Work For Expert Ahmed. Research I. Week 7

Children and Youth Services Review 59 (2015) 10–18

Contents lists available at ScienceDirect

Children and Youth Services Review

journal homepage: www.elsevier.com/locate/childyouth

Transgender youth homelessness: Understanding programmatic barriers through the lens of cisgenderism

Jama Shelton Social Welfare Department, CUNY Graduate Center, Silberman School of Social Work, Hunter College, 2180 3rd Avenue, New York, NY 10035, USA

http://dx.doi.org/10.1016/j.childyouth.2015.10.006 0190-7409/© 2015 Elsevier Ltd. All rights reserved.

a b s t r a c t

a r t i c l e i n f o

Article history: Received 23 January 2015 Received in revised form 10 October 2015 Accepted 10 October 2015 Available online 22 October 2015

Keywords: Transgender Youth Homeless Cisgenderism LGBT

Service access and acquisition are often complex and sometimes dangerous for transgender and gender expan- sive young people, who frequently experience stigma and discrimination and face systemic barriers including sex segregated programs and institutional practices that deny their own understanding and articulation of their gender. A common theme in the literature is recognition of the need for affirming services specifically designed to meet the needs of transgender young people experiencing homelessness, as this population may not utilize or have access to much needed services due to systemic barriers and fear of rejection and harassment. The current study investigates the lived experiences of transgender and gender expansive young people with histories of homelessness. This phenomenological qualitative investigation explores aspects of transgender and gender expansive youth's experiences, both at home and on the street. A recurring theme emerged in the partic- ipants' narratives — the seemingly insurmountable barriers constructed by systems that were not designed with their unique needs in mind. When understood through the lens of cisgenderism, the findings illuminate the structural barriers that exist for transgender and gender expansive young people and the systemic challenges service providers must address.

© 2015 Elsevier Ltd. All rights reserved.

1. Introduction

An estimated 20 to 40% of the approximately 1.6 million homeless youth in the United States identify as lesbian, gay, bisexual, or transgen- der (LGBT) (Choi, Wilson, Shelton, & Gates, 2015; Durso & Gates, 2012; Kipke, Weiss, & Wong, 2007; Ray, 2006; Lankenau, Clatts, Welle, Goldsamt, & Gwadz, 2005; Quintana, Rosenthal, & Krehely, 2010; Van Leeuwen et al., 2006). According to this estimate, the percentage of LGBT youth experiencing homelessness is at least three times greater than the percentage of the general LGBT youth population, which is thought to be between 5 and 7% of the overall youth population (Quintana et al., 2010; Ray, 2006). In a recent survey of street outreach programs, 7% of young people (n = 656) identified as transgender (Whitbeck, Lazoritz, Crawford, & Hautala, 2014).

Service access and acquisition are often complex and sometimes dangerous for transgender and gender expansive young people, who frequently experience stigma and discrimination and face systemic barriers including sex segregated programs and institutional practices that deny their own understanding and articulation of their gender. A common theme in the social work literature is recognition of the need for affirming services specifically designed to meet the needs of trans- gender young people experiencing homelessness (Cochran, Stewart, Ginzler, & Cauce, 2002; Mallon & DeCrescenzo, 2006; Whitbeck, Chen, Hoyt, Tyler, & Johnson, 2004; Bolas, 2007; Nolan, 2006). Also noted is the need for affirming practices for transgender young people, who

make up a disproportionate amount of the homeless LGBT youth popu- lation (Whitbeck et al., 2014; Mallon & DeCrescenzo, 2006; Bolas, 2007).

The current study investigates the lived experiences of a group of New York City-based transgender and gender expansive young people with histories of homelessness. The phrase transgender and gender expansive is used to encompass the range of genders and gender expressions noted by the participants. Gender expansive is preferred to the commonly used ‘gender non-conforming,’ which implies individ- ual pathology rather than societal intolerance of diverse genders and gender expressions. Recent psychological literature suggests avoiding the binary categorization of people as ‘transgender’ and ‘cisgender’ due to the inherent implication that transgender people and cisgender people are distinctly different beings and the potential for this implica- tion to obstruct a focus on systemic oppression (Ansara & Hegarty, 2014). The adoption of the label transgender was of significant impor- tance for many of the study participants. As such, the term transgender is utilized herein, as part of the phrase ‘transgender and gender expan- sive,’ to respect the self-designated genders of the study participants. When the term transgender is used alone, it is reflective of the catego- ries utilized in the cited research.

2. Literature review

LGBT young people comprise between 20 and 40% of the approxi- mately 1.6 million homeless youth in the United States (Durso &

11J. Shelton / Children and Youth Services Review 59 (2015) 10–18

Gates, 2012; Kipke et al., 2007; Lankenau et al., 2005; Quintana et al., 2010; Van Leeuwen et al., 2006). They are more likely to be thrown out of their homes than are non-LGBT youth, frequently due to parental rejection related to their sexual orientation, gender identity, and/or gender expression (Choi et al., 2015; Durso & Gates, 2012; Mallon, 1992; Whitbeck et al., 2004). Recent attention has been drawn to the overrepresentation of transgender young people within the population of youth experiencing homelessness, as well as the issue of homeless- ness among transgender people in general (Quintana et al., 2010; Yu, 2010; Bolas, 2007; Ray, 2006; Mottet & Ohle, 2006; Xavier, 2000). Trans- gender young people are often forced to live outside of mainstream society, due to prejudice and discrimination in employment, housing, health care, and education. They often end up living on the streets or without a permanent residence (Grossman & D'Augelli, 2006; Mallon & DeCrescenzo, 2009; Thaler, Bermudez, & Sommer, 2009; Quintana et al., 2010; Yu, 2010; Bolas, 2007; Ray, 2006; Xavier, 2000).

