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LGBTIQA+ Community

Challenges faced, topics to be discussed, discrimination in palliative care, healthy work practices, inclusive communication, glossary of common terms, and coming out models for young and older people

This page has three sections:

  1. Background Material that provides the context for the topic

  2. A suggested Practice Approach

  3. A list of Supporting Material / References

Feedback welcome!

Background Material

Definitions See CFCA Resource Sheet (2022). LGBTIQA+ glossary of common terms. Retrieved from

Sex: A label assigned at birth of female, male, or sometimes intersex.

Gender: A social and legal status of male or female. A set of expectations from society about behaviours and characteristics. Each culture has standards about the way that people should behave based on whether they’re male or female.

Gender Identity: A person’s inner feelings about themselves. Gender identity is how someone views their own gender and what they call themselves. Someone’s gender identity doesn’t have to match their sex assigned at birth. Some examples of gender identity include identifying as a man, woman, or gender non-binary.

Heteronormativity: The cultural assumption that everyone is heterosexual until they tell you otherwise, i.e. heterosexuality is the default (preferred) expression of sexuality.

Transgender: A general term used to describe someone whose gender expression or gender identity are different than the sex they were assigned at birth.

Heterosexism: The belief that heterosexuality is better than other sexual orientations.

Homophobia: Fear or hatred of people who are gay, lesbian, or bisexual.

Transphobia: Fear and hatred of people who are, or are perceived to be, trans-identified or gender non-conforming.

Heteronormativity is the belief that heterosexuality is the default, and therefore the preferred, expression of sexuality. It is also often associated with beliefs in birth-based gender expression (e.g., the genitals you are born with determine your gender identity), a clear gender binary, and traditional gender roles. Heteronormative culture can reinforce homophobia, heterosexism (discrimination in favor of opposite-sex relations), and the belief that same-sex relationships are non-conforming. Social theorist Michael Warner coined the term “heteronormative” in 1991, and further examined the ideology in his book Fear of a Queer Planet (1993), one of the building blocks of queer theory.

1. Treatment of homosexuality as “a phase.” One of the most common examples of heteronormativity is the belief that any non-conforming sexual orientation or sexual identity (especially homosexuality and bisexuality) is “just a phase” and that the individual will grow out of it and live a heterosexual life.

2. Media representation of heterosexual couples. There is a prevalence of heterosexual couples in mainstream media—from commercials to romantic comedies. This prevalence reinforces heterosexuality as a social standard for sexual expression.

3. Preference for biological pronouns. When someone insists on referring to another person according to their biological sex rather than their personal preferences, they are reinforcing heteronormative beliefs.

4. Health care discrimination. LGBTQ people, especially transgender people, may face struggles when trying to receive proper healthcare due to lower rates of insurance coverage and fewer healthcare providers that understand their needs—a result of heteronormative culture.

5. Parental disapproval of LGBTQ+ children. Some heteronormative parents subscribe to homophobia or transphobia and disapprove of their children coming out as LGBTQ+ or dating those individuals (instead preferring heterosexual, cisgender individuals).

6. Assigning gender to intersex people. Some parents of intersex babies elect to perform medically unnecessary surgery on their baby’s genitalia to ensure they are unambiguously male or female.

Homophobia is an aversion to gay or homosexual people or their lifestyle or culture and behaviour or an act based on this aversion. Other definitions identify homophobia as an irrational fear of homosexuality.

Heterosexism is an ideological system that denies, denigrates, and stigmatizes any non-heterosexual form of behaviour, identity, relationship, or community. Examples of heterosexism include a ban against lesbian and gay military personnel; widespread lack of legal protection from antigay discrimination in employment, housing, and services; hostility to lesbian and gay committed relationships, e.g., laws against same-gender marriage; and the existence of sodomy laws.

Note: Homophobia has typically been employed to describe individual antigay attitudes and behaviours whereas heterosexism has referred to societal-level ideologies and patterns of institutionalized oppression of non-heterosexual people.

Transgender is a term that includes the many ways that people’s gender identities (how you feel inside and how you express your gender) can be different from the sex they were assigned at birth.

