LGBTQIA+

RESOURCE GUIDE

BROCKTON PUBLIC SCHOOLS

By Linda Cahill DNP, MSN, RN
Kim Fallon BSN, BA, RN, CPN
Revised: May 2022 by Lisa Rodrigues
Purpose of a Resource Toolkit
To improve the comfort level of School Personnel to provide appropriate gender sensitive
interactions and responses to the Lesbian, Gay, Bisexual, Transgender, Queer/Questioning,
Intersexual, Asexual (LGBTQIA+) +. The “+” symbol stands for any additional group not represented by
LGBTQIA acronym. The "+" designation in this position statement is used for inclusivity, to encompass
other sexual and gender minorities not captured within the acronym LGBTQIA+ (Stokes, 2019).

Population: LGBTQIA+ Youth

Lesbian, gay, bisexual, transgender, and queer (LGBTQIA+) youth, a diverse group that includes youth
who identify as lesbian, gay, or bisexual (LGB; regardless of behavior) and/or identify as transgender
or a gender identity that does not conform to prevalent binary gender constructions (Garbers, et al.
2018).The Centers for Disease Control and Prevention estimated that there are 1.7 million youth of
high school age who identify as LGBTQIA+ (Kann et al., 2016). Two common assumptions that nurses
make pose barriers to quality care of LGBTQIA+ patients: the idea that all clients are heterosexual and
that all people identify as either male or female (Carabez, et al., 2015).

According to the Human Rights Campaign’s survey, Growing Up LGBTQIA+ in America:

1 in 5 LGBTQIA+ youth say that feeling they cannot come out is the greatest problem facing them
today.
1 in 4 LGBTQIA+ youth believe they cannot come out to their families because it will directly affect
their well-being.
1 in 3 LGBTQIA+ youth do not feel they have a single adult they can talk to about their identity.
(IT GETS BETTER PROJECT, 2018)

The key findings in regards solely to the “Hostile School Climate, Educational Outcomes, and
Psychological Well-Being” section of the 2017 National School Climate Survey show:
LGBTQIA+ students who did not plan to graduate high school (e.g., who planned to drop out or
were not sure if they would finish high school) most commonly reported mental health concerns
and hostile school climate as reasons for leaving school (GLSEN, 2019).

·LGBTQIA+ students who experienced high levels of in-school victimization:

Had lower GPAs than other students
Were less likely to plan to pursue any post-secondary education
Were three times as likely to have missed school in the past month because of safety concerns
Were less likely to feel a sense of belonging to their school community
Had lower levels of self-esteem and higher levels of depression (GLSEN, 2019).
·
LGBTQIA+ students who experienced discrimination at school:
Had lower GPAs than other students
Were more than three times as likely to have missed school in the past month because of
safety concerns
Were less likely to feel a sense of belonging to their school community
Had lower levels of self-esteem and higher levels of depression. (GLSEN, 2019).
Background and Significance

Educators share many roles and responsibilities in the ever-changing field of education. Assessing a
students social, emotional and physical needs are a big part of their roles. School nurses are viewed as
trusted individuals who can provide counseling and guidance. LGBTQIA+ students need trusting
adults in their lives to navigate such important and transformational times in their lives. With allies
and trusted individuals as part of their circle, educators are quite frankly saving the lives of LGBTQIA+
youth.

Youth Risk Behavioral Surveillance Survey (YRBSS) data are used widely to compare the prevalence of
health-related behaviors among subpopulations of students; assess trends in health-related behaviors
over time; monitor progress toward achieving 21 national health objectives; provide comparable state
and large urban school district data; and take public health actions to decrease health-risk behaviors
and improve health outcomes among youth, grades 9-12 (Center for Disease Control, 2017).

According to the 2017 YRBSS, results show LGBTQIA+ youth suffer from harassment,
family/school/community discrimination, an increased risk for suicide, depression, substance abuse,
and inequities in care (Kahn, et al., 2018). Khan and colleagues (2018) reported that 33 % of LGBTQIA+
youth have been bullied at school or online compared to 19% of heterosexual students. The
prevalence of having been threatened or injured with a weapon on school property was higher among
gay, lesbian, and bisexual (9.4%) students than heterosexual (5.4%) students. The study reported that
more than 47% of LGBTQIA+ students had seriously contemplated suicide; 23% reported having
attempted suicide during the past year; and that LGBTQIA+ students are up to five times more likely
than other students to report using illegal drugs. According to the Agency for Health Care and Quality
(2011), transgender people are more likely to be uninsured and half of transgender people defer care
when sick or injured and among uninsured transgender people, 88% postponed care due to cost and
some reported provider denied services based on their gender status.

A survey by the Human Rights Campaign (HRC) reported that 42% of LGBTQIA+ youth do not feel
accepted in their communities (HRC, 2016). Also, the HRC (2016) reported that forty percent of
homeless youth identifying as LGBTQIA+ felt rejected by their family. Another study by Robinson and
Espelage (2011), found similar results related to LGBTQIA+ youth being at greater risk of suicidal
thoughts, suicide attempts, harassment by peers, and increased unexcused absences are significant in
high school, these gaps are significantly greater in middle school, putting the younger LGBTQIA+
students at more risk for depression and suicidality.

