Protecting children by creating inclusive environments

By Jyll Walsh, DrPH, Assistant Director and Mariah Smith, Public Health Intern

Promoting well-being and ensuring the safety of all children and families drives the work of Prevent Child Abuse Georgia. Decades of child development research tell us that, in order to thrive, children must have their physical, social, emotional, and educational needs addressed. Creating inclusive environments, supports, and policies to account for the differing needs of LGBTQIA+ youth, such as gender-affirming care, is essential to supporting their well-being.

Nationally, there has been a stark increase in anti-LGBTQI+ legislation proposed at the state level. Many of these bills have specifically targeted supports available to transgender youth. There have been over 400 bills proposed across the Nation in 2023 compared to 200 proposed from 2015 to 2019¹. This surge in social discrimination, stigma, and reduction in care has contributed to the toxic stress LGBTQI+ people experience. A study by Child Trends found that the number of texts to Crisis Text Lines in states where anti-LGBTQI+ legislation was proposed significantly increased in the four weeks after such legislation was proposed².

Some proposed bills would even criminalize parents who affirm their children’s gender identity, defining such affirmation as child abuse. Dr. Melissa Merrick, President and CEO of Prevent Child Abuse America, emphasizes that “These laws stand in direct opposition to the evidence-based care recognized by numerous professional societies, including the American Academy of Pediatrics, American Medical Association, Endocrine Society, and American Academy of Child and Adolescent Psychiatry^3,4.”

To recognize Pride Month, PCA Georgia is raising awareness of the role gender-affirming care can play in the healthy development of transgender children and youth.

What is gender-affirming care?

Gender-affirming care refers to medical, psychological, and social support provided to individuals whose gender identity differs from the sex they were assigned at birth⁵. It seeks to affirm and validate a person’s self-identified gender, helping them align their physical appearance, social roles, and overall well-being with their gender identity⁶.

While there are many different types of gender-affirming care, components of gender-affirming care can vary depending on an individual’s needs. Components comprise but are not limited to, the following: medical intervention, mental health support, social support, use of pronouns, and education and awareness.

Affirming Care7	What is it?	When is it used?	Reversible or not
Social Affirmation	Adopting gender-affirming hairstyles, clothing, name, gender pronouns, voice therapy and restrooms and other facilities. Affirmation extends beyond individual support to broader societal change. It involves educating service providers, employers, and the general public about transgender and gender diverse experiences, needs, and rights8. This helps reduce stigma, discrimination, and disparities in healthcare access.	At any age or stage	Reversible
Individual and Social Support	Mental health professionals play a crucial role in helping individuals explore and affirm their gender identity. They help to navigate challenges related to coming out, social acceptance, and gender dysphoria (discomfort or distress resulting from a disconnect between one’s gender identity and assigned sex). Creating safe and inclusive environments where individuals can express their gender identity freely. This may include support groups, community organizations, or LGBTQI+ resource centers that provide education, advocacy, and social networks8. Assistance with name and gender marker changes on legal documents, such as driver’s licenses or passports, is also an essential part of social support and affirmation.	At any age or stage	Reversible
Puberty Blockers	Using certain types of hormones to pause pubertal development	During puberty	Reversible
Hormone Therapy	Testosterone hormones for those who were assigned female at birth Estrogen hormones for those who were assigned male at birth	Early adolescence onward	Partially reversible
Gender-Affirming Surgeries	“Top” surgery – to create male-typical chest shape or enhance breasts “Bottom” surgery – surgery on genitals or reproductive organs Facial feminization or other procedures	Typically used in adulthood or case-by-case in adolescence	Not reversible

Table Adapted from the Office of Population Affairs: https://opa.hhs.gov/sites/default/files/2022-03/gender-affirming-care-young-people-march-2022.pdf

“The goal is not treatment, but to listen to the child and build understanding — to create an environment of safety in which emotions, questions, and concerns can be explored,” says Rafferty, lead author of a policy statement from the American Academy of Pediatrics (AAP) on gender-affirming care⁸.

All in all, it is crucial to note that gender-affirming care is not a one-size-fits-all approach. The specific interventions and support provided vary based on an individual’s unique needs, goals, and preferences. Collaborative decision-making, respect for autonomy, and individualized care are key principles guiding gender-affirming care.

Gender-affirming care and well-being

For transgender children and youth, early gender-affirming care is crucial to overall health and well-being. Evidence shows that gender-affirming care improves mental health⁹. A 2019 study reveals that individuals that receive pubertal suppression, a mode of gender-affirming care, during adolescence have lower mental health concerns compared to those that did not receive treatment¹⁰. This coincides with a 2022 observational study where there were “60% lower odds of depression and 73% lower odds of suicidality” in youth that had gender-affirming care¹¹. Without access to these treatments, transgender youth may experience increased rates of depression, anxiety, self-harm, and even suicide.

Creating inclusive environments

PCA Georgia is calling on all child and youth-serving organizations to cultivate a culture of inclusion and affirmation by using their chosen names and stated pronouns, providing equal access to facilities and activities, in materials, examining your practice and policies to ensure they are inclusive, and connecting LGBTQ+ youth with appropriate resources and community connections.

Organizational resources:

• GLAAD https://glaad.org/ 
• Webinar: Engaging Families in Affirming Trauma-Informed Care for LGBTQ Children and Youth (SAMHSA)
• Tipsheet with practical suggestions: Gender-Affirming Care is Trauma-Informed Care (The National Child Traumatic Stress Network)
• Resources for working with LQBTQ Youth (The National Child Traumatic Stress Network)
• The Center of Excellence in LGBTQ+ Behavioral Health Equity
• Children’s Bureau Learning and Coordination Center https://cblcc.acf.hhs.gov/shareable-media/social-media-resources-lgbtqia2s/
• Free Your Feels- promoting youth mental health https://www.freeyourfeels.org/
• The Trevor Project: https://www.thetrevorproject.org/

Mental Health Resources

• Georgia Parent Support Network https://www.gpsn.org/
• Chris 180 https://chris180.org/
• Youth Spark https://www.youth-spark.org/
• Georgia Mentor https://www.ga-mentor.com/
• Summits Edge Counseling https://summitsedgecounseling.com/
• All in One Family https://www.all1familyinc.org/
• Atlanta Therapeutic Collective https://www.atlantatherapeuticcollective.com/
• The Comfy Place https://thecomfyplacellc.com/
• Leaf Therapy https://www.leaftherapyservices.com/
• Colgate Pride Center https://www.colgate.edu/about/campus-services-and-resources/colgate-pride
• Balanced Living https://balancedliving.info/
• Middle Georgia Behavioral Health https://mgabehavioralhealth.com/

Social Supports

• Lambda Legal https://lambdalegal.org/
• Multi-agency Alliance for Children https://www.maac4kids.org/
• Charis Books & More https://www.charisbooksandmore.com/