Supporting Transgender Youth: A Case Study on Care Challenges

Case Presentation Clarice Fels

Demographics Served The demographic that we serve are youth ages 13-21 that are in the care of the state. Along with impoverished families needing extra resources. Presentation title 2

Presenting Client Problem & Relevant Social History Cut themselves off from family My client's family cut her off because she came out as transgender at fourteen and was not accepted. She is only in contact with her siblings and wants to provide a stable environment for them someday instead of their parents. Keeping stable employment to save funds Longest employment has been a year, working at McDonald's. Recently passed Missouri Options tests and received her high school diploma. Which will open many more doors for her. Getting gender affi rming care Medicaid makes this impossible, but this is a big goal that she has. Presentation title 3

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Reasons I'm working with this client Practicum I have been managing this client's case. Build Rappore I need to work on building that client social worker relationship with them so they can feel like they can trust me. Help build independent living skills Help them to reach their personal and professional goals to be able to live on their own successfully. Presentation title 4

Name of Organization and Services Provided • The Good Samaritan Boys Ranch • Non-for-profit private agency Providing • Family Services, Stabilization Services, Specialized Care, Transitional Living, and Transitional Living Apartments Presentation title 5

How does The Good Samaritan Boys Ranch engage in practices that advance social, economic and environmental justice? • We encourage youth to be involved in the local and state legislature to help them be informed about things going on regarding their lives. Whether Medicaid is having their funding expanded or cut. Also, things regarding children and youth in care of the state. • We are supportive of youth if they feel like they need to stand up for a cause. GLO here in the community is really involved in making sure LGBTQ+ youth feel supported and that they have a safe space to come and have friends. • Environmental justice is probably one of the ones that we use every single day. The goal of this nonprofit is to make sure these youth are well taken care of and do not feel isolated or less than because of the things they do not get to do or have. We strive to provide the best home as possible while providing a stable and welcoming environment. Presentation title 6

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What social policies at the local, state, and federal level impact this agency’s service delivery system (EPAS 5)? • The state legislatures that just got passed regarding youth/minors and hormone replacement therapy for transgender youth. This prevents our organization from providing gender affirming care. The recent legislature that bans drag, this prevents our youth from seeing relatable and affirming supportive culture in the LGBTQ+ community. Presentation title 7

How does this agency use evidence- based research to inform and improve practi ce, policy, and/or service delivery Constantly making sure we as an organization are qualified by constantly having staff participate in trainings regarding our service population. Trauma informed care training is one of them.

Engagement (EPAS 6) Building Relationships with Residents This particular resident and I clicked really well, had the same sense of humor and could laugh at ourselves. We both talked about our abuelas (grandmother). This resident and I could bond over our shared culture. Along with being able to talk about my past in hormone replacement therapy. We have the same primary care doctor, and I was letting them know how the process was for me getting on hormones. Presentation title 9 Describe how you and the client developed a helping relationship.

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What specific social work techniques did you use to develop a helping relationship? Strengths Based/ Solution focused approach Task Centered Social Work Practice Groupwork Presentation title 10

Were there challenges? How were these overcome? Presentation title 11 Yes, there were many challenges, mostly work- related stress. Motivation issues due to depression and anxiety about upcoming permanency hearing. These were overcome mainly because the client realized she hated being broke. They were hoping to get out of the fast-food industry but to do that they had to get their high school diploma. They dropped out as soon as they turned 18. They then re enrolled in school and is currently two HiSet tests away from their high school diploma!

Assessment (EPAS 7) Presentation title 12 1. Using ecological systems theory to guide your assessment, develop a client genogram (of at least three generations) and/or an ecomap (at least one of these tools is required for this project; both tools are encouraged). 2. Discuss what information you gleaned from the genogram and/or ecomap using the following domains as a guide: economic, spiritual, cultural, physical, mental, emotional, and social. 3. Describe any standardized or agency assessment tools that you administered and their results. 4. How did assessment affect your understanding of the client? These assessments do not help me whatsoever. I don't like ecomaps or genograms, so this did nothing for me. Included is an ecomap I did for this client.