The 2015 National Climate Survey, comprised of middle (11.8%) and high school (88.1%) responses,
demonstrated that 57.6% of LGBTQIA+ students felt unsafe because of their sexual orientation and
43.3%, because of their gender expression (Kosciw, et al., 2016). Eighty-two percent of LGBTQIA+
students reported being verbally harassed in the past year because of their sexual orientation, and
54.5 %, because of their gender expression (Kosciw, et al., 2016). Furthermore, Mahdi, et al., (2014)
reported that much of school nurses conveyed limited or no experience practicing skills to interact
with LGBTQIA+ youth. According to Mahdi and colleagues (2014), only 22% of school nurses had
moderate levels of experience referring students to behavioral health providers with LGBTQIA+
experience, compared to 50% of school counselors. Even fewer school nurses (17.6 %) reported they
had moderate to high experience intervening to stop LGBTQIA+ harassment compared to 66.7% of
school counselors (Mahdi, et al., 2014).
As an advocate for the individual student, the school nurse provides skills and education that
encourage self-empowerment, problem solving, effective communication, and collaboration with
others (ANA, 2015).Promoting the concept of self-management is an important aspect of the school
nurse role and enables the student to manage his/her condition and to make life decisions (Tengland,
2012). The school nurse advocates for safety by participating in the development of school safety plans
to address bullying, school violence, and the full range of emergency incidents that may occur at
school (Wolfe, 2013).

Disparities
Among the most significant issues identified by the Institute of Medicine’s (IOM) (2011) are the
following: LGBTQIA+ youth are more likely to suffer from depression and anxiety disorders, to be
homeless and are two to three times more likely to attempt suicide as mentioned previously.
LGBTQIA+ populations have high rates of tobacco, alcohol, and other drug use; lesbians are less likely
to get preventive services for cancer; lesbians and bisexual women are more likely to be overweight or
obese; and gay men are at higher risk of HIV and other sexually transmitted diseases, especially
among communities of color (Carabez, et al., 2015; Parker, et al., 2018).

In the realm of sexual and reproductive health, disparities among some LGBTQIA+ youth subgroups
include higher rates of sexually transmitted infections and HIV among young men who have sex with
men compared to other groups and higher sexual risk including rates of unintended pregnancy among
lesbian and bisexual young women compared to those who identify as heterosexual (Garbers, et al.,
2018). These health disparities may stem from the stigma, discrimination, and victimization faced by
LGBTQIA+ youth at home, in their communities, and at school (Garbers, et al., 2018).

Among persons aged 15-19 years, 209,809 births, 488,700 cases of chlamydia, gonorrhea, and syphilis
and 1,652 diagnoses of human immunodeficiency virus (HIV) were reported (Kann, et al., 2018).

Data from the 2017 National Youth Risk Behavior Survey (YRBS) conducted by the Center for Disease
Control (CDC), reported that:
33% LGB students were bullied on school property
27.1% LGB students were electronically bullied
10% LGB students did not go to school due to safety concerns

Even school-based victimization of LGBTQIA+ young people may have profound consequences for
students’ school success, health and well-being. LGBTQIA+ students skip classes (13–30%) and miss
full days of school (20–32%) at alarming rates because they feel unsafe (Snapp, et al., 2015).The most
common reason students reported feeling unsafe was related to their appearance or body size
followed by sexual orientation and race (U.S. News & World Reports, 2018). Research from population-
based studies has found that young people who experienced biased-based harassment (e.g.
harassment based on sexual orientation or factors biases such as race) reported higher rates of
mental health concerns and drug use, as well as lower grades and higher rates of truancy (Snapp, et
al., 2015).
An article by Rasberry, et al. (2015) shares the following responses from High School youth regarding
their School Nurse:

“The nurses could probably reach out more, too, and just pick up more information and learn more about, like,
this type of stuff besides the stuff they just regular do like in the office... Because barely nobody just goes there,
unless they’re like referral to like take medication during the day, they have to go down there and get like a pill or
whatever.” - Philadelphia youth

“She’s just there to, like, you break your arm, here’s a Band-Aid. Like, she’s not going to do much. And, like, you
can’t even take . . . let’s say you have a headache. She can’t even give you, like, and aspirin or anything”. - New
York City youth

“I know some people can be annoying...but you should still have patience because you’re a nurse. You’re there to
help.” - Philadelphia youth

School health services directors and supervisory staff should carefully consider implementation of
professional development opportunities to help their health services staff better position themselves
to work effectively with sexual minority youth (Rasberry, et al., 2015). Professional development may
be used to help nurses and other health staff learn how to engage sexual minority youth in culturally
competent ways that allow staff to assess each youth’s specific needs while ensuring the youth can
feel safe and supported through the process (Rasberry, et al., 2015). The Society for Adolescent Health
and Medicine’s position that all health care providers who work with adolescents ‘‘should be trained
to provide competent and nonjudgmental care for lesbian, gay, bisexual, or transgendered (LGBT)
youth’’ (Society for Adolescent Health and Medicine, 2013, p. 506). Professional development may also
be used to help a broad range of school staff (e.g., teachers, counselors, and GSA advisors) understand
the role that school nurses can play in helping teach youth about and connect youth to critical sexual
health services (Rasberry, et al., 2015).
Glossary of Terms
According to the National LGBT Health Education Center (2019), the following is a glossary of
appropriate LGBT terms. Be mindful that:
1. Definitions vary across communities; not all of your LGBT individuals will agree with all of these
definitions;
2. There are many terms not included on this list; we tried to keep the list as concise and relevant as
possible;
3. Terms and definitions change frequently; we will try to update this list to keep up with changing
language (National LGBT Health Education Center, 2019).