Western cultures often render invisible transgender and gender expansive young people through marginalizing social structures that assume a binary classification of gender (Shelley, 2009; Grossman & D'Augelli, 2006). While some young people of transgender experience may prefer a binary classification of their gender, the utilization of a binary classification becomes problematic when the classification is imposed and does not align with one's understanding of their gender, also referred to as their self-designated gender (Ansara & Hegarty, 2012). LGBT youth serving organizations' policies and practices may not apply to or include transgender young people (Pyne, 2011; McGuire & Conover-Williams, 2010; Mallon, 2009). For example, trans- gender and gender expansive young people have difficulty accessing shelter services, which commonly impose binary gender rules, room as- signments, and dress codes (Thaler et al., 2009). Navigating gendered spaces and programs can cause marked distress for transgender and gender expansive individuals (Herman, 2013), due to the frequent failure on the part of programs to respect how people would like to be classified within the gendered space. Problematic classification occurs when the policies or procedures of programs require young people to be segregated based on their assigned sex, rather than their self- designated gender. Therefore, many young people end up on the street rather than in shelters that are meant to keep them safe. The above factors point to a need for safe places for transgender and gender expan- sive young people; the spaces in which other youth might feel safe – social service agencies, health care clinics, schools, group homes – are often the places where transgender and gender expansive young people are subject to abuse and harassment (Stieglitz, 2010).

Though the literature suggests that transgender young people are disproportionately represented in the population of unstably housed young people (Whitbeck et al., 2014; Bolas, 2007; Ray, 2006), little is known about their specific experiences, challenges, and needs accessing housing related services and supports. Missing from the discourse is a critique of the social service system that is failing to meet the needs of this particular population. The web of cultural oppression composed of transphobia, homophobia, heterosexism, and cisgenderism and the internalization of each impact the culture at large and affects LGBT people in profound and subtle ways (Connolly, 2005). The aforemen- tioned concepts are important to comprehend for those seeking to pro- vide better programs and services to transgender and gender expansive young people experiencing homelessness and those at risk of becoming homeless. Without an understanding of the pathways into homeless- ness for transgender and gender expansive youth, or what they identify as their primary needs, prevention and intervention efforts are less like- ly to be effective for this population of young people.

3. Cisgenderism

Lennon and Mistler (2014) define cisgenderism as “the cultural and systemic ideology that denies, denigrates, or pathologizes self- identified gender identities that do not align with assigned gender at

birth as well as resulting behavior, expression, and community (p. 63).” Cisgenderism is an ideology that is prejudicial in nature; it others people labeled as transgender (Ansara & Hegarty, 2012). Outlined in depth by Ansara and colleagues, cisgenderism provides a framework for understanding the delegitimization of one's self- identified gender as a form of societal oppression (Riggs, Ansara, & Treharne, 2015; Ansara & Hegarty, 2014). Cisgenderism includes both individual and systemic acts, which may be purposeful or inadvertent (Riggs et al., 2015). As an orienting framework, cisgenderism broadens the analysis of the harassment and discrimination experiences of homeless transgender and gender expansive young people from a focus on the micro level of interpersonal interactions to include the macro level of institutional structures that produce and maintain their marginalization.

Misgendering and pathologizing are two forms of cisgenderism explored in recent research. Misgendering refers to the inaccurate use of gendered language, such as not using an individual's current name, using an incorrect gender pronoun, or describing people who identify as men as biological women. Pathologizing refers to the labeling and treatment of people's self-designated genders as disordered (Ansara & Hegarty, 2012; McLemore, 2014; Riggs et al., 2015; Ansara & Hegarty, 2014). Misgendering and pathologizing contribute to the erasure of transgender people. Cisgenderism shapes the social context of the United States, from the individual practices of human interaction to the establishment of organizations and the procedures of institutions (Bauer et al., 2009). For example, within the United States' youth home- lessness system, the majority of programs segregate young people based on their sex. Sex is often linked to genitalia, or the sex designation on an individual's birth certificate. These types of exclusionary policies lead to exclusionary programs and practices that deny young people's understanding of their genders. Cisgenderist ideology creates and maintains a system of power and privilege that subjugates transgender identities, expressions, and experiences (Ansara & Hegarty, 2012; Lennon & Mistler, 2014).

The cisgenderism framework can aid in understanding the experi- ences of transgender and gender expansive youth experiencing home- lessness, focusing on the ways in which their self-understanding is overlooked, denied, and challenged by individuals and systems. Such conceptualizations are lacking in social work scholarship examining the needs, experiences, and challenges of transgender and gender expansive youth experiencing homelessness and the social service response to addressing youth homelessness. It is imperative that social workers grasp this concept if they are to make lasting change for trans- gender youth experiencing homelessness.

4. Methods

4.1. Sampling and procedures

Participants were recruited from New York City based youth serving organizations, utilizing a purposive sampling technique. Flyers were distributed to LGBT youth serving organizations and homeless youth serving organizations. Potential participants completed a questionnaire to determine eligibility. Young people were eligible if they were be- tween the ages of 18 and 25, self-identified as transgender or described their gender as something different than what was societally expected of them based on their assigned sex, had experienced housing instabil- ity for a minimum of 60 days within the past 18 months, and were not living on the street at the time of the interview.

