The Professional Counselor | Volume 11, Issue 4 441 the populations served by 354 agencies serving homeless youth. Of the 381 youth that responded to the survey, 46% reported that they ran away from home because of family rejection of their affectional orientation or gender identity, and 43% reported that they were forced out by their parents because of their affectional orientation or gender identity. According to the 2015 U.S. Transgender Survey, TGD people have also had their access to health care limited by stigma and discrimination by health care providers (James et al., 2016). One-third (33%) of respondents reported experiencing at least one negative experience with a health care provider in relation to their gender identity, and nearly a quarter (23%) did not seek services for fear of being mistreated. One-third (33%) did not seek health care because of an inability to afford the cost of TGD-specific or other services. These disparities are among the many motivators of the current movement to make health care, and professional counseling in particular, more affirming of TGD people (Rose et al., 2019; Vincent, 2019). Factors Influencing Rejection and Affirmation of TGD Identity Factors that support the pathologization of TGD identity and behavior find their roots across a variety of intersecting segments of American society. One of the more prominent influencers of these practices in the United States has been religion (Drescher, 2010; Stryker, 2008; Vines, 2014). More than 70% of the U.S. population identifies as Christian, with more than half the population practicing Christianity as members of evangelical denominations, which have been associated with traditionally rejecting attitudes toward lesbian, gay, bisexual, transgender, queer, questioning, intersex, asexual, and pansexual (LGBTQ+) people and behavior (Pew Research Center, 2014; Vines, 2014). Chronic suicidal thinking among LGBT people ages 18 to 24 has been associated with parents’ rejecting religious beliefs, and fears about being forced to leave one’s religion have been associated with a suicide attempt within a 12-month period for the same population (Gibbs & Goldbach, 2015). Religion has been closely associated with recent changes in state legislation and federal policy that suggest that disparities in the treatment of TGD people are socially and professionally acceptable. At least four states (Arkansas, Montana, Ohio, and South Dakota) have passed legislation that has included what is known as a conscience clause that could impede access to health care for LGBTQ+ people (Dailey, 2017; Goodkind, 2021; Rose et al., 2019). These health care–related laws have allowed legal protection for health care providers, sometimes specifically addressing professional counselors, who refuse services to clients who request help in ways that conflict with the provider’s particular religious beliefs (Dailey, 2017; Rose et al., 2019). In 2018, conscience clause–type considerations were expanded to the federal level when the U.S. Department of Health and Human Services (DHHS) created the Conscience and Religious Freedom Division (CRFD) in the DHHS Office for Civil Rights (DHHS, 2018a). At the time, CRFD policy explicitly cited protections for health care practitioners who declined to provide services related to abortion and assisted suicide (DHHS, 2018b); however, some noted that the division’s loose language could have left room for health care providers to deliver sub-standard care for LGBTQ+ clients as well (Gonzalez, 2018; Rose et al., 2019). In fact, a DHHS spokesperson stated at the time that the department would not interpret prohibitions on sex discrimination in health care to cover gender identity (Gonzalez, 2018). It should be noted that federal protections of TGD individuals in health care were restored in 2021 (Shabad, 2021). Awareness of Gender Diversity The general beginnings of the social consciousness of gender diversity in the United States can be traced to the attention that Christine Jorgensen commanded during her transition in the 1950s (Drescher, 2010; Stryker, 2008). Jorgensen was a U.S. Army veteran who served during World War II and travelled to Europe to undergo orchiectomy and penectomy procedures. Upon her return to the
RkJQdWJsaXNoZXIy NDU5MTM1