do not have a regular practice of taking gender identity into account. Wilma, who works in a residential care home for boys, shares her thoughts on the consequences of having care homes separated by gender and how it can be perceived to be misplaced:

I think that can be difficult because it’s very important what you are called. And if it says on the website for the home that it’s a home for boys, then I think that is hard to say, “Well, I feel like a girl and that doesn’t matter.” Regarding that, to open up for it to be okay, one could widen it and just write an age span and not include gender, or open it up for both girls and boys.

The institutional structure of the residential care homes, which is highly gendered, is an important context for understanding how social workers navigate offering support, and the strict binary structure of residential care homes is related to how placements are made. This framework has a long history in the Swedish system and is based on the assumption that youth need “a break from sexuality” (Överlien, 2004) and that gender specific care is beneficial. However, it also hinders the implementation of LGBTQ-affirmative initiatives.

Handling Discrimination and Harassments

During the interviews, the social workers expressed an awareness of the transgender youth’s vulnerability. They were particularly concerned about the interactions with other young people. Several reported that transgender youth often face various forms of bullying and harassment from their peers at the care home. Alexandra relates, ‘A lot of things can happen when adults turn their backs or just leave the room. So, I think this is still… it’s far from fully accepted, so it’s a very sensitive issue, still.’ The transgender youth may experience minority stress, either because of actual or potential harassment and violence, and Alexandra elaborates how dealing with prejudice and discrimination affects the everyday activities at the residential care home: ‘They do face abuse, and some of the other boys distance themselves from them. There is one here that refuses to go on outings if “those people” come along. You know, consistently not joining outings on Saturdays.’ The transgender youths face a lot of stress in some situations and activities, according to the interviewees, for instance when visiting the swimming hall. Sara elaborates:

I think they are very scared… like not coming along. They are really, like, keeping to themselves. Even if we call them by their chosen name, it doesn’t matter. If we’re going to the baths, they would have to… I think there is a collision for them there. Because others would see that person as a girl. They would have to wear shirts or bikini tops at the baths. They can have shorts, but still, it shows… so no one really… in my experience has come along to the baths, for example.

As member of staff of a residential care home for boys, William observes that the boys are expected to conform to a certain kind of rigid and narrow masculinity: ‘A lot of youth here are bothered by the feminine, by make-up and such. It shouldn’t be on a boy, they think, and then they are commenting. […] They are called “fucking trannies” and “trans whores.”’ Similar to what professionals who meet groups of young men in other institutional settings, such as jails and prisons, have described (Larsdotter et al., 2022), interviewees express their challenges and struggles with dealing with toxic masculinity. Related to this, Alexandra emphasizes the need for professionals to act as role models and show respect for everyone, regardless of gender identity:

I can see that it’s not easy here for those that see themselves as girls. I can see that they are not fully accepted by the other youths, the other boys that live here. And some want nothing to do with them. So, there is this constant… well, what would you call it? A struggle and a balancing act to be a role-model regarding that. To show, with how we act, that everyone is equal and has a right to their space and to exist. Regardless of what one considers oneself to be.

Sometimes the professionals show a lack of understanding and acceptance. When one of the youths at the care home wanted to change his pronouns, Kristin recalls a colleague who joked at the expense of the youth: ‘There are still staff who don’t really understand. You can see that, like “Uh, but what? Should I come tomorrow and say that I call myself a cat?”’ If a colleague expresses themself in a homophobic or transphobic way, Kristin thinks it is important to stand up and speak out. In such a situation, she would reply to her colleague: ‘You don’t have to understand, you just have to respect it.’

The stories of everyday life at the residential care homes reveal recurring instances of discrimination, harassment and abuse. Some of it appears directed at LGBTQ-positions in general, but most of it focuses on trans youth specifically. This is in line with other studies that have identified how LGBTQ + youth, and especially trans youth, face significant risks in care homes (Schaub et al., 2022).