Agender (adj.) – Describes a person who identifies as having no gender.

Ally (noun) – A person who supports and stands up for the rights of LGBT people.
Aromantic (adj.) – An orientation that describes a person who experiences little or no romantic
attraction to others and/or a lack of interest in forming romantic relationships.
Asexual (adj.) – Describes a person who experiences little or no sexual attraction to others.
Asexuality is not the same as celibacy.
Assigned male/female at birth (noun) – This phrase refers to the sex that is assigned to a child at
birth, most often based on the child’s external anatomy.
Assigned sex at birth (noun) – The sex (male or female) assigned to a child at birth, most often
based on the child’s external anatomy. Also referred to as birth sex, natal sex, biological sex, or sex.
Bigender (adj.) – Describes a person whose gender identity is a combination of two genders.
Binding (noun)- The process of tightly wrapping one’s chest to minimize the appearance of having
breasts. This is achieved using constrictive materials such as cloth strips, elastic or non-elastic
bandages, or specially designed undergarments.
Biological male/female (see assigned male/female at birth) (noun) – We avoid using the phrases
“biological male” and “biological female” because they may not accurately describe a person’s
physical sex characteristics, and more importantly, they may not reflect how a person identifies
regarding their gender.
Biphobia (noun) – The fear of, discrimination against, or hatred of bisexual people or those who are
perceived as such.
Bisexual (adj.) – A sexual orientation that describes a person who is emotionally and sexually
attracted to people of their own gender and people of other genders.
Bottom surgery (noun) – Colloquial way of describing gender affirming genital surgery.
Cisgender (adj.) – A person whose gender identity and assigned sex at birth correspond (i.e., a
person who is not transgender).
Coming out (noun) – The process by which one accepts and/or comes to identify one’s own sexual
orientation or gender identity (to come out to oneself). Also, the process by which one shares one’s
sexual orientation or gender identity with others (to come out to friends, etc.).
Deadname (noun) - A deadname is the birth name of someone who has changed it. The term is
especially used in the LGBTQ community by people who are transgender and elect to go by their
chosen name instead of their given name.
Disorders of Sex Development (DSD) (noun)- Group of rare conditions where the reproductive
organs and genitals do not develop as expected. Some DSDs include Klinefelter Syndrome and
Androgen Sensitivity Syndrome. Sometimes called differences of sex development. Some people
prefer to use the term intersex.
Drag (verb) – The performance of one or multiple genders theatrically. Those who perform are
called Drag Kings and Drag Queens.
Gay (adj.) – A sexual orientation that describes a person who is emotionally and sexually attracted to
people of their own gender. It can be used regardless of gender identity, but is more commonly
used to describe men.
Gender affirming surgery (GAS) (noun) – Surgeries used to modify one’s body to be more
congruent with one’s gender identity. Also referred to as sex reassignment surgery (SRS) or gender
confirming surgery (GCS).
Gender affirming hormone therapy (noun) – The administration of hormones for those who wish to
match their physical secondary sex characteristics to their gender identity. Also referred to as
cross-sex hormone therapy.
Gender binary (noun) – The idea that there are only two genders, male and female, and that a
person must strictly fit into one category or the other.
Gender dysphoria (noun) – Distress experienced by some individuals whose gender identity does
not correspond with their assigned sex at birth.Manifests itself as clinically significant distress or
impairment in social, occupational, or other important areas of functioning. The Diagnostic and
Statistical Manual of Mental Disorders (DSM-5) includes gender dysphoria as a diagnosis.
Gender expression (noun) – The way a person acts, dresses, speaks, and behaves (i.e., feminine,
masculine, androgynous). Gender expression does not necessarily correspond to assigned sex at
birth or gender identity.
Gender fluid (adj.) – Describes a person whose gender identity is not fixed. A person who is gender
fluid may always feel like a mix of the two traditional genders, but may feel more one gender some
days, and another gender on other days.
Gender identity (noun) – A person’s internal sense of being a man/male, woman/female, both,
neither, or another gender.
Gender non-conforming (adj.) – Describes a gender expression that differs from a given society’s
norms for males and females.
Gender role (noun) – A set of societal norms dictating what types of behaviors are generally
considered acceptable, appropriate or desirable for a person based on their actual or perceived sex.
Genderqueer (adj.) – Describes a person whose gender identity falls outside the traditional gender
binary. Other terms for people whose gender identity falls outside the traditional gender binary
include gender variant, gender expansive, etc. Sometimes written as two words (gender queer).
Heteronormativity (noun)– The assumption that everyone is heterosexual, and that heterosexuality
is superior to all other sexualities.
Heterosexual (straight) (adj.) – A sexual orientation that describes women who are emotionally and
sexually attracted to men, and men who are emotionally and sexually attracted to women.
Homophobia (noun) – The fear of, discrimination against, or hatred of lesbian or gay people or those
who are perceived as such.
Intersectionality (noun) – The idea that identities are influenced and shaped by race, class,
ethnicity, sexuality/sexual orientation, gender/gender identity, physical disability, national origin,
etc., as well as by the interconnection of all those characteristics.