  • Sex is a label — male or female — that you’re assigned by a doctor at birth based on the genitals you’re born with and the chromosomes you have. It goes on your birth certificate.

  • Gender is much more complex: It’s a social and legal status, and set of expectations from society, about behaviours, characteristics, and thoughts. It’s not about body parts; it’s about how you’re expected to act because of your sex. Each culture has standards about the way that people should behave based on their gender.

  • Gender identity is how you feel inside and how you express your gender through clothing, behaviour, and personal appearance. It’s a feeling that begins very early in life.

Transphobia is the fear, hatred, disbelief, or mistrust of people who are transgender, thought to be transgender, or whose gender expression doesn’t conform to traditional gender roles. Transphobia can prevent transgender and gender nonconforming people from living full lives free from harm. Transphobia can take many different forms, including

  • negative attitudes and beliefs

  • aversion to and prejudice against transgender people

  • irrational fear and misunderstanding

  • disbelief or discounting preferred pronouns or gender identity

  • derogatory language and name-calling

  • bullying, abuse, and even violence

Transphobia can create both subtle and overt forms of discrimination.

Challenges for those identifying as LGBTIQA+

People identifying as LGBTIQA+ must cope with a sexual orientation that is different from those around them and is often not accepted or tolerated by others. Consequently, they may experience additional stress as a function of their LGBTIQA+ identity and the stigma and oppression associated with it, which puts them at risk for experiencing a variety of emotional and physical challenges. These challenges include

  • Coming out and disclosure—during this turbulent time, LGBTIQA+ may experience social isolation, rejection by peers, humiliation, discrimination, victimization, abandonment by family and caregivers, and limited access to people who will listen to their concerns and provide guidance

  • Mental health and substance use issues—higher rates of depression and suicide attempts than heterosexual people; substance use is used to escape the emotional and physical pain LGBTIQA+ experience.

  • Sexuality and sexually transmitted diseases—this includes risk of sexually transmitted diseases, a higher risk of engaging in unsafe sex through loneliness, isolation, low self-esteem, high emotional distress.

  • Harassment and violence—from peers and family.

Writing Themselves in 4 (A report which looked at the health and wellbeing of LGBTQA+ young people)

Writing Themselves In 4 (Hill et al., 2021) involved an online survey of 6418 young people living in Australia aged between 14 and 21 years who identified as LGBTIQA+. The survey was open for completion between 2 September and 28 October 2019. Findings included:

  • 81.0% of participants displayed signs of high or very high psychological distress (K10) – four times higher than the general population

  • 25.6% of participants had attempted suicide at some point in their lives

  • 10.1% had attempted suicide within the previous 12 months – three times higher than the general population

    • More common among those aged 14-17 – possibly because of living with unsupportive families

    • Number is 1 in 7 for those living in rural or remote areas – twice as high as those in capital cities

  • 40.8% experienced verbal harassment in the past 12 months

  • 22.8% experienced sexual harassment or assault in the past 12 months – this group was twice as likely to attempt suicide

  • 9.7% experienced physical harassment or assault in the past 12 months

  • 60.2% of those at secondary school felt unsafe or uncomfortable in the past 12 months

  • 63.7% of those at school frequently heard negative remarks regarding sexuality in the past 12 months

  • 38.4% missed days of school because they felt unsafe

What makes LGBTIQA+ young people feel good about themselves?

  • Finding meaningful connections with others

    • ‘Having loving friends and a partner and being comfortable with the thought that whatever happens in life I’ll still have them.’

  • Social connectivity to friends and family

    • ‘Having friends who get me out of my depressive episodes and into real life, they support me.’

  • Creating and achieving

    • ‘Making music, singing, writing, walking, gym, wearing clothes I like, talking about my sexuality openly, acting, performing, creating fiction.’

  • Affirmation from others

    • ‘Dressing the way I want to having friends and family refer to me by the right name and pronouns, seeing the changes in my body as I progress in HRT.’

