Foster Care: Further Assistance from HHS Would be Helpful in Supporting Youth's LGBTQ+ Identities and Religious Beliefs
Fast Facts
A majority of states have nondiscrimination protections for youth in foster care. But selected states and stakeholders identified challenges supporting youth with LGBTQ+ identities, and those who belong to various religious groups. Challenges include addressing bias among child welfare staff and caregivers, as well as recruiting foster families from religious minority groups.
The information Health and Human Services provides to states to help them support these youth doesn't fully address these challenges. HHS therefore can't assure states will effectively promote the well-being of such young people.
Our 2 recommendations address these issues.
Highlights
What GAO Found
A majority of all states had some protections from discrimination in place for youth in foster care on the basis of sexual orientation, gender identity, and religion as of February 2021, based on state survey responses that GAO corroborated. The sources of these protections ranged from state laws to child welfare agency policies or practices. Officials in several states indicated that their protections on the basis of sexual orientation and gender identity for youth and parents continue to evolve. While some states are expanding protections, other states are debating the appropriateness of certain services for LGBTQ+ youth.
Literature GAO reviewed and interviews with officials from five selected states and stakeholder groups highlighted several promising practices for supporting lesbian, gay, bisexual, transgender, queer or questioning (LGBTQ+) youth in foster care (see figure). Promising practices for supporting youth of various religious beliefs are generally limited to enabling youth to practice their beliefs.
Selected Promising Practices for Supporting LGBTQ+ Youth in Foster Care
Selected states and stakeholders identified several challenges with supporting LGBTQ+ youth and the religious beliefs of youth in foster care, and information provided by the Department of Health and Human Services (HHS) to help states support youth does not fully address states' challenges. According to officials in selected states, one challenge with supporting LGBTQ+ youth is limited data on youth's sexual orientations and gender identities and difficulties collecting these data. Another challenge is providing appropriate placements for transgender youth.
HHS helps states support LGBTQ+ youth in foster care by funding research and providing information, according to officials from the Administration for Children and Families (ACF) within HHS. In March 2022, ACF also issued an Information Memorandum on LGBTQ+ youth, but it did not fully address states' challenges related to data collection and how youth's gender identity should inform placement decisions. Regarding youth's religious beliefs, selected states and stakeholders noted a lack of specific practices or services to support this aspect of youth identity, and identified challenges with recruiting foster families from religious minority groups. ACF officials said they do not provide assistance to states specifically related to supporting youth in foster care of various religious beliefs. Without providing information that specifically addresses challenges with supporting LGBTQ+ youth in foster care and the religious beliefs of youth in foster care, ACF will not have assurance that states are equipped to promote the wellbeing of these youth, as called for in HHS's strategic plan.
Why GAO Did This Study
Studies suggest that LGBTQ+ youth are over-represented in foster care. Further, youth in foster care may not be placed with families who share their religious beliefs. GAO was asked to review related protections and supports for foster youth.
This report examines (1) state protections against discrimination on the basis of sexual orientation, gender identity, and religion in foster care; (2) promising practices for providing supportive care to LGBTQ+ youth and youth of various religious beliefs in foster care; and (3) challenges selected states reported facing in supporting LGBTQ+ identities and religious beliefs among foster youth, and how HHS assists states in supporting these youth.
To address these objectives, GAO surveyed child welfare agencies in 53 states and territories and interviewed officials and reviewed documentation in five states selected for their variation in reported discrimination protections, state child welfare framework, and region. GAO also conducted a literature review that included peer-reviewed studies by a range of experts, reviewed HHS documentation and relevant federal laws and regulations, and interviewed HHS officials.
Recommendations
GAO is making two recommendations that ACF provide additional information to states on (1) data collection for LGBTQ+ foster youth and how youth's gender identity should inform placement decisions; and (2) supporting the religious beliefs of youth in foster care. HHS agreed with the recommendations.
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Administration for Children and Families | The Assistant Secretary for ACF should provide additional information to state child welfare agencies on addressing challenges related to data collection for LGBTQ+ foster youth, and how youth's gender identity should inform placement decisions. (Recommendation 1) |
HHS's Children's Bureau Capacity Building Center for States and its Child Welfare Information Gateway (the Information Gateway) developed and disseminated various tools and resources in calendar year 2022 to help the child welfare field more effectively support LGBTQ+ youth. For example, in June 2022, the Information Gateway launched an LGBTQ+ Resources page. This webpage features links to several resources, including an infographic and tip sheet on collecting data on youth's sexual orientation and gender identity. Further, in April 2024, ACF published a Final Rule on Designated Placement Requirements Under Titles IV-E and IV-B for LGBTQI+ Children. The rule requires that child welfare agencies implement specific processes and requirements to ensure children in foster care who identity as LGBTQ+ have access to placements the agency designates as safe and appropriate, and with services that are necessary to support their health and wellbeing. It further requires that transgender, gender nonconforming, and intersex children be offered placements consistent with the child's self-identified gender identity.
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| Administration for Children and Families | The Assistant Secretary for ACF should develop, identify, and disseminate information to state child welfare agencies on ways to support youth of various religious beliefs in foster care. (Recommendation 2) |
HHS agreed with this recommendation. In November 2023, HHS reported that the Children's Bureau will soon release a publication on the rights of youth in out-of-home care, including their right to have a choice in the type and frequency of religious or spiritual practice. Additionally, HHS officials said that the publication will discuss the rights and responsibilities of out-of-home caregivers and the application by the caregiver of the reasonable and prudent parent standard when making decisions about allowing a youth to participate in age- and developmentally appropriate extracurricular, enrichment, cultural, or social activities. We will continue to monitor the status and content of this publication.
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