Intersex (noun) – Group of rare conditions where the reproductive organs and genitals do not
develop as expected. Some prefer to use the term disorders (or differences) of sex development.
Intersex is also used as an identity term by some community members and advocacy groups.
Lesbian (adj., noun) – A sexual orientation that describes a woman who is emotionally and sexually
attracted to other women.
Men who have sex with men/Women who have sex with women (MSM/WSW) (noun) – Categories
that are often used in research and public health settings to collectively describe those who engage
in same-sex sexual behavior, regardless of their sexual orientation. However, people rarely use the
terms MSM or WSW to describe themselves.
Minority stress (noun) – Chronic stress faced by members of stigmatized minority groups. Minority
stress is caused by external, objective events and conditions, expectations of such events, the
internalization of societal attitudes, and/or concealment of one’s sexual orientation.
Outing (noun) – Involuntary or unwanted disclosure of another person’s sexual orientation or
gender identity.
Non-binary (adj.) – Describes a person whose gender identity falls outside of the traditional gender
binary structure. Sometimes abbreviated as NB or “enby.” See more at gender binary structure.
Pangender (adj.) – Describes a person whose gender identity is comprised of many genders.
Pansexual (adj.) – A sexual orientation that describes a person who is emotionally and sexually
attracted to people regardless of gender.
Polyamorous (adj.) – Describes a person who has or is open to having more than one romantic or
sexual relationship at a time, with the knowledge and consent of all their partners. Sometimes
abbreviated as poly.
Preferred pronouns (see pronouns that you use) (noun) – We avoid using the phrase “preferred
pronouns” because it implies that we can choose to respect or not respect a person’s gender
identity. We should respect the pronouns a person uses.
Pronouns that you use (noun) – Pronouns are the words people should use when they are referring
to you but not using your name. Examples of pronouns are she/her/hers, he/him/his, and
they/them/theirs.
QPOC (noun) – An acronym that stands for Queer Person of Color or Queer People of Color.
Queer (adj.) – An umbrella term used by some to describe people who think of their sexual
orientation or gender identity as outside of societal norms. Some people view the term queer as
more fluid and inclusive than traditional categories for sexual orientation and gender identity. Due
to its history as a derogatory term, the term queer is not embraced or used by all members of the
LGBT community.
Questioning (adj.) – Describes an individual who is unsure about or is exploring their own sexual
orientation and/or gender identity.
Same gender loving (SGL) (adj.) – A term used as an alternative to the terms gay and lesbian. SGL is
more commonly but not exclusively used by members of the African American/Black community.
Sex (noun) – See assigned sex at birth.
Same-sex attraction (SSA) (noun) – A term that is used to describe the experience of a person who
is emotionally and/or sexually attracted to people of the same gender. Individuals using this term
may not feel comfortable using the language of sexual orientation (i.e., gay, lesbian, bisexual) for
personal reasons. Use of this term is not indicative of a person’s sexual behavior. It is used most
commonly in religious communities.
Sexual orientation (noun) – How a person characterizes their emotional and sexual attraction to
others.
Social stigma (noun) – Negative stereotypes and social status of a person or group based on
perceived characteristics that separate that person or group from other members of a society.
Structural stigma (noun) – Societal conditions, policies, and institutional practices that restrict the
opportunities, resources, and well-being of certain groups of people.
Top surgery (noun) – Colloquial way of describing gender affirming surgery on the chest.
Trans man/transgender man/female-to-male (FTM) (noun) – A transgender person whose gender
identity is male may use these terms to describe themselves. Some will just use the term man.
Trans woman/transgender woman/male-to-female (MTF) (noun) – A transgender person whose
gender identity is female may use these terms to describe themselves. Some will just use the term
woman.
Transfeminine (adj.) – Describes people who were assigned male at birth, but identify with
femininity than with masculinity.
Transgender (adj.) – Describes a person whose gender identity and assigned sex at birth do not
correspond. Also used as an umbrella term to include gender identities outside of male and female.
Sometimes abbreviated as trans.
Transition (noun) – For transgender people, this refers to the process of coming to recognize,
accept, and express one’s gender identity. Most often, this refers to the period when a person makes
social, legal, and/or medical changes, such as changing their clothing, name, sex designation, and
using medical interventions. Sometimes referred to as gender affirmation process.
Transmasculine (adj.) – Describes people who were assigned female at birth, but identify with
masculinity than with femininity.
Transphobia (noun) – The fear of, discrimination against, or hatred of transgender or gender non-
conforming people or those who are perceived as such.
Transsexual (adj.) – Sometimes used in medical literature or by some transgender people to
describe those who have transitioned through medical interventions.
Trauma-informed care (noun) – an organizational structure and treatment framework that centers
on understanding, recognizing, and responding to the effects of all types of trauma.
Tucking (verb)- The process of hiding one’s penis and testes with tape, tight shorts, or specially
designed undergarments.
Two-Spirit (adj.) – A contemporary term that connects today’s experiences of LGBT Native
American and American Indian people with the traditions from their cultures.