  • Affirmation from within

    • ‘Thinking of me as a girl’

Findings in the report are summarised under headings:

  • Disclosure and support from others

  • Educational settings: supportive structures and practices

  • Experiences of affirmation or discrimination in the workplace

  • Experiences of harassment or assault

  • Mental health and wellbeing

  • Experiences of homelessness

  • Alcohol, tobacco and other drug use

  • Engagement with professional support services

  • LGBTIQA+ community connection

  • Feeling good as LGBTQA+ young people

  • Trans and gender diverse participants

  • Disability or long-term health conditions

  • Ethnic and cultural background

  • Areas of residence

Twenty-one recommendations are made under seven headings:

  • The importance of primary prevention

  • Mental health sector

  • Other health and social care settings

  • Families, allies and communities

  • Educational settings

  • Future research

  • Maximising impact of the findings

Commenting on this report, Florance and Hermant (2021) point out that coming out is getting easier for LGBTQA+ youth but not in all areas. They receive support from friends at a high rate (over 85%), but receive less support from family and classmates. The authors point out that psychological distress is three times higher than the general population. Furthermore, harassment and assault based on gender or sexuality is still not uncommon.

Meixner (2021) found LGBTQA+ young people look for acceptance by their peers and families, freedom to affirm and express their identity and feel safe.Unfortunately 60% reported feeling unsafe or uncomfortable at secondary schools

Discrimination in Palliative Care

From Doherty & Barrrett (2021)

Palliative care for LGBTIQA+ people with life-limiting conditions should be accessible, inclusive and affirm their right to dignity and respect. However, palliative care services are not living up to this ideal.

Palliative care services today still discriminate against patients’ family of choice and continue to preference biological families even though LGBTIQA+ communities are more likely to involve their family of choice rather than their family of origin when in palliative care.

Recent research revealed high rates of discrimination or “anticipatory fear” of discrimination that limited access to palliative care for people in the LGBTIQA+ community. This discrimination is a result of the experiences of partners, friends and families during the HIV/AIDS epidemic that happened 40 years ago. There is a need for workforce education and training, inclusive policies, and procedures and services that are respectful, compassionate and person-centred.

Barriers to palliative care for sexuality and gender diverse people include:

  • a lack of recognition of chosen family partners, carers and next of kin,

  • discrimination and stigma,

  • social isolation and loneliness,

  • fear of sub-standard care from faith-based palliative care providers,

  • disrespect for bodily autonomy,

  • fears of being mis-gendered, and

  • failure by staff to use preferred pronouns.

Because of this LGBTIQA+ people can delay palliative care, not disclose their sexuality, and report fatigue when having to educate healthcare professionals about their needs.

What works well?

  • Dignity and respect for the chosen family and partner.

  • Correct gendering.

  • Using a person’s correct name and pronoun.

  • Allowing the partner to stay in the room with a patient at end of life.

Key Competencies

Fredriksen-Goldsen et al. (2014) suggest ten key competencies required to promote culturally competent practice with LGBT adults and their families.

  1. Critically analyse personal and professional attitudes toward LGBTQIA+ individuals and how this may impact on your practice.

  2. Understand the historical circumstances of LGBTQIA+ individuals

  3. Recognise LGBTQI+ subgroups are not necessarily homogenous.

  4. Apply current theories of ageing and social health perspectives with LGBTQIA+ individuals.

  5. Include the larger social context and structural and environmental risks and resources in a BPS assessment..

  6. Ensure the use of language is appropriate for working with LGBTIQA+ individuals to establish and build rapport.

  7. As past experience may discourage LGBTQIA+ individuals from seeking services, provide sensitive and appropriate outreach to adults, their families, caregivers and other supports.

  8. Enhance the capacity of LGBTIQA+ individuals and their families, caregivers, and other supports to navigate ageing, social and health services.

  9. Analyse agency program and service policies to ensure they do not marginalise and discriminate against LGBTQIA+ individuals.

  10. Understand and articulate the ways that social, state and federal laws negatively and positively impact LGBTIQA+ individuals and advocate on their behalf.

Same-sex couple families in Australia

  • The number of same-sex couple parented families in Australia is growing.

  • Acceptance of the equality of same-sex couples is steadily increasing and is strongest among women and young people.