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EPAS 7contd. 6, Present the treatment plan or goal planning you developed with the client. Goal plan was to get their license or permit, graduate high school, and get a better more fulfilling job. 7. Identify goals and tasks including parties responsible and timeframes. This was all up to my client; we could only get them to the resources, but we couldn't make them follow through. 8, How did the client and you choose and prioritize these goals? These goals were all high on the list, so to say one was more important than the other is not realistic. It was honestly whichever was the easiest one to complete first. 9.What diversity factors influenced treatment planning? These may include, but are not limited to, age, class, color, culture, disability and ability, ethnicity, gender, gender identity and expression, immigration status, marital status, political ideology, race, religion/spirituality, sex, sexual orientation, and tribal sovereign status (EPAS 2). Presentation title 13

Intervention (EPAS 8) • Describe the intervention strategies you utilized with the client system. With this client system I used case management along with active listening and advocacy. Using these helped the client feel like they were the ones choosing this for themselves. In this case “this” refers to completing the HiSet tests to attain their high school diploma. During their permanency hearing on April 4 th the judge requested the only thing he wanted to see my client accomplish by next permanency hearing was that she obtain their high school diploma or GED. • How did your interventions connect with treatment goals and your assessment? The interventions connected well because the treatment goals were to obtain their driver's license or permit, complete or work towards their GED or diploma. Also, trying to find a better more fulfilling job. • What specifically did you do to help the client? Helped them get enrolled at Hillcrest High School so they could start studying to take the HiSet tests, helped them get to and from the tests, help them if they were to ask for extra support or if they needed a break from the pressure, we would have a “1 on 1” spending quality time together usually over a meal and just talk about silly things or anything in general. This really helped the client to decompress and recoup from all that had going on. • How did you address client resistance or other challenges? Well before I got involved with this client they had just gotten off a bender. Not being sober at all at any point of the day. Was honestly spiraling and we were considering releasing her from the program. Before I met her she seemed really jaded towards meeting new people and her guard was up to the max. I tried not to take any of that personally and just gave her the time and space to react as she saw fit. Within a couple weeks she came around and was acting like she trusted me. • What theory(ies) guided your intervention with the client and the presenting problem? Ecological systems theory was the one I used to guide me in terms of intervention with the client when needed and listening to their presenting problem. It was external factors (quitting their job, family alienation (self inflicted), and other outside stressors that provided me with the clues as to which theory was most relatable to this client and their situation. Presentation title 14

Evaluation and Termination (EPAS 9) • How did you evaluate the client progress on the treatment plan? I would evaluate it by looking to see what was being worked on or had already been completed. • Describe any standardized instruments or agency tools that you used and their results. The agency has templates for going over and setting goals with the client during every quarter. In the quarterly report we write new ones. Typically this is every three months. • What were the evaluation findings? That this client was well on their way to accomplishing all their goals. • How did you terminate with the client? (e.g., planned termination, unplanned termination, case transfer, or case closure). I gave them two weeks notice basically, like you would do for an employer. Of course in this case I wasn’t being too formal I just simply let them know that I was going to be leaving in two weeks on May 5th and to let me know “if there was anything I could do or provide for them in the meantime I will still be around helping in any way I can until then.” • What, if any, follow-up referrals upon formal termination did you make? I did not need to make any follow up referrals because it was I that would be leaving them. Not the other way around like if this were at Laura’s Home instead of the apartment program, they would be getting “evicted” if they had broken rules repeatedly or was just not working the program. In that case I would help them and their case worker work on referrals to other programs in Missouri. But this was not the case. Presentation title 15

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Ethical and Professional Behavior (EPAS 1) What did you learn about personal values and maintaining professionalism in practice? I learned to keep personal values out of my work. What I value might not be at all what my client values. This is pertinent, because you cannot have your personal values in practice and still have professionalism. You can have personal values, but they must be left at the door when you walk into work. How did you utilize supervision to guide professional judgement behavior? I utilized supervision to explain my encounters with my clients to my field advisor to review with them on how I could have done better in that situation. I also decompress to my field advisor too if I have had an intense day of not being able to voice how I have truly felt all day. How has this experience impacted your future social work? It has taught me how to maintain professionalism in my future career. I have a feeling I will have to do that a lot working in a hospital. There will be all different types of people there, ones that do not share my values. Presentation title 16

Presentation title 17 References 2022 epas . (n.d.). CSWE. https://www.cswe.org/accreditation/standards/2022-epas/

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