Outdated Terms to Avoid

The following terms may have been used in the past, but are now considered outdated and
sometimes offensive. We recommend replacing these words with the suggested terms provided.
-Berdache See two-spirit
-Hermaphrodite See intersex/disorders of sex development
-Homosexual See gay or lesbian
-Sexual preference See sexual orientation
-Transgendered/A transgender/Tranny See transgender
-Sex change See gender affirmation surgery
Guidance for Massachusetts Public Schools Creating a Safe and Supportive
School Environment
Adapted from the Department of Elementary and Secondary Education

Nondiscrimination on the Basis of Gender Identity

An Act Relative to Gender Identity (Chapter 199 of the Acts of 2011),1 which became effective on July
1, 2012, amended several Massachusetts statutes prohibiting discrimination on the basis of specified
categories, to include discrimination on the basis of gender identity. Among the statutes amended is
G.L. c. 76, § 5, prohibiting discrimination on the basis of gender identity against students who enroll
in or attend the public schools. G.L. c. 76, §5 now reads as follows:

Every person shall have a right to attend the public schools of the town where he actually resides,
subject to the following section. No school committee is required to enroll a person who does not
actually reside in the town unless said enrollment is authorized by law or by the school
committee. Any person who violates or assists in the violation of this provision may be required
to remit full restitution to the town of the improperly-attended public schools. No person shall
be excluded from or discriminated against in admission to a public school of any town, or in
obtaining the advantages, privileges and courses of study of such public school on account of
race, color, sex, gender identity, religion, national origin or sexual orientation. (Emphasis added)

In June 2012, the Massachusetts Board of Elementary and Secondary Education (Board) adopted
revised Access to Equal Education Opportunity Regulations, 603 CMR 26.00, and Charter School
Regulations, 603 CMR 1.00, to reflect the broadened student anti-discrimination provision in G.L. c.
76, §5. The Board also directed the Department of Elementary and Secondary Education
(Department) to provide guidance to school districts to assist in implementing the gender identity
provision.

All students need a safe and supportive school environment to progress academically and
developmentally. Administrators, faculty, staff, and students each play an important part in creating
and sustaining that environment. This guidance is intended to help school and district
administrators take steps to create a culture in which transgender and gender nonconforming
students feel safe, supported, and fully included, and to meet each school's obligation to provide
equal educational opportunities for all students, in compliance with G.L. c. 76, §5 and the state
regulations. The guidance sets out general principles based on the law, and addresses common
issues regarding transgender and gender nonconforming students. It offers case studies based on
experiences of schools and students in Massachusetts, and reflects the need to consider issues on a
case-by-case basis. The list of issues is not exhaustive, and the examples are intended to be
illustrative, not prescriptive.

In preparing this guidance, the Department reviewed policies and guidance from several states,
organizations, and athletic associations and consulted with the field. We appreciate the input we
received from school and district administrators, advocacy groups, parents, students, and other
interested constituents.
The Law
The gender identity law amended G.L. c. 76, § 5,2 to establish that no person shall be excluded from
or discriminated against in admission to a public school of any town, or in obtaining the advantages,
privileges and courses of study of such public school on account of gender identity, among other
characteristics. The amended Access to Equal Educational Opportunity regulations, 603 CMR 26.00,
and the non-discrimination provision of the Charter School regulations, 603 CMR 1.00, require
schools to establish policies and procedures, provide training, and implement and monitor practices
to ensure that obstacles to equal access to school programs are removed for all students, including
transgender and gender nonconforming students.

All districts and schools should review existing policies, handbooks, and other written materials to
ensure that they are updated to reflect the new law. At a minimum, this means including the
category of "gender identity" within the identification of legally protected characteristics. For
example:

The [ ] Public Schools strives to provide a safe, respectful, and supportive learning environment in
which all students can thrive and succeed in its schools. The [ ] Public Schools prohibits discrimination
on the basis of race, color, sex, gender identity, religion, national origin, or sexual orientation and
ensures that all students have equal rights of access and equal enjoyment of the opportunities,
advantages, privileges, and courses of study.
The gender identity law reflects the reality that transgender and gender nonconforming students are
enrolled in Massachusetts public schools. These students, because of widespread misunderstanding and
lack of knowledge about their lives, are at a higher risk for peer ostracism, victimization, and bullying.
The 2011 National School Climate Survey by the Gay, Lesbian & Straight Education Network (GLSEN),
found that 75.4% of transgender students had been verbally harassed in the previous year, 32.1% had
been physically harassed, and 16.8% had been physically assaulted. Educators play an essential role in
advocating for the well-being of these students and creating a school culture that supports them.

An Act Relative to Gender Identity (The General Court of the Commonwealth of Massachusetts,
2019), amended several Massachusetts statutes prohibiting discrimination based on specified
categories, to include discrimination based on gender identity. Among the statutes amended is G.L.
c. 76, § 5, prohibiting discrimination based on gender identity against students who enroll in or
attend the public schools. G.L. c. 76, §5 now reads as follows:

Every person shall have a right to attend the public schools of the town where he resides, subject to
the following section. No school committee is required to enroll a person who does not actually
reside in the town unless said enrollment is authorized by law or by the school committee. Any
person who violates or assists in the violation of this provision may be required to remit full
restitution to the town of the improperly attended public schools. No person shall be excluded from
or discriminated against in admission to a public school of any town, or in obtaining the advantages,
privileges and courses of study of such public school on account of race, color, sex, gender identity,
religion, national origin or sexual orientation. Some transgender and gender nonconforming
students are not open at home about their gender identity for reasons such as lack of acceptance,
and safety concerns. A discussion with the student should occur first about parental knowledge of
the student’s gender identity, names and pronouns before any phone calls are made to the parents.
Understanding Gender Identity

The gender identity law defines "gender identity" to mean "a person's gender-related identity, appearance or
behavior, whether or not that gender-related identity, appearance or behavior is different from that
traditionally associated with the person's physiology or assigned sex at birth."3 The law also states that "
[g]ender-related identity may be shown by providing evidence including, but not limited to, medical history,
care or treatment of the gender-related identity, consistent and uniform assertion of the gender-related
identity or any other evidence that the gender-related identity is sincerely held as part of a person's core
identity; provided, however, that gender-related identity shall not be asserted for any improper purpose."

Transgender youth are those whose assigned birth sex does not match their internalized sense of their gender
(their "gender-related identity"), and gender nonconforming youth are those whose gender-related identity
does not meet the stereotypically expected norms associated with their assigned sex at birth. A transgender
boy, for example, is a youth who was assigned the sex of female at birth but has a clear and persistent identity
as male. A transgender girl is a youth who was assigned the sex of male at birth but has a clear and persistent
identity as female. Gender nonconforming youth range in the ways in which they identify as male, female, some
combination of both, or neither.

The responsibility for determining a student's gender identity rests with the student or, in the case of young
students not yet able to advocate for themselves, with the parent.5 One's gender identity is an innate, largely
inflexible characteristic of each individual's personality that is generally established by age four, although the
age at which individuals come to understand and express their gender identity may vary based on each
person's social and familial social development.6 As a result, the person best situated to determine a student's
gender identity is that student himself or herself.

In one Massachusetts town, the parents of a pre-school-age biologically female child noted throughout the child's
early years that their child identified as a boy. For as long as the parents could remember, the child preferred to
play with boys rather than girls, wanted a short haircut, rejected wearing any clothing that the child identified as
"something a girl would wear," and ignored anyone who called him by his stereotypically feminine name. When it
was time for the child to enter kindergarten, the child said to his parents, "You have to tell them when I go to
kindergarten that I'm a boy."

Consistent with the statutory standard, a school should accept a student's assertion of his or her gender
identity when there is "consistent and uniform assertion of the gender-related identity, or any other evidence
that the gender-related identity is sincerely held as part of a person's core identity." If a student's gender-
related identity, appearance, or behavior meets this standard, the only circumstance in which a school may
question a student's asserted gender identity is where school personnel have a credible basis for believing that
the student's gender-related identity is being asserted for some improper purpose.

In most situations, determining a student's gender identity is simple. A student who says she is a girl and
wishes to be regarded that way throughout the school day and throughout every, or almost every, other area of
her life, should be respected and treated like a girl. So too with a student who says he is a boy and wishes to be
regarded that way throughout the school day and throughout every, or almost every, other area of his life. Such
a student should be respected and treated like a boy.

The statute does not require consistent and uniform assertion of gender identity as long as there is "other
evidence that the gender-related identity is sincerely held as part of [the] person's core identity." Many
transgender people experience discrimination, and some experience violence due to their status. Some
environments may feel safe and inclusive, and others less so, challenging a person's ability to live consistently
with one gender identity in all aspects of life.
For example, it is possible that a biologically male student with a female gender identity who lives as a girl does
not express her female gender identity all the time. In one case, such a student agreed to present as a boy
when visiting relatives until the student's parents could explain the student's transgender identity to them. The
fact that the student did not exclusively assert her female identity did not alter the fact that she had a female
gender identity.

Confirmation of a student's asserted gender identity may include a letter from a parent, health care provider,
school staff member familiar with the student (a teacher, guidance counselor, or school psychologist, among
others), or other family members or friends. A letter from a social worker, doctor, nurse practitioner, or other
health care provider stating that a student is being provided medical care or treatment relating to her/his
gender identity is one form of confirmation of an asserted gender identity. It is not, however, the exclusive
form upon which the school or student may rely. A letter from a clergy member, coach, family friend, or
relative stating that the student has asked to be treated consistent with her/his asserted gender identity, or
photographs at public events or family gatherings, are other potential forms of confirmation. These examples
are intended to be illustrative rather than comprehensive.

In one Massachusetts middle school, a biologically male student explained to her guidance counselor that she was a
transgender girl who expressed her female gender identity only at home. The stress associated with having to hide
her female gender identity at school was having a negative impact on her mental health, as well as on her
academic performance. The student and her parents asked if it would be okay if she expressed her female gender
identity at school. The guidance counselor assured the student and her parents that she could do so. The fact that
the student presented no documentation to support her gender identity was not a concern since the school had no
reason to believe the request was based on anything other than a sincerely held belief that she had a female gender
identity.