Creating a Trustful Alliance

Several studies have shown that LGBTQ youth in out-of-home care need the support and affirmation of the professionals who work with them (Banghart, 2013; Forge et al., 2018; Mallon, 2019). Professionals’ ability and willingness to establish close and confident relationships with transgender and non-binary youth has been put forward as vital (González-Álvarez et al., 2022; González-Álvarez et al., 2023). This is also confirmed by the professionals in this study, who all stress the importance of building trust to establish a close relationship with the young person. Alexandra clarifies:

I have to earn their trust by being stable, interacting with them in the right way, by being responsive, by not judging. It’s a big word but being loving and making them feel that I really want what’s best for them. It’s not always easy to make them understand this. It depends on their experiences, but I think that is the absolute most important thing; and I think that as an adult, you have to… well not be perfect, but still be a role-model and create a safe space for them. To be able to say, “I’m sorry if I over-stepped.” I have to be able to say I’m sorry, otherwise I can never count on them learning to do that.

The interviews also revealed different approaches to engaging with the youths, and this might involve creating a safe space for dialogue. For instance, if the young person preferred to talk privately in a car, staff could go for a drive; or if the young person liked horses, staff could chat while taking care of horses. Another idea was to suggest to the young person to write down their concerns instead of talking, which Kristin highlights:

If you think it’s hard to talk to me, we can text or whatever.” You have to like be, “I am here and I’m happy to talk to you about this, if you want to.” Then it’s always up to them if they dare to and feel comfortable doing that.

When Wilma is asked what she thinks is the most important aspect of being supportive, she answers, ‘To dare to talk about it. That I can talk openly and without prejudice. Don’t be afraid to answer questions. Being comfortable to talk about these issues.’ Another way to show support and affirmation is to take practical and concrete protective actions. Sara exemplifies:

If we have a boy here… or he or she feels like a boy and he’s going to wash himself, then we always lock the door because it’s very sensitive how others will react to him wearing briefs, for example. So, then you’d lock the door to the washroom for his sake. Oftentimes, they ask for that.

Another practical and concrete action that is suggested is to provide menstrual protection without “revealing” the assigned sex of birth of the person concerned.

The interviewees share how some of the young people at the residential care home gradually start to question their gender identity or feel that they are misgendered. Rebecka highlights the need to be respectful and affirmative of experiences and feelings:

If we, for example, help with the laundry and see that this youth has both panties and briefs, then you’d talk to the youth about it, but in a neutral way. Not like “Why do you have briefs here?” but rather… if she wants to have that, she can, but perhaps trying to get closer to how… like, checking these little things, what name and pronouns does she want us to use for her or him.

Rebecka’s statement highlights several factors that can enable professionals to discuss gender identity and sexual experience with young people. It is in line with previous research that underline that the professional’s relationship with the young person is a crucial factor (Schaub et al., 2022). The stronger the relationship with the young person, the easier it is to initiate and have conversations. Kristin’s quote illustrates that trust and confidence have been built because the young person has felt comfortable enough to ask the professional and talk about intimate things:

Then they have also had some help… now I don’t know the proper terms, but when you tape up your genitals, if they have wanted to do that and have some special underwear for that purpose. And we have helped to look up what you can put in your bra to make it look like breasts, and stuff like that.

Social support can buffer the effect of stressors related to minority stress, and thus prevent or reduce health problems (Meyer, 2015). It is evident that the social workers in residential care homes play a significant role in reducing minority stress among transgender and non-binary youth in care. Their abilities are crucial.

Discussion

This study explored the practices and challenges of professionals at residential care homes who deal with gender identity and sexual health issues among transgender and non-binary youth in their clinical social work and the institutional limitations they face. The results show that due to knowledge being a personal matter, social work professionals seek the knowledge they need, rather than getting it in education or training. The contextual heteronormativity and binarity creating consequences at the residential care home force social workers to be creative when working with transgender and non-binary youth, and when handling discrimination and harassments. Last, but not least, the social workers suggest ways forward, thereby showing they are creating a trustful alliance. Overall, our findings are consistent with previous research that indicates that social care systems face difficulties meeting the needs of transgender and nonbinary youth (Erney & Weber, 2018; Gerassi & Pederson, 2022; Greeno et al., 2022; Kaasbøll et al., 2022; Lindroth, 2021; Mallon, 2019; Mountz et al., 2018; Schaub et al., 2022).