In depth semi-structured interviews were conducted with 27 young people (see Table 1 for demographic information). The semi-structured interview guide asked participants to describe their experiences related to both their self-designated genders and also their experiences of homelessness. Interviews lasted approximately 60–90 min. Interviews were audio recorded and transcribed. The Institutional Review Board

Table 1 Participant demographic data — age, race, birthplace, pronouns.

Descriptor N %

Age 18–20 8 30 21–25 19 70

Race Black/African American 10 37 Mixed race 9 33 Hispanic 4 15 White 4 15

Birthplace New York City 7 26 NY tri-state area (NJ, CT, NY states) 4 15 Other U.S. 13 48 Non-U.S. 3 11

Pronouns She/Her 14 51 He/Him 8 30 Ze/They 1 4 Don't care 4 15

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at Hunter College at the City University of New York approved the protocol for this study.

4.2. Data analysis

The heuristic process of phenomenological inquiry described by Moustakas (Patton, 2002) guided data analysis. The author transcribed all of the interviews, and read through each transcript, recording initial reactions to the data. Due to the exploratory nature of the study, active interpretation did not occur at this early stage of interacting with the data. Rather, Moustakas advises the researcher to “permit the glimmer- ings and awakenings to form, allow the birth of understanding to take place in its own readiness and completeness” (as cited in Patton, 2002, p. 486). Initial themes were recorded during the second read through of the transcripts. These thirty-two initial themes were grouped into overarching themes as an essence of shared experience in the partici- pant narratives became clear. The overarching themes included: the journey, gender designations & housing status, the other side of risk, programs, and unique needs of transgender young people. From these groupings, codes were produced and data were thematically coded in the third reading of the transcripts. NVivo9 was utilized for data management and storage.

5. Findings

The findings indicate that participants' programmatic experiences were characterized by challenges associated with navigating institu- tions that did not recognize or affirm their self-designated genders and/or gender expression. Participant narratives are included verbatim to describe the findings. Pseudonyms have been used and mentions of specific program names have been removed.

5.1. The pivotal role of programs

Connection to a program that was affirming of transgender and gender expansive youth was crucial to the survival of the young people in this study. A transgender and gender expansive affirming program can be understood as one that supports self-designated genders, gender exploration, and gender assertion. Such a program does not pathologize self-designated genders or diverse/non-binary gender expressions. Within this type of program, affirming the genders of program members is an integrated part of the program structure, from the language used for speaking and documentation, to the types of services offered. All of

the study participants were connected to such a program at some point during their homeless experiences. Programs provided the par- ticipants with necessities such as food and supportive services, and in some instances, shelter. Programs offered a temporary home base from which the young people in this study could learn about, explore, and/or express their gender. Transgender and gender expansive affirming programs also acted in the vital roles of information provider and facilitator of community. For example, through the programs he accessed, Nate was able to gain transition related information that enabled him to begin taking testosterone. Programs facilitated partici- pants' connection to legal services and medical services that assisted in their social and medical transitions. TC shared a story about learning terminology through a support group offered at her shelter, and Rebecca and Paris both credited a transgender support group with deepening their understanding of transgender history and advocacy.

Although programs played a central role in participants' lives follow- ing their departure from home, an analysis of programmatic impacts upon the experiences of the participants revealed a more complex relationship for the study participants. On the one hand, programs pro- vided life saving services and facilitated multiple beneficial experiences. At the same time, programs included institutional barriers created by policies and procedures that were cisgenderist in nature and failed to address the unique needs of the study participants.

5.2. Unique needs of transgender and gender expansive young people

The study participants experienced challenges related to discrimina- tion and harassment and also faced systemic barriers within the pro- grams that were meant to help facilitate their paths to independence. Furthermore, individuals working within programs often lacked specific knowledge that would enable them to recognize and respond to the needs of the participants in an affirming manner. Therefore, both institutional barriers as well as interpersonal challenges existed that made the successful navigation of homeless youth programs difficult for the transgender and gender expansive young people in this study, as evidenced in the following statement by 18-year-old Nate:

I have more of a struggle as to doing stuff, like…um, like a normal teen, all they gotta worry about is school. All they gotta worry about is whatever, what clothes they gonna wear, something. Me? I worry about, um…going to appointments to try to be…what I want, what I, I am, you know? Going to like, having special centers where to go to feel secure and, and to be with people like me…Like I think there's more of a…of…of…more of a weight on my back, that I'm like this, you know?

As they discussed their involvement in shelter programs, the study participants articulated numerous needs unique to their experiences as transgender and gender expansive homeless youth. As Nate de- scribed, transgender young people may be engaged with a variety of medical and mental health providers and must be responsible for ensur- ing their compliance with protocols if they are participating in medically assisted gender confirming processes (such as hormone injections). Additionally, due to unequal treatment within mainstream systems of care, study participants described seeking out specific centers or programs where they would have access to culturally and linguistically competent care and support. Because they are informed by a cisgenderist ideology, most youth shelter programs have not been de- signed with the particular needs of transgender and gender expansive young people in mind. As such, they inherently limited the ability of the transgender and gender expansive young people in this study to succeed. Study participants communicated programmatic challenges related to safety, physical presentation, privacy, feeling misunderstood, and employment related needs. The participants' narratives also conveyed a need for affirmation and validation related to their gender.