Gender Transition
Many, though not all, transgender youth undergo the experience of gender transition. The term "gender
transition" describes the experience by which a person goes from living and identifying as one gender to living
and identifying as another. For most youth, and for all young children, the experience of gender transition
involves no medical intervention. Rather, most transgender youth will undergo gender transition through a
process commonly referred to as "social transition," whereby they begin to live and identify as the gender
consistent with their gender-related identity. Some transgender youth who are close to reaching puberty, or
after commencing puberty, may complement social transition with medical intervention that may include
hormone suppressants, cross-gender hormone therapy, and, for a small number of young people, a range of
gender-confirming surgeries. The decision about whether and how to undergo gender transition is personal
and depends on the unique circumstances of each individual. There is no threshold medical or mental health
diagnosis or treatment requirement that any student must meet in order to have his or her gender identity
recognized and respected by a school.

Some transgender and gender nonconforming students are not openly so at home for reasons such as safety
concerns or lack of acceptance. School personnel should speak with the student first before discussing a
student's gender nonconformity or transgender status with the student's parent or guardian. For the same
reasons, school personnel should discuss with the student how the school should refer to the student, e.g.,
appropriate pronoun use, in written communication to the student's parent or guardian.
Names and Pronouns

The issue of the name and pronoun to use in referring to a transgender student is one of the first that schools
must resolve to create an environment in which that student feels safe and supported. Transgender students
often choose to change the name assigned to them at birth to a name that is associated with their gender
identity. As with most other issues involved with creating a safe and supportive environment for transgender
students, the best course is to engage the student, and in the case of a younger student, the parent, with
respect to name and pronoun use, and agree on a plan to initiate that name and pronoun use within the school.
The plan also could include when and how this is communicated to students and their parents. In the case of a
transgender student who is enrolling at a new school, it is important that the school respect the student's
privacy (see the following section) and chosen name.

In one situation where a transgender girl was entering high school, she and her parent asked the principal to
inform her teachers that even though her school records indicate that her name is John, she goes by the name Jane
and uses female pronouns. The school principal sent the following memorandum to the student's classroom
teachers: "The student John Smith wishes to be referred to by the name Jane Smith, a name that is consistent with
the student's female gender identity. Please be certain to use the student's preferred name in all contexts, as well as
the corresponding pronouns. It is my expectation that students will similarly refer to the student by her chosen
name and preferred pronouns. Your role modeling will help make a smooth transition for all concerned. If students
do not act accordingly, you may speak to them privately after class to request that they do. Continued, repeated,
and intentional misuse of names and pronouns may erode the educational environment for Jane. It should not be
tolerated and can be grounds for student discipline. If you need any assistance to make sure that Jane Smith
experiences a safe, nondiscriminatory classroom atmosphere, please contact me or Ms. O'Neill. - Mr. Jones,
Principal."

Massachusetts' law recognizes common law name changes. An individual may adopt a name that is different
from the name that appears on his or her birth certificate provided the change of name is done for an honest
reason, with no fraudulent intent. Nothing more formal than usage is required.7 Hence, when requested,
schools should accurately record the student's chosen name on all records, whether or not the student, parent,
or guardian provides the school with a court order formalizing a name change
.
The Department has a procedure in place to update name changes and gender markers in the Student
Information Management System (SIMS) upon request. The document Assigning State Assigned Student
Identifiers (SASIDs) to Massachusetts' Public School Students guides schools through changing names and
gender markers on school records.

In sum, school personnel should use the student's chosen name and pronouns appropriate to a student's
gender identity, regardless of the student's assigned birth sex. For those students who have been attending a
school and undergo gender transition while attending the same school, it is important to develop a plan for
initiating use of the chosen name and pronouns consistent with the student's gender identity.
The Individuals with Disabilities Education Act (IDEA) and Section 504 of the Rehabilitation Act
(Section 504) are the two main special education laws. IDEA governs the creation and
implementation of Individualized Education Plans (IEPs), and Section 504 establishes the rules for
Section 504 Plans. Although these laws serve similar purposes, the level of supports, services and
accommodations a school must provide to meet its legal obligations under IDEA tend to be higher,
which translates into more legal protections for students than under Section 504. A student also
must be experiencing more significant difficulties in school to qualify for an IEP. Even when the
school is fully supportive of a transgender student, having an IEP or Section 504 Plan in place will
help ensure that the student receives a consistent level of support throughout any changes in
school or district administration, even if the student moves to another school or district (National
Center for Lesbian Rights, 2019).

Privacy, Confidentiality, and Student Records

Under state law, information about a student's assigned birth sex, name change for gender identity
purposes, gender transition, medical or mental health treatment related to gender identity, or any
other information of a similar nature, regardless of its form, is part of the individual's student record
(see Massachusetts Student Records Regulations, 603 CMR 23.00), is confidential, and must be kept
private and secure, except in limited circumstances. 603 CMR § 23.04.8 One circumstance is when
authorized school personnel require the information to provide administrative, teaching,
counseling, or other services to the student in the performance of their official duties. For
transgender students, authorized school personnel could include individuals such as the principal,
school nurse, classroom teacher(s), or guidance or adjustment counselor.