  • Overall, research evidence indicates that children raised in same sex parented families do as well emotionally, socially and educationally as other children.

  • Children raised in same sex parented families may be adversely affected by social stigma (Qu, Knight & Higgins, 2017).

Practice Approach

Gay affirmative practice does not prescribe a particular method of practice but is consistent with many social work practices, e.g. person in environment (social settings and influences) and a strengths perspective (highlight strengths and support self-determination). LGBTIQA+ may experience stress, social isolation, rejection by peers, discrimination, abandonment by family and caregivers, mental health and substance use issues, sexually transmitted diseases, harassment and violence from family and peers.

Farrugia (2022) has a brief article describing the importance of and how to achieve inclusive communication with LGBTIQA+ clients.The main points covered are included in a box under the Farrugia reference in the Supporting Material section that follows.

There are 10 important topics that gay men and lesbians should discuss with health care providers. For gay men, these issues include: safe sex, HIV/AIDS, and other sexually transmitted diseases; alcohol, illicit drug, and tobacco use; depression and anxiety; prostate, testicular, and colon cancer; and diet and exercise issues. For lesbians, the list includes: breast and gynecologic cancer; alcohol, illicit drug, and tobacco use; depression, suicide, and anxiety; diet and exercise; domestic violence; osteoporosis; and heart health. Health issues for bisexuals include: alcohol, illicit drug, and tobacco use; sexual health; cancer; nutrition, fitness, and weight issues; social support; and for women only, heart health. Institutionalized heterosexism and a reluctance to disclose sexual orientation and/or same-sex relationships to medical and social service providers may prevent older LGBTIQA+ adults from accessing adequate health care.

Social workers should avoid imposing their values on clients and support clients’ right to self-determination. Treat them as equal partners in the relationship. Empowerment practice embraces: accepting the clients’ definitions of problems; identifying and building on clients’ strengths; and advocating for clients.

Social workers should be aware of coming out models for both young and older people.

Young People Indentifying as LGBTIQA+

Prosser (2019) provides an overview of ways to support a child or young person who is questioning their gender identity or who has come out as trans or gender diverse. Some of the key messages are:

  • Being trans or gender diverse is not a mental illness.

  • It is important to acknowledge that what this child is experiencing is real.

  • Not everyone who is trans will want to have an identity of being ‘trans’, but rather will just want to live in their affirmed gender. This is important to keep in mind as you are supporting a child who may simply see themselves as a boy or a girl, not as a trans girl or trans boy.

  • Gender is socially constructed and often strictly controlled. Society has very strong views and expectations on how people should express their gender as either male or female, which may not fit with how the child feels.

  • Treat every child as an individual. The affirmation journey is different for every person and medical affirmation is not the only way to ‘be transgender’.

  • Referral to a paediatrician/gender specialist to discuss puberty blocking medication before puberty is crucial for long-term medical affirmation.

  • Be open to having a discussion with the child and their family about what they are experiencing and affirm for them that how they are feeling is valid.

  • Take the time to do more research to improve your understanding, so that you can provide informed advice. The responsibility for education should not fall upon the child and their family.

Prosser’s article is worth consulting if social workers wish to educate themselves about how to support trans and gender diverse children and young people and their families throughout the ‘coming out’ process. You’ll find the link in the Supporting Material together with the resources (websites) listed in the article.


Social Workers who work with youth are advised to develop the following skills that will provide support to LGBTIQA+:

  1. create safe environments for LGBTIQA+;

  2. assess, don’t assume, LGBTIQA+ sexual orientation;

  3. help LGBTIQA+ work through the stages of the coming out process;

  4. determine who supports the person’s sexual orientation;

  5. treat the presenting challenge, not the sexual orientation;

  6. examine the presenting challenge in the context of their lives as LGBTIQA+ individuals;

  7. work with family members to accept LGBTIQA+ and support their identities;

  8. refer people to gay affirmative resources;

  9. acknowledge negative feelings about LGBTIQA+ and work to address these feelings;

  10. engage in ongoing training and continuing education around LGBTIQA+ issues.