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5.2.1. Safety Programmatic safety was essential for the study participants. Safety,

as described by the transgender and gender expansive young people in this study, included both physical safety and emotional safety. Physical safety can be understood as being without the danger of experiencing bodily harm. Emotional safety can be understood as being free from emotional attack or harm; it means to be accepted for who one is. The notion of safety was directly related to the participants' self- designated gender and/or gender expression, as many had experienced consistent and persistent discrimination and mistreatment related to their self-designated gender and/or gender expression. Both real and perceived safety issues prevented some of the study participants from accessing shelter beds within particular programs. For example, his perception of where he would be safe limited the number of shelter programs Nate was willing to access. He says:

People are still gonna ask…all this stuff and like, wonder. But other shelters I was like, nah. First of all, too much questions. They gonna single me out…out of everybody. I don't want to be in that predica- ment. I'm gonna end up fighting 'cuz I don't like getting singled out, like, and especially if you saying, like, like, if you trying to dis me about who I am…like, I just felt a whole bunch of confrontations gonna happen over there… that was like, kinda something that, it didn't make me homeless, but it made me not have a bed to sleep in.

In the above quote, Nate describes the impact of constant questioning and being singled out. The questioning can be understood as the pathologizing form of cisgenderism (McLemore, 2014; Riggs et al., 2015; Ansara & Hegarty, 2014). The underlying assumption is that Nate's gender requires explanation; that his gender is disordered and needs to be explained. This impacted his ability to access services. In fact, his desire to keep himself safe from both emotional harm (“trying to dis me about who I am”) and physical harm (“I'm gonna end up fighting”) kept him from being involved with particular shelter programs. An uninformed observer may interpret Nate's refusal to access certain programs as a form of rebellion or defiance. In reality, the cisgenderist practices are to blame. Cisgenderism redirects the focus from Nate and places it on the institutions and their failure to adequately serve transgender and gender expansive youth.

The study participants reported challenges not only in mainstream shelter programs, but also in LGBT-specific shelter programs. Partici- pants reported feeling unsafe or experiencing anxiety about their safety as it related to their cisgender peers within the programs, the program staff, and the procedures of some programs. Christie expressed concern over hir emotional safety. Ze highlighted the threat that other shelter users may pose for transgender young people:

Like…anyone can walk through the door and be like, I'm bisexual. And you're straight as a bone. But they'll give you housing. With a transfemale. And a queer kid, lesbian, a gay boy and they have this one straight man in here, talking crap about transfemales, in the housing making us feel low, dirty, disrespected.

In addition to the threats emanating from other young people, the study participants also perceived the program staff and the procedures they enacted as threats to their emotional safety. Initial interactions between program staff and young people were often based on assump- tions about young people's gender. Those assumptions were based on a staff member's interpretation of a young person's gender expression, or in some cases, on the gender marker present on government issued identification (M/F). The assumptions made by program staff resulted in the misgendering of young people, and contributed to feelings of anxiety, alienation, and/or impending danger for the young people seeking services. Blumer, Ansara, and Watson (2013) explored this same phenomenon in the field of family therapy, noting the ways in which clinical alliance building between family therapists and therapy participants is inherently cisgenderist. For example, the cisgenderist

assumption that both members of a gay male couple have always been perceived and recognized as men since birth led to a line of questioning that rendered them invisible and invalidated their experi- ences (Blumer, Ansara, and Watson, 2013).

Isa experienced an intake questionnaire as invalidating and alienat- ing. He said:

There was one document I filled out, as a trans man and it asked me questions about pregnancy. And that may be something they want to think about. Should you have something about pregnancy there? Should you have something about menstrual shit there? Cuz that may trigger a transguy. You know what I mean, like, should you have that? Is, is it really necessary? You know, so that would be some- thing to think about.

Questions about menstruation and pregnancy communicated to Isa the intake worker's disbelief about his gender. Because the intake processes in the programs they accessed were not developed with the particular needs and experiences of transgender and gender expansive young people in mind, programmatic protocols unintentionally rein- forced cisgenderist practices common in society at large. These proto- cols included the questions asked of program participants, the kinds of clothing/care packages they were offered, and in some programs, the programmatic spaces they were given access to.

5.2.2. Physical presentation The young people in this study who were in the process of medically

assisted gender transition during their stay in programs faced chal- lenges that their cisgender and non-transitioning transgender counter- parts did not. Rebecca summed up her experience this way:

The worst part of our transition is the transition. You know. Um, whenever the surgery is done and all of that I can just go and live my life. But until then, it's going to be a struggle.

Rebecca was not often acknowledged as a woman, and believed her gender wouldn't be respected until after receiving sexual confirmation surgery. A component of cisgenderist ideology is the devaluation of people's own designations of their genders in favor of other authorita- tive designations (Blumer, Ansara & Watson, 2013). An example of cisgenderist ideology in practice would be the invalidation of Rebecca's self-designated gender, and a reliance on the medical authority that designated her as male at birth.

Paris began medically transitioning once she gained access to a longer-term bed in a transitional living program. She described some of her struggles related to this process, which were compounded by her homelessness.

And I really took off and then got the hormones and all that type of stuff and that was difficult because I was dealing with homelessness and then I had to, like, learn myself all over again and then dealing with society, being trans and…that was just a whole big, that was hard. I got through it but that was so hard. Like, the actual steps of transitioning and what comes along with that, period.

Study participants were not only challenged by the stresses associat- ed with their homeless experiences, but also dealt with the psycholog- ical stress of navigating a world highly critical of their very existence. Christie's struggle, like many of the young people in this study, included uncertainty in hir physical appearance.