When a student new to a school is using a chosen name, the birth name is considered private
information and may be disclosed only with authorization as provided under the Massachusetts
Student Records Regulations. If the student has previously been known at school or in school
records by his or her birth name, the principal should direct school personnel to use the student's
chosen name. Every effort should be made to update student records (for example, Individualized
Education Programs) with the student's chosen name and not circulate records with the student's
assigned birth name. Records with the student's assigned birth name should be kept in a separate,
confidential file.

When determining which, if any, staff or students should be informed that a student's gender
identity is different from the assigned birth sex, decisions should be made in consultation with the
student, or in the case of a young student, the student's parent or guardian. The key question is
whether and how sharing the information will benefit the student.

Transgender and gender nonconforming students may decide to discuss and express their gender
identity openly and may decide when, with whom, and how much to share private information. A
student who is 14 years of age or older, or who has entered the ninth grade, may consent to
disclosure of information from his or her student record. If a student is under 14 and is not yet in
the ninth grade, the student's parent (alone) has the authority to decide on disclosures and other
student record matters.
Gender Markers on Student Records

A gender marker is the designation on school and other records that indicates a student's gender.
For most students, records that include an indication of a student's gender will reflect a student's
assigned birth sex. For transgender students, however, a documented gender marker (for example,
"male" or "female" on a permanent record) should reflect the student's gender identity, not the
student's assigned sex. This means that if a transgender student whose gender identity is male has a
school record that reflects an assigned birth sex as female, then upon request by the student or, in
the case of young students not yet able to advocate for themselves, by the parent or guardian, the
school should change the gender marker on the record to male.10 Schools are advised to collect or
maintain information about students' gender only when necessary.

Restrooms, Locker Rooms, and Changing Facilities

All students are entitled to have access to restrooms, locker rooms and changing facilities that are
sanitary, safe, and adequate, so they can comfortably and fully engage in their school program and
activities. In meeting with the transgender student (and parent) to discuss the issues set forth in this
memorandum, it is essential that the principal and student address the student's access to the
restrooms, locker room and changing facility. Each situation needs to be reviewed and addressed
based on the particular circumstances of the student and the school facilities. In all cases, the
principal should be clear with the student (and parent) that the student may access the restroom,
locker room, and changing facility that corresponds to the student's gender identity. While some
transgender students will want that arrangement, others will not be comfortable with it.
Transgender students who are uncomfortable using a sex-segregated restroom should be provided
with a safe and adequate alternative, such as a single "unisex" restroom or the nurse's restroom.
Similarly, some transgender students may not be comfortable undressing in the changing facilities
that correspond to the student's gender identity.

The following are examples of ways in which school officials have responded to these situations:

In one elementary school, a transgender second-grader socially transitioned from female to

male. The principal informed the staff: For the remainder of this year, he will use Nurse
Margaret's restroom, and toward the end of the year we will make future determinations of
restroom use in consultation with his family.

In one middle school, a male-to-female transgender sixth-grader socially transitioned after

spring break. For the rest of the school year, she used the nurse's restroom and the other unisex
restrooms at the school. Beginning in seventh grade, she used the girls' restroom.

In one high school, a transgender male-to-female student was given access to the female
changing facility, but the student was uncomfortable using the female changing facility with
other female students because there were no private changing areas within the facility. The
principal examined the changing facility and determined that curtains could easily be put up
along one side of a row of benches near the group lockers, providing private changing areas for
any students who wished to use them. After the school put up the curtains, the student was
comfortable using the changing facility.
Some students may feel uncomfortable with a transgender student using the same sex-segregated
restroom, locker room or changing facility. This discomfort is not a reason to deny access to the
transgender student. School administrators and counseling staff should work with students to
address the discomfort and to foster understanding of gender identity, to create a school culture that
respects and values all students.

The Department strongly recommends that districts include an appropriate number of gender-
neutral restrooms commensurate with the size of the school, and at least one gender-neutral
changing facility, into the design of new schools and school renovations.

School staff as well as students and their families may find the use of restrooms and changing
facilities to be among the more challenging issues presented by the gender identity law, perhaps due
to issues of personal privacy. As emphasized in other sections of this guidance, these issues should be
resolved on a case-by-case basis, through dialogue with students and parents, and through
leadership in creating safe and supportive learning environments.

Physical Education Classes and Intramural and Interscholastic Athletic Activities

Physical education is a required course in all grades in Massachusetts' public schools, and school-
based athletics are an important part of many students' lives. Most physical education classes in
Massachusetts' schools are coed, so the gender identity of students should not be an issue with
respect to these classes. Where there are sex-segregated classes or athletic activities, including
intramural and interscholastic athletics, all students must be allowed to participate in a manner
consistent with their gender identity. With respect to interscholastic athletics, the Massachusetts
Interscholastic Athletic Association will rely on the gender determination made by the student's
district; it will not make separate gender identity determinations.

At one school, a transgender girl joined the girls' cheerleading squad. The school supported the student's
participation on the team. When the team was going to a regional competition, however, several of the
team members raised a concern that the school would be made to compete in the coed cheerleading
portion of the competition rather than in the all-girls portion for which they prepared. With the
permission of the student, the principal wrote a letