About 2-10% of North Americans self-identify as LGBTQ+ or lesbian, gay, bisexual, transgender, and queer (PHAC, 2009). Whereas in a study of Edmonton street-involved youth, about 23% identified as LGBTQ+ (Alberta Health Services, 2011).

A growing body of research demonstrates that LGBTQ+ youth face a number of increased social, mental health, educational and physical health concerns. It is not being LGBTQ+ that increases these risks. Rather, it is the lived experience of stigma, discrimination, isolation and prejudice that result in these challenges.


LGBTQ+ youth are more likely to:

  • Attempt suicide,
  • Experience high levels of depression (Ryan, 2009),
  • Use illegal drugs (Gaetz, 2004),
  • Have high risk sexual encounters,
  • Be involved in an unintended pregnancy (US Department of Health & Human Services, Office of Adolescent Health, 2012),
  • Contract HIV and sexually transmitted infections (STIs) (Ryan, 2009),
  • Experience assault,
  • Experience dating violence,
  • Have been sexually assaulted,
  • Experience bullying (Centers for Disease Control and Prevention, 2014), and/or
  • Be street involved or homeless (National Coalition for the Homeless, 2009).



I thought I was getting it together and now this. I was close to telling my friends I’m gay, but then I hooked-up with some girl at a party, and now I’m as confused as ever. I was sure that I was gay and that I like guys, but I’ve never had sex with a guy yet. When I told my aunt I was gay, she wasn’t surprised and even said that it’s all in the genes- I probably caught being gay from my uncle. Is it OK to like both guys and girls? What’s wrong with me?



A date beat me up last night. Gotta make some money you know. How else am I going to get my own place? Funny, they pay extra to get a girl like me, but then they get pissed off about it, like they’re worried that they’re gay or something. Maybe I deserve it, you know? Still better than my own dad being the one to punch me and call me lady-boy while my mom just stands by and watches him throw me out. She could have said something. I’d rather be here on the street than there…what kind of parents are they? I’m just sick of all of this.


Sexual and gender diversity are broad terms that include all of the ways a person’s sexuality is uniquely their own including sex (reproductive biology), sexual orientation, gender identity and gender expression. Often these broad terms are expressed as acronyms including: LGBT, GLBT, LGBTQ+, LGGBTTTQQAAAIP, LGBTQ2S+

When people are talking about sexual and gender diversity, they are talking about:

  • Sex: categories (male, female) to which people are typically assigned at birth. Sex assigned at birth typically appears on proof of identity documents, unless a person has documentation changed.
  • Sexual orientation: a person’s emotional and sexual attraction to others. It can be fluid and may or may not reflect sexual behaviors. Sexual orientation and gender identity are not the same thing.
  • Gender/gender identity: a person’s internal sense of identity as female, male, both, or neither, regardless of sex assigned at birth.
  • Gender expression: how a person presents their gender. This can include appearance, name, and pronoun. A cisgender person’s identity conforms to the cultural expectations of the sex assigned at birth.

Click here to learn more about sexual orientation, gender identity and gender expression.




LGBTQ+ Organizations such as PFLAG Canada or PREVNET have resources to support LGBTQ+ youth and their allys.


The acronym LGBTQ+ (lesbian, gay, bisexual, transgender, and queer) is often used as an umbrella term to refer to the spectrum of sexual minorities. The aim of defining terms is to help people increase their understanding. When we have better understanding, we are better able to provide good care.

Language is fluid. Some terms may have a negative meaning for some people and other terms go out of favour. Terms change and new terms become more accepted. Some words, like “queer” have been reclaimed by some members of the LGBTQ+ community; others find these words hurtful and offensive.  Some words that were once commonly used, like “homosexual” or “hermaphrodite” are now generally considered offensive.

Definitions of commonly used terms:

(Alberta Health Services, Sexual & Reproductive Health, Calgary Zone, 2017)




Always reflect the language the person is using and avoid using terms to label people. If a person uses a term to identify themselves, it can be useful to check understanding and ask “can you tell me more about what that means?”


When a person comes out, it is important to show supportive behaviors.

Supportive behaviors include:


  • Active listening,
  • Having encouraging and positive body language,
  • Talking about and supporting a youth’s LGBT identity,
  • Advocating for a youth when they are mistreated,
  • Bringing youth to LGBT organizations or events,
  • Connecting youth with an LGBT role model,
  • Working to make a faith community supportive of LGBT members or find a supportive faith community that welcomes LGBT youth and their families,
  • Welcoming a youth’s LGBT friends and partner,
  • Supporting a youth’s gender expression, and
  • Believing youth can have a happy future as LGBT adults (Ryan et al., 2010).

For more information on how to be and ALLY click here.

Rejecting behaviors, on the other hand, are harmful and may include:


  • Expressing disappointment when youth come out,
  • Discounting or ignoring LGBT youth,
  • Physical or verbal abuse,
  • Excluding youth,
  • Blocking access to LGBT friends, events and resources,
  • Blaming youth if they are discriminated against,
  • Pressuring youth to be more or less masculine or feminine,
  • Telling youth that God will punish them because they are LGBT, and
  • Telling youth to keep LGBT identity a secret and not letting them talk about it (Ryan, 2009).






Adolescence is a time of experimentation and curiosity. It is common for youth to have crushes and relationships. These early experiences do not necessarily indicate sexual orientation.


People are usually aware of their gender identity in early childhood (American Academy of Pediatrics, 2015), but gender expression and understanding of gender identity may shift over time.


Children often experiment with gender roles.  This is typical child development. Children who are transgender have consistent mild to severe discomfort with the sex they were born with and this can include confusion or stress about their genitals and expressing unhappiness at being the gender they have been assigned (Children’s Hospital of Eastern Ontario [CHEO] & Fedoroff, 2014).


Below are seven tips for community service providers working with LGBTQ+ youth:

  1. Focus on the client and their needs not their sexual orientation or gender identity.
  2. Avoid making assumptions about gender, sexual orientation, sexual behaviors/practices, family structures, or relationships.
  3. Use inclusive language and be aware of non-verbal communication such as facial expression, body language and tone of voice.
  4. Communicate as respectfully about people as you do to people. People recognize when these are not consistent.
  5. Express willingness to learn about individual needs. Listen to what the client is saying, both in their words and in non-verbal communication.
  6. Acknowledge and apologize for mistakes and slip-ups without dwelling on the issue.
  7. Protect the confidentiality of all information. This includes not revealing gender identity or sexual orientation to others, even those who may be present at an appointment or session between the client and service providers.


Here are seven tips for community service providers working with LGBTQ+ youth:

  1. Provide all-gender bathrooms and change rooms.
  2. When possible, avoid separating people according to sex. When separation is required, consideration needs to be given to the client’s gender identity.
  3. Include images of sexually and gender diverse people and families in posters, literature, and resources.
  4. Create a non-discriminatory policy and code of conduct outlining the expectations and responsibilities of staff and clients.
  5. Post a non-discriminatory statement that equal service will be provided to all clients regardless of age, sex, race, gender identity, gender expression, sexual orientation and religion.
  6. Consider displaying LGBTQ+ welcoming symbols such as the trans flag and rainbow flag.
    Trans and LGBTQ Flags
  7. Take the time to learn more about LGBTQ+ inclusive practice. It is important for all staff (e.g., clerical, administrative, security, custodial, technical, executive, volunteer, and front line workers). For more information, see the resources below.


Do a visual scan of your workplace to check to see if the space is inclusive. Start with the front entrance and include waiting spaces, common areas, offices, bathrooms, staff spaces. Do posters, handouts, signs, resources and other images reflect sexual and gender diversity? Are there all-gender inclusive bathrooms? Does your work place display a rainbow flag?




Bathroom harassment can be common for people with gender expressions and identities that do not reflect societal gender norms. Historically, public bathrooms have been separated according to class, race, ability and gender – all based in myths and stereotypes. A common myth is that women and children will be put at risk if men are allowed in the same bathroom. This myth adds to stereotypes about men as predators. Having all gender bathrooms allows safe spaces for everyone and can break down stereotypes.


Heterosexist and heteronormative (see definitions) culture is often reflected in even the most basic communication. For example:

  • Teachers calling their classes to attention by saying “OK boys and girls;” or
  • Admission forms asking to identify as either female or male.


When service providers find ways to make their language inclusive, ALL clients and colleagues are recognized and included. It is important to avoid:

  • Joking or teasing about biological sex, gender identity or sexual orientation (such as, “you throw like a girl” or “that’s so gay”), or
  • Using derogatory slang (such as, homo or tranny).

