When a child has a health crisis with substance use or a combination of mental health and substance use problems, it can be frightening and stressful. You may be tempted to grab whatever resource is closest. However, taking a moment to ask questions and assess your options will help get your child into a program that's right for them.

Whether outpatient or inpatient, not all treatment programs are alike, nor do they all offer the same services. LGBTQ patients, and especially transgender patients, have high rates of leaving treatment before completion. Lack of support, inadequate facilities, therapists who don’t understand, disrespect by staff and bullying by other patients are all reasons that LGBTQ people leave early.

The following are questions to consider when choosing an affirming treatment program for your child.

1. Do you have any LGBTQ-identified counselors, therapists or other support staff?

Opening up to a counselor is challenging. Talking about personal experiences, such as sexual or gender identity, is vital for recovery. A counselor, therapist or mentor who shares some of those experiences can win your child’s trust in a way that an inexperienced one may not. Request that your child be paired with support staff from the same community; it can help your child feel seen and supported.

Be sure to ask if all staff are screened and have confirmed they will work with anyone who identifies as LGBTQ.

2. What certifications or training does your staff have to treat my child’s needs?

While LGBTQ-related certifications are more common in substance use treatment, they are far from universal. Certified and competent staff is one way to support your child’s recovery. Certifications aren’t a guarantee that treatment will go smoothly, but it shows that the program has basic knowledge of your child’s needs related to identity and gender experience. You may also want to ask about on-going training to make sure staff is aware of current issues and concerns impacting the community.

3. How will your program make my child feel welcome and included?

While this can vary greatly from program to program, it’s important that your child feels welcome and safe. Did they ask your child what name and pronouns they use? Is a Pride flag hanging? Was your child introduced to an LGBTQ staff member? These, among other actions, may help your child feel less guarded. The program should also be aware of the cultural differences among people of color who identify as LGBTQ.

Confidentiality is another important consideration. Your child has the right to decide if information about their sexual orientation or gender identity is given to other providers outside of the program.

4. Does your program offer specialized groups for LGBTQ people?

Research shows that outcomes are better if your child’s treatment program offers specialized groups specifically for LGBTQ clients. At a minimum, the program should ask about sexual orientation and gender identity in their intake process. Effective therapies to ask about include motivational interviewing, social support therapy, contingency management and cognitive behavioral therapy. Ask if any of their program materials are LGBTQ-specific or use educational examples related to identifying as LGBTQ.

5. How does the treatment program address trauma, self-harm, depression and other mental health issues?

Many LGBTQ people entering treatment have other mental health problems that need to be addressed in addition to their substance use disorder. If this applies to your child, make sure that any program you are considering is equipped to handle these. Having psychiatric care, therapy and medication management integrated with substance use treatment leads to better health and reduces the risk of relapse.

6. How will you address special needs my child has due to their identity?

Treatment is a significant investment of time, money and resources. Set your child up for success by asking questions about LGBTQ-specific needs. For example, will they include family of origin and family of choice as part of social supports, education and therapy in their family program? How will hormonal therapy be managed if your trans child is in residential treatment? How do they address HIV, STDs, Hepatitis and other health issues if necessary?

Notice whether the counselor or director you are speaking with is comfortable talking about LGBTQ people and what terminology they use. Are their words respectful, up-to-date and informed? Other people’s ignorance can harm your child’s recovery, but an affirming treatment program can make all the difference.

Stay away from programs offering Conversion Therapy which includes dangerous practices geared toward changing a loved one’s sexual orientation or gender identity. It can also include efforts to change one’s gender expression – to “act” more feminine or masculine as an example or to reduce romantic attachment or involvement with someone of the same gender.

7. What has the provider’s experience been with treating LGBTQ people like my child?

Although treatment programs can’t share particulars, they should be able to tell you about how they serve your child’s population. It is difficult to be any program’s “first” because they are often unprepared to support your child. You can protect your child from any missteps by asking how the recovery program has helped other LGBTQ patients in the past. Did those patients complete the program? Did the program make any changes to accommodate them, and if so, what were they?

8. What are the bathroom and sleeping arrangements?

Transgender people, including genderfluid and nonbinary people, often feel shut out of places where bathrooms, dorms and other facilities are separated by and only for “men” and “women.” If your child is transgender, ask if the treatment center has co-ed bathrooms, showers and dorms. Will your child have a roommate? Will they share a room with people who share their gender expression? Requesting a private room and bathroom may be an option.

Asking these questions can help increase your child’s level of comfort with the program.

9. How familiar is the program with LGBTQ resources in your community for your child’s continuing care plan?

Your child will need a detailed plan when they are discharged to a lower level of care. The services offered for LGBTQ clients may differ because of ongoing matters related to their sexual orientation or identity. Understanding your child’s social supports, living situation, work or school needs are as important as connecting them with LGBTQ-affirming health care providers. For example, if your child isn’t comfortable sharing their identity as an LGBTQ person, suggesting they attend an AA meeting for the LGBTQ community might not be helpful. Be sure the plan addresses all of your child’s needs so that they can be successful in their recovery.