Making schools more inclusive to LGBTQ+ students

It is a well-supported fact in mental health research that LGBTQ+ individuals are at greater risk for mental health challenges than those from other groups. According to the National Alliance on Mental Illness, those who identify as LGBTQ+ are nearly three times more likely to develop a mental health disorder such as depression or anxiety and are significantly more likely to attempt suicide and abuse substances. The risks are especially high for adolescents and young adults, with LGBTQ+ youth ages 10–24 being four times more likely than their peers to attempt suicide.

Because many students in districts across the nation are part of the LGBTQ+ community and use mental health services, schools can play an important role in creating an inclusive and trauma-informed environment to prioritize mental health prevention and intervention.

Steps to creating an inclusive environment

Providing and promoting an inclusive, welcoming and trauma-informed school environment is more critical than ever for ensuring that all students, including LGBTQ+ students, can experience the sense of safety and belonging that they deserve. How can this be accomplished?

  • Create a culture shift. School staff must first be willing to take responsibility for all students in the school. This necessitates learning from one another through communication, collaboration and professional development opportunities.

  • Become trauma informed. Establishing a safe and inclusive school setting requires that staff be trauma informed. Staff must be willing to recognize their own implicit biases and understand that everyone has their own story. All staff — not just teachers and administrators — need to be educated and equipped to recognize basic signs and symptoms of mental health challenges and know who to contact if they have concerns about a student’s well-being.

  • Provide resources. Students and families need to be aware of the resources available to them on and off campus. All staff should be familiar with key resources, including local mental health authorities, LGBTQ+ organizations, crisis hotlines and bilingual providers. In addition, posters with inclusive language celebrating diversity and addressing the stigmas surrounding mental health challenges need to be visible throughout campuses.

  • Make time for connection. Staff should make an effort to learn the names of all their students and use their correct names and pronouns. This will allow each student to feel valued. It also models respect and acceptance for all students. To create or strengthen students’ support systems, staff should also establish regular contact with families to develop trust and build a successful partnership (Opiela, 2023).

A comprehensive assessment with LGBTIQA+ adults should include the standard assessment components such as problem identification, client perception of the problem and its solutions, examination of bio-psycho-social-spiritual functioning, identification of social supports and community resources, and an inventory of client strengths. Age-specific assessments should include discussions of clients’ wishes for the future, exploration of clients’ cultural background, consideration of their family dynamics, and potential caregiver concerns.

Social workers should recognize the importance of support networks and assist older LGBTIQA+ adults in identifying community resources that build on these networks of family and friends. Embrace client strengths and (a) support clients’ self-determination; (b) view clients’ LGBTIQA+ identities as healthy, not pathological; and (c) assist clients in questioning and challenging oppressive structures in their lives. Affirmative practice means engaging in advocacy efforts, being aware of the complexity of self-identity and healthy identity development, and assisting LGBTIQA+ individuals to be productive older members of society.

Having conducted a thorough assessment, social workers can link LGBTIQA+ adults with appropriate resources and services. Such referrals should be made on the basis of the assessment and consider clients’ physical, social, mental, and spiritual needs.

Intimate Partner Violence

Even though people who identify as LGBTIQA+ experience intimate partner violence at similar rates as thoe who identigy as heterosexual, there has been an invisibility of LGBTIQA+ relationships in policy and practice responses and a lack of acknowledgement that intimate partner violence exists in these communities. In addition, service providers lack awareness and understanding of the LGBTIQA+ population and their experience of intimate partner violence. (Campo & Tayton, 2015)

Informal Supports for LGBTIQA+ People

Informal support is a key source of social support and belonging for LGBTIQ+ people, particularly for those LGBTIQ+ clients who have faced rejection from their families of origin, have been unable to access inclusive support and are unable to access LGBTIQ+ specialist services. Connecting LGBTIQ+ clients to peer support initiatives, support groups and positive informal friend and family relationships can be affirming and may improve outcomes alongside inclusive service provision (Farrugia, 2022). Farruguia lists a selection of resources and organisations that may be helpful in this area:

Maintaining a Balanced / Healthy Relationship to One’s Work

Working with LGBTIQA+ can be dynamic and rewarding while also personally and politically challenging. The latter can lead to trauma and burnout. The Rainbow Network suggest strategies for managing stress, preventing burnout, and creating personal and professional sustainability.

For some, engaging in advocacy and activism is empowering and energising, for others it can be tiring, especially if you do this kind of work as your day job. If feeling tired:

  • Read the good news stories as well as the bad. For Example in Australia

    1. Same-sex marriage became legal in 2017

    2. Birth certificates can be amended to reflect gender identity

    3. In 2021 88.3% of young people reported their friends were supportive of their gender identity.

  • Choose a level of engagement that is personally sustainable

  • Join community action groups to support each other and share the load

If you feel isolated and carry a heavy workload:

Look after your personal wellbeing:

  • Make space in your day for mindfulness practices.

  • Make boundaries that separate work life from personal life, e.g. changing from work clothes to home clothes.

  • Look after your physical health and be aware of the impact of drug or alcohol use.

  • Recognise the signs of burnout and take appropriate action. Signs of burnout can include feeling tired most of the time, feeling ‘jaded’ about the work or industry (also known as ‘compassion fatigue’), feeling hopeless or helpless about your clients, or making snappy remarks at work or with loved ones. Help colleagues recognise the signs of burnout too.

  • Ask for help.

Supporting Material

(available on request)

Campo, M., & Tayton, S. (2015). Intimate partner violence in lesbian, gay, bisexual, trans, intersex and queer communities. Retrieved from

CFCA Resource Sheet. (2022). LGBTIQA+ glossary of common terms. Retrieved from

Crisp, C., & McCave, E. L. (2007). Gay affirmative practice: A model for social work practice with gay, lesbian and bisexual youth. Child and Adolescent Social Work Journal, 24: 403-421.

Crisp, C., Wayland, S., & Gordon, T. (2008) Older gay, lesbian, and bisexual Adults: Tools for age-competent and gay affirmative practice. Journal of Gay & Lesbian Social Services, 20, 5-29, DOI: 10.1080/10538720802178890

Doherty, L, & Barrett, A. (2021). Palliative care needs to address end of life discrimination experienced by LGBTIQ+ people. Retrieved from

Farrugia, C. (2022). Inclusive communication with LGBTIQ+ clients. CFCA Evidence to Practice Guide. Retrieved from “LGBTIQA+ Glossary of Common Terms” supports this article and can be found at

Florance, L., & Hermant, N. (2021). Coming out is getting easier for LGBTQA+ youth, but not for everyone. Retrieved from

Fredriksen-Goldsen, K. I., Hoy-Ellis, C., Goldsen, J., Emlet, C. A., & Hooyman, N. R. (2014). Creating a vision for the future: Key competencies and strategies for culturally competent practice with lesbian, gay, bisexual and transgender (LGBT) older adults in the health and human services. Journal of Gerontological Social Work, 57(0), 80-107. doi: 10.1080/01634372.2014.890690

Hill, A. O., Lyons, A., Jones, J., McGowan, I., Carman, M., Parsons, M., Power, J., & Bourne, A. (2021) Writing Themselves In 4: The health and wellbeing of LGBTQA+ young people in Australia. National report, monograph series number 124. Melbourne: Australian Research Centre in Sex, Health and Society, La Trobe University. Retrieved from

Inclusive services for LGBT older adults: A practical guide to creating welcoming agencies. (2018). Retrieved from

Meixner, S. (2021). National survey finds safety and affirmation essential fundamental needs for LGBTQA+ young people. Retrieved from

Opiela, S. (2023, August 15). Making schools more inclusive for LGBTQ+ students. Counseling Today.

Prosser, S. (2019). Supporting trans and gender diverse children and their families. Retrieved from

Qu, L., Knight, K., & Higgins, D. (2017). Same-sex couple families in Australia. AIFS Fact Sheet, July 2017. Retrieved from

Rainbow Network. (2021). Balance or burnout; Sustainability for workers in the LGBTIQA+ youth sector. Retrieved from


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