Providing adequate care and support appears to be especially difficult in residential care homes that are segregated by gender. These settings are permeated by heteronormative assumptions about gender, sexuality and sexual health, which implies a high risk that transgender and non-binary youth become ignored, excluded or discriminated. Our findings align with results from a recent systematic review exploring the challenges experienced by transgender youth within juvenile justice contexts. Only four studies were identified, and transgender youth shared that overall, they did not have access to adequate, continued health care, gender-considered housing, and that they were subjected to rules written for cisgender incarcerated youth (Watson et al., 2023). As there are no guidelines on how to work with gender identity and sexual health in a knowledge-based fashion at the residential care homes, the responsibility lies on individual professionals committed to these issues. However, our result show that they face institutional barriers when trying to support or being allies, barriers related to cis- and heteronormativity. Perhaps, residential care homes for transgender and non-binary youth only are needed? Staff working in such settings describe how they navigate between ‘inside’ and ‘outside’ (Nadan et al., 2024). They see the world outside the service as hostile, transphobic, violent, oppressive, and exploitative of trans youth, and the inside as a safe, inclusive, respectful, and protective environment. Another distinction between ‘outside’ and ‘inside’ is connected to staff perceptions of the knowledge regarding care and therapy for trans youth: the outside is perceived as ignorant, the inside as knowledgeable (Nadan et al., 2024). In our study, many professionals say they lack knowledge about how to work with (affirming or promoting) gender identity, sexuality and sexual health, which often leads them to avoid or mishandle these topics in their conversations with the youth. They also tell of harassments and discrimination on the inside, from other youth, and from staff. This is especially worrisome, and noteworthy considering how Northern European countries, like Sweden, are often portrayed as being at the forefront of LGBTQ + rights.

Study Strengths and Weaknesses

This study is qualitative and has a relatively small sample size, which limits its transferability. However, it also offers a rich and detailed account of how these professionals work daily to improve the situation for LGBTQ + youth in residential care homes. The professionals provide a concordant description of the current challenges they face working with these issues and insights on how to address these issues in everyday clinical social work. The study has some limitations, such as focusing only on the professionals’ perspectives; hence, further studies might include the views of the youth, their families of origin, or the authorities responsible for placing the young persons in out-of-home care. In addition, the sample is self-selected and may reflect a positive bias towards the study topic. Consequently, the results may not accurately reflect the practices of social workers in residential care homes towards transgender and nonbinary youth.

Implications for Clinical Social Work

So, what can clinical social workers at residential care homes do to promote an affirmative and inclusive care towards transgender and non-binary youth in their everyday practices? How can they become allies? Our result show that the individual actions of the professionals have great potential to alleviate the situation for young persons. The interviewees emphasise the need to address and manage situations of harassment and discrimination, to build trust and confidence and to provide emotional support. They also highlight concrete examples of creating an inclusive trans- and non-binary affirming space, such as using appropriate pronouns, ensuring access to menstrual hygiene products and gender-affirmative clothing and other items. Furthermore, the interviewees stress the importance of being role models and self-reflective practitioners and they argue that it is essential to examine and challenge their own prejudices and attitudes regularly. They also share that approaching transgender and non-binary youth with openness and respect create space for dialogue, care and support which they see as key factors in building affirming and supportive relationships. Overall, our findings are in line with recommendations based on a scoping review of how to promote the resilience of LGBTQIA + youth in out-of-home care, and to prevent and eliminate adversities, despite the low representation of transgender and non-binary youth in the studies found and included (González Álvarez et al., 2022).

Conclusion

In the present study, we have focused on the perspectives of clinical social workers at residential care homes in Sweden. Overall, they identify significant challenges to developing clinical social work that is affirming of transgender and non-binary youth.