A lot of people say I'm feminine in the face and I look like a girl in the face, but when I see myself in the mirror. I don't see that. At all. And trust me, I look. Every car I walk past, I'm always looking at it.

Christie was hypercritical of hir physical appearance, mirroring the disparaging interactions that characterized hir everyday interactions with the world around hir.

14 J. Shelton / Children and Youth Services Review 59 (2015) 10–18

In addition to an understanding of the quality of their daily interac- tions and the subsequent impact those interactions have on their self esteem, programs should also recognize that young people who are engaged in hormone therapy may need additional supports as they undergo both emotional and physical changes. For example, while man- aging the emotional changes she experienced as a result of hormone therapy, Charlotte also had to deal with facial hair, a grooming ritual which required time and privacy to carry out, and which directly impacted her sense of self. She said:

I still kind of grow a beard and that's annoying. Like, the whole facial hair thing, because…it's just, that's just kills my confidence. It really does.

As the primary source of support for young people experiencing homelessness, it is imperative that programs are aware of the chal- lenges associated with gender transitions. While all transgender and gender expansive young people will not choose medical intervention, some young people will. In addition to understanding the challenges young people may face and supporting them through those challenges, it is also important that program staff are aware of the joys transgender and gender expansive young people experience as their bodies become more aligned with their genders. For example, Nikita shared:

I guess as my transition progressed, like…I got pretty, like I'm getting, my body is changing and everything. Like people tend to just notice me, you know what I mean?.

As her transition progressed, Nikita began to feel more confident. Having that reflected back to her by an affirming program staff would validate her experiences and help to solidify her emerging stronger sense of self.

5.2.3. Privacy The ability to physically articulate their gender was crucial to the

overall functioning of the study participants, and the process of physi- cally articulating their gender was also time-consuming for some young people. The emergency shelter programs accessed by the study participants were overnight programs; the residents were required to exit the program for the day by 8:00 am in most cases. The morning routines usually included breakfast, chores, and making preparations for the day ahead. Though privacy is not only a concern of transgender and gender expansive young people, the participants related a need for privacy to their self-designated genders and gender expression. Jay expressed the need for private space and also discussed needing more time to prepare for her day than her cisgender peers might need.

There's no private space. I'm sorry, I have to wake up and tape in the morning, I'm not trying to do that in front of 15 people. Um. Even things like this, like being able to do my make up and stuff like that. I…I paint. So I need some time to be able to paint my face…can't do it. That kind of stuff…that is where it's really hard 'cuz it's really getting sore on me.

A lack of privacy within shelter programs emerged as a primary complaint of the study participants. Privacy concerns were not only in relation to the preparation for one's physical presentation; concerns also revolved around previous experiences of trauma. For example, a lack of privacy further complicated Starr's ability to trust other people.

It's hard, especially in New York, 'cuz it's so many people, you know what I'm saying, and the housing I'm staying in now…um…six peo- ple, you know what I'm saying? Including the staff is seven, you know what I'm saying? And…it's not much privacy, you know… you trying to trust but you really can't 'cuz you really don't know.

Due to privacy concerns, dormitory style living proved to be a challenge for the study participants. In the housing programs within

which study participants were involved, anywhere from 6 to 15 young people shared a large living space. Rebecca explained her need for privacy:

You know, I was up every morning and I, you know, I live at [program name], which is a very open area, we all get dressed in the same room and…I mean, I'm very…private, you know, especially during my transition. There's one other trans girl there that kind of just takes off her clothes and this and that. She's not as conservative as I am. Like, I don't want people to see me. Um, so, I mean it's very difficult, you know.

Participants described housing programs with shared living quarters and bathrooms. When navigating a lack of private space and shared bathrooms within a limited amount of time, preparing for one's day was increasingly difficult. Time and privacy to conduct grooming rituals was essential to the well being of the study participants. For example, putting on make up was not only critical to Nikita's self-concept, it was also critical to her ability to navigate a world that would otherwise harshly judge her based on her appearance.

And when I put on my make up, like everyday I feel, like a change… and then hearing from people, oh you look different. Like, a lot of people tell me I look totally different from before…more feminine.

If not given time and space required to prepare for their day, trans- gender and gender expansive young people must exit their shelter programs for the day feeling less confident, and more prone to experiencing continued rejection and harassment. Several study partic- ipants discussed a constant fear of being “clocked,” or being recognized as a person of transgender experience. Nikita shared:

It's kind of difficult, you know. Like, being in society, you gotta worry about getting clocked and spooked, and um…I mean, just fitting in, basically. In society. Which I am, I don't have a problem with now…I mean, they notice me in a positive way and then a negative way, too. 'Cuz they're like oh she's pretty, but then they get on to me…And they be like, oh that's a man, so…..

5.2.4. Feeling misunderstood

That's when I feel homeless. Cuz they ain't no box for me. I'm Isa, ain't no box. Ain't no box for me, you know what I mean? And so that's when I felt homeless. When people will try to categorize me, felt they couldn't. So you're just some thing. Go somewhere. — Isa

Pervasive judgment and discrimination had a profound impact on the young people in this study, evident in their depictions of daily living. Study participants reported having to contend with frequent questioning related to their self-designated genders and/or gender ex- pression, and subsequently having to provide a steady stream of expla- nations about who they are and why. Whether they were being questioned by their families or peers, or those working within systems that were meant to help them, the relentless questioning they were faced with took a toll on their sense of self and on their confidence. Nate explained:

It's like, I want I want people to acknowledge me as…like as I feel as I present myself, not having to say it, you know? It's like, it's like com- mon sense basically, you know. If you see someone present – if they walk like a duck, talk like a duck – they a duck, you know?

In addition to questioning, study participants were frequent targets of verbal harassment. Jaime experienced such persecution that she felt

15J. Shelton / Children and Youth Services Review 59 (2015) 10–18

under constant judgment and scrutiny. She described her experiences navigating society on a daily basis:

It's like when I'm wearing my make up and everything, I feel like, if somebody stares at me the first thought is — like, what is that person thinking? What are they saying about me in their head or whatever?

The participants' experiences managing a contemptuous society resulted in feelings of fear, frustration, and uncertainty. Having an envi- ronment in which they were supported, both individually and also within programmatic processes, played a critical role in their well being. However, program structures were frequently unable to accom- modate their needs. Starr conveyed the lack of knowledge possessed by the programs she attended, including the need for bathroom access, adequate rest, and respite from the harassment she experienced throughout the day.

It's really a lot that they should know about transgender people. I know I need time to myself. I need some rest. It be times where I can't handle stuff outside and I need to come back inside to try to calm myself or get myself together and then…I can't be able to do that because the house open up at a certain time or, you know what I'm saying or, it's…you know what I'm saying, or somebody in the bathroom. It's one bathroom, it's somebody else in the bathroom. I have to sign the list and I have to wait. Everything like that, you know.

Some young people found respite in shelter programs that were spe- cifically for LGBT young people. However, LGBT specific environments were not void of difficulty for all of the study participants. Just because a program was inclusive of gay, lesbian, and bisexual young people did not mean they were affirming for transgender and gender expansive young people. The acronym LGBT conflates sexual orientation and gender identity, suggesting homogeneity among LGBT people and communities and masking the discrimination and exclusion that trans- gender and gender expansive people experience from LGB people. Ansara (2010) refers to this as coercive queering — “the act of automat- ically lumping people of transgender experience into the category queer (p. 33).” An organization's ability to effectively serve LGB people does not inherently mean it will also serve transgender and gender expansive people well. Even LGBT serving institutions are developed on the premise that the gender self-designations of people accessing services will match their gender assignments.

Isa described his experience accessing services at LGBT organizations:

Trans is still very new to some people. They don't quite understand it yet. So you just encounter ignorance. You know, about the, the trans- gender stuff, um….the like, the um, the vocabulary involved with the transgender like, post op, pre op, what does that mean, you know that type thing. You know, um…sometimes, um…like incorrect information regarding that. But…and sometimes, like being misun- derstood by people on a like, peer to peer level, or patient to patient, client to client level..

Even when staying in LGBT specific housing programs, some of the transgender and gender expansive young people in this study were harassed by their cisgender roommates. When programs are designed with the unique needs of transgender and gender expansive young peo- ple in mind, they can become a respite from the persecution described by the participants. Such a reprieve was uncommon in the participants' experiences.

5.2.5. Employment related needs Young people are often required to either be employed or enrolled

in school in order to gain access to a bed in a longer-term transitional living program. These program requirements are meant to guide

young people onto a path of independence; staying in school makes one better suited for a competitive job market and obtaining employ- ment allows young people to save for independent living. These program goals make good sense. However, these processes were espe- cially difficult for the study participants, for whom 1) no federal employment protections exist and 2) access is limited to resources necessary for authentic gender presentation. Additionally, a young person's success on the job market is also highly contingent upon where they are staying. If they are in a shelter, they have access to a shower (though they may not have ample time or privacy to complete their required grooming rituals). If they are couch surfing or sleeping on the subways, parks, or street, their ability to be presentable for an interview or a job is likely to be severely compromised. Without access to facilities or the resources needed to complete grooming rituals, transgender and gender expansive young people are more likely to be misgendered. When transgender and gender expansive young people are able to secure employment, they face higher rates of discrimination and mistreatment than their cisgender counterparts. Starr explained an instance of employment discrimination that she faced:

But at my job they told me that I couldn't come in wearing female attire, so…I had felt discriminated. They told me I could still work, I just couldn't come in there with hair on my head, a bra on, or make up or eyelashes and stuff like that.

Jaime arrived at the emergency shelter with only the clothes she wore. Her father destroyed all of her feminine clothing and products. She said:

Due to my age, they're like you should be working you should be able to support yourself and it's like not easy when you don't have a place to stay, you don't have clothing, you don't have this, you don't have that. And then people try to make it seem like if it's the easiest thing in the world.

With no feminine clothing or grooming products, and no means to acquire these things, Jaime was unable to actively seek employment. Rather than prioritizing job interviews, an alternative affirming ap- proach would be to assist Jaime in procuring the items that are critical to her well being.

In addition to facing harassment and discrimination in the em- ployment sector, transgender and gender expansive young people often experience high rates of harassment and discrimination in educa- tional settings. According to a recent report by GLSEN, 80% of transgen- der students reported feeling unsafe at school (Kosciw, Greytak, Bartkiewicz, Boesen, & Palmer, 2012). Several of the study participants dropped out of high school due to violence and harassment placing them at an even greater disadvantage on the job market. Like many other transgender young people, Charlotte left high school due to pervasive bullying.

School, junior high school was ok, but then I went to high school and those were like some of the worst years of my life. It caused me to drop out of high school because I, it was, I couldn't go there, um, as….as I should, because I was being teased. I was getting into fights with peo- ple and it seemed like, like the principals and all the other, everybody else that was there wasn't really too trans friendly or ok with it.