Below are some inclusive language strategies (Alberta Health Services, Sexual & Reproductive Health, Calgary Zone, 2015):



Talking with people

  • Avoid assuming gender identity.
  • Avoid using Mr., Ms., Mrs., Sir or Ma’am unless the person has requested it.
  • Listen and then REFLECT the clients’ language when describing relationships, gender and sexual orientation.

Intake or meeting client for the first time

  • Ask what a client would like to be called and document it for future reference and for other staff.
  • Ask the client’s preferred pronoun and document it for future reference and for other staff.
  • Use the preferred name and pronoun and ensure others do the same.

Talking about clients

  • Use the preferred name and pronoun.
  • If preferred pronoun is unknown, use gender neutral pronoun such as “they.”

Asking about relationships/h6>

  • Avoid assuming relationships based on sex, gender or age.
  • Use gender neutral terms such as parent, sibling, spouse, partner, or youth.
  • Avoid assuming youth have two parents, opposite sex parents or that parents are active in their life.

Gender or name shown on file doesn’t match youth’s presentation

  • Respond respectfully and ensure confidentiality and privacy.

A client “comes out” to staff

  • Respond with respect and ensure confidentiality.

Staff makes a mistake or assumption

  • Acknowledge the mistake, politely apologize and move on.
  • Avoid blaming the client for the mistake.

Gathering information

  • Only ask for information necessary to do your job.
  • Ask self: What do I need to know? Why do I need to know that? How can I ask this in a sensitive way?
  • Avoid asking clients questions just to satisfy your curiosity or to learn about sexual diversity.

For more information on inclusive language see Rainbow Health Ontario (2016):

Media Reference Guide – Discussing Trans and Gender-Diverse People. 




Did you know Alberta Education has many resources on supporting students and creating safe schools? Click here to see more.




In addition to using the tips provided above, service providers can offer support by referring LGBTQ+ youth to these local community services:
Crisis phone numbers

Peer chat or phone support

Social support

Mental health services and resources

Addiction treatment

STI testing and treatment

Sexual health clinical services

Anti-bullying information and advocacy

Victims of violence support

Domestic, dating and intimate partner violence education, prevention and safety planning

Housing first initiatives





To learn more about support, resources, inclusive practice and sexual diversity, see here:
















Alberta Health Services. (2011). E-SYS. Enhanced street youth surveillance Edmonton site results (1999-2010). Edmonton AB: Communicable Disease Control, Alberta Health Services.


Alberta Health Services, Sexual & Reproductive Health, Calgary Zone. (2015). Sexual and gender diversity: Patient experience pilot project final report. Calgary: Author.


American Academy of Pediatrics. (2015). Gender non-conforming and transgender children. Retrieved from https://www.healthychildren.org/English/ages-stages/gradeschool/Pages/Gender-Non-Conforming-Transgender-Children.aspx


Centers for Disease Control and Prevention. (2014). Lesbian, gay, bisexual and transgender: LGBT Youth.  Retrieved from http://www.cdc.gov/lgbthealth/youth.htm


Children’s Hospital of Eastern Ontario [CHEO], & Fedoroff, P. (2014). Gender identity and diversity. Retrieved from http://www.cheo.on.ca/en/genderidentity


Gaetz, S. (2004). Safe Streets for Whom? Homeless youth, social exclusion and criminal victimization. Canadian Journal of Criminology and Criminal Justice, 423-455.


National Coalition for the Homeless. (2009). LGBT homelessness. Retrieved http://nationalhomeless.org/issues/lgbt/


Ryan, C. (2009). Supportive families, healthy children: Helping families with lesbian, gay, bisexual and transgender children. San Francisco: San Francisco State University.


Ryan, C., Russell, S. T., Huebner, D., Diaz, R., & Sanchez, J. (2010). Family acceptance in adolescence and the health of LGBT young adults. Journal of Child and Adolescent Psychiatric Nursing, 23(4), 205-213.


US Department of Health & Human Services, Office of Adolescent Health. (2012). LGB Youth: Challenges, risks and protective factors. Retrieved from http://www.hhs.gov/ash/oah/oah-initiatives/teen_pregnancy/training/tip_sheets/lgb-youth-508.pdf