Increased identity-related victimization is related to decreased levels of self-esteem and higher rates of depression (Kosciw et al., 2012). The victimization that transgender and gender expansive young people experiencing homelessness have faced is multi-faceted and should be considered in the development of housing programs. For example, obtaining a job may be nearly impossible for a young person who has experienced victimization in their homes, in their schools, victimization on the streets, has inadequate time to properly

16 J. Shelton / Children and Youth Services Review 59 (2015) 10–18

prepare for their day, does not have access to appropriate grooming items or who cannot afford items crucial to their presentation, and who has inaccurate identification documents.

5.2.6. Identification and employment One additional step that transgender and gender expansive young

people may need to undertake when seeking employment revolves around the acquisition of identification. Some of the study participants arrived at shelter programs with documents identifying them with their assigned sex at birth and their government names. Others arrived with no identification at all. For transgender and gender expansive young people to obtain employment, they must have proper identifica- tion that accurately reflects their gender. Two indicators of gender exist on identification documents — the gender maker, which marks one as male or female (with the letter F or M), and the first name, which may or may not be associated with a particular gender. Without identification documents that match their self-designated gender and presentation, transgender and gender expansive young people face harassment and discrimination when applying for jobs. Furthermore, the lack of accurate identification documents increases the likelihood that transgender and gender expansive young people will experience misgendering during the hiring process and while on the job, if hired. These frequent experiences of cisgenderism may lead some young people to not seek employment without these documents. They should not be required to subject themselves to the discrimination and victimi- zation that results when showing identification with an incorrect gender marker and/or name. Therefore, transgender and gender expansive young people may need additional time to complete this process.

The process for obtaining documents that accurately reflect a young person's name and gender can take more than the 30 days they are al- lotted in an emergency shelter program. If they are granted an addition- al 30 days in the program, they still must find a job in order to be eligible for a bed in a transitional living program. Even with appropriate identi- fication, obtaining employment posed significant challenges for the study participants. Issues related to gender based discrimination and harassment were widespread in the lives of the study participants as they navigated institutions of education and employment. The well- intentioned policies often caused insurmountable barriers for transgen- der and gender expansive young people.

6. Discussion

This study explored the experiences of homeless transgender and gender expansive youth, separate from their lesbian, gay, and bisexual counterparts. LGBT youth are often grouped together for the purposes of research and service provision. Referred to as coercive queering (Ansara, 2010), this practice contributes to the erasure of transgender and gender expansive people, their needs, and experiences. The findings illuminate unique aspects of the homeless experience for transgender and gender expansive young people.

At the same time that programs were helpful in meeting basic needs and facilitating the transmission of knowledge, they did not offer a sense of residential stability for the study participants. The lack of residential stability can be attributed to institutional barriers resulting from cisgenderist program structures. These program structures may be challenging for all unstably housed young people; however the barriers they erected for the transgender and gender expansive study participants were often insurmountable. Aspects of programs that created barriers include employment requirements, length of stay requirements, age restrictions, dormitory living/lack of privacy, and sex segregation. As a result of these barriers, study participants were often unable to meet program requirements and/or expressed concerns for their safety (resulting from dormitory living and sex segregation). The programs produced what I refer to as “shelter surfing,” when partic- ipants moved between short term shelter programs, leading to contin- ued housing instability.

For study participants under the age of 21, stays within shelter pro- grams were limited to 30 days with a possible additional 30-day exten- sion, pending approval from the governing body of the program's contract. This was an insufficient amount of time for young people to po- sition themselves for independent living. Many young people arrived at these programs with little more than themselves. Among the tasks that a transgender or gender expansive young person might need to com- plete once arriving at a shelter are obtaining proper identification (social security card, birth certificate, state ID card) and obtaining clothing and other items crucial for their gender presentation. For instance, Jaime's fa- ther destroyed all of her clothing, make up, and wigs before kicking her out of the house. When she arrived at the shelter, she had only the clothes on her back and no financial resources. Starr was robbed while sleeping on the subway, and had no identification and no money. The tasks associated with obtaining identification, clothing, and other transi- tion related supplies require time and financial resources, and must be completed before a young person begins the process of seeking employ- ment, which will enable them to meet the requirements for entry into a longer-term transitional living program.

For a transgender or gender expansive young person to legally change their name in most jurisdictions in the United States, they must go through a multi-step process that involves both time and money. A certified copy of their birth certificate is required. This costs approximately $15 and can take anywhere from 2 days to 4 weeks to re- ceive, depending on the state from which it is requested and whether or not they are able to expedite the request (an additional cost). The young person must also provide an address where the birth certificate will be mailed. The residential instability that characterizes the experiences of many transgender young people reduces the likelihood that they will receive their documents in the mail. Once they have received a certified copy of their birth certificate, they must file their paperwork with the court and await a hearing date, which also costs money. When the name change is granted, it must be published, an additional expense.

The restrictions on length of stay, coupled with the difficulties of meeting the requirements of longer term housing programs, resulted in shelter surfing for the young people in this study. They moved from 30-day bed to 30-day bed to 30-day bed, with no continuity of services or consistency in living arrangements. If a program was full, their names were put on waiting lists and they were forced to find other places to stay until a bed opened up. With the uncertainty of where they would go after their 30 days, in addition to a discontinuity of care, young peo- ple were challenged to set and reach goals that would enable them to progress into longer term housing programs and eventually out of the system altogether. Interventions need to be devised that support the continued growth of these young people and facilitate their indepen- dence, rather than shuffling them from short term stay to short term stay, in effect shelter surfing.

The majority of the young people in this study were 21 years of age and older. Though recognized by researchers and practitioners, the cat- egory of emerging adulthood is not accounted for in public policy geared towards unstably housed young people. As such, the majority of study participants lacked adequate access to shelter beds, the major- ity of which are reserved for young people under the age of 21. Consid- ered alone, this regulation does not seem to specifically limit the ability for transgender young people to succeed. When contemplated in rela- tion to additional road blocks described by the transgender young peo- ple in this study and the additional time they required to accomplish routine tasks, such as obtaining proper identification or acquiring tran- sition related products and services, the need for additional time beyond their 21st birthday becomes more clear.

6.1. Addressing the unique needs of transgender and gender expansive young people

The research findings establish the need to consider unstably housed transgender and gender expansive young people as a distinct population

17J. Shelton / Children and Youth Services Review 59 (2015) 10–18

with unique needs that differentiate them from their LGB counterparts. Some parallel processes do occur, such as coming out, negotiating familial conflict, and navigating institutions that may not welcome LGB people. However, the findings herein reflect differential needs of transgender and gender diverse young people. First and foremost, transgender and gender diverse people must contend with a cisgenderist society that con- tinues to be intolerant of gender diversity, harshly punishing those who transgress gender norms. The study participants were constantly navigat- ing an oppressive society that denied their self-designated genders. From gendered bathrooms and sex-segregated facilities to exclusionary paper- work and the cisgenderist practices, transgender and gender expansive young people experienced cisgenderism daily. They were misgendered; their genders were pathologized or ignored; they were subject to con- stant questioning within the organizations that were meant to help them. Homeless youth systems in the United States are not designed to accommodate anyone whose gender varies from the dyadic categories of male and female, or anyone whose self-designated gender is different from their gender assignment. Transphobia was a pervasive part of the participants' lives, shaping their interactions with systems, communities, and individuals such that discrimination and rejection become the norm.

Program policies and practices must be examined to better under- stand the ways in which they perpetuate cisgenderism through the pathologization and erasure of transgender and gender expansive young people. Cisgenderist practices systematically limit the potential success and stability of transgender and gender expansive young people. Housing programs can better serve transgender and gender expansive young people by recognizing the critical importance of affirming services for the overall health and well being of transgender and gender expansive young people, and examining their policies and practices for barriers to the success of transgender and gender expan- sive young people. Specific actions that programs can take include, but are not limited to: adopt non-discrimination policies that are inclusive of self-designated genders and diverse gender expressions, develop procedures for ensuring the safety of the physical space, examine paper- work for exclusionary questions, train direct care staff on cisgenderism and assist them in becoming aware of their own cisgenderist assump- tions, ensure all young people can self-designate their gender on all paperwork and that their self-designated gender can be recorded in the agency's data management systems, and include case plan goals that are reflective of the needs of transgender and gender expansive young people (for some this may be engagement in hormone therapy, for some it may be obtaining identification that accurately reflects their gender).

7. Conclusion

A primary tenet of social work practice is meeting the client where they are. When meeting transgender and gender expansive young people experiencing homelessness where they are, we cannot neglect that one facet of where they are is within a cisgenderist societal struc- ture made up of institutions not designed to facilitate their pathways to success. This position, coupled with a lack of resources for youth experiencing homelessness, places homeless transgender and gender expansive young people in a precarious state of existence. Transgender and gender expansive young people are capable of achieving the same goals as any other young person, however due to institutional oppres- sion, they often must complete additional steps to reach their goals and may require additional supports. Programs must be examined for structural barriers to their success. It is imperative that social service providers understand the impact of macro level systems on the pro- grams in which they work, and the ways in which those programs may play a role in the maintenance of the marginalization of transgen- der and gender expansive young people. Cisgenderism provides a framework for understanding the barriers transgender and gender expansive young people face within programs and within society at large.

8. Limitations

Inherent in a phenomenological research study involving a small group of participants are certain limitations. Namely, the results report- ed herein cannot be generalized to all transgender and gender expan- sive young people, or to all young people experiencing homelessness. Situated in a major metropolitan area, the study participants were involved in programs and systems that cannot be generalized to the programs and systems found in other cities, whether urban centers or rural locales. While this study does not provide generalizable findings, it does provide useful insights for policy and practice with transgender and gender expansive young people experiencing homelessness.

An additional limitation is the frequent gatekeeping that transgen- der and gender expansive young people must contend with in order to acquire the services they desire. Transgender and gender expansive young people frequently have to prove that they are who they say they are, and many have learned the script that will allow the successful navigation of social service systems. As a former direct service provider and administrator in an agency that provided direct services to LGBTQ young people experiencing homelessness, participants may have felt they needed to convey a particular set of experiences. It is important to recognize the limitations to this study, however these limitations do not diminish the insights generated. The research herein gives voice to a population whose stories are not often heard, and when heard, are rarely conveyed through a non-pathological lens.

Acknowledgements

The author thanks the young people who participated in this study, and the programs from which they receive services. Additionally, the author thanks Dr. SJ Dodd, Dr. Gary Mallon, Dr. Deborah Tolman, Dr. Mary McKay, and Dr. Alan Detlaff for their assistance.

Portions of this study have been presented in electronic poster for- mat at the Society for Social Work and Research annual conference and the Society for Research on Adolescence biennial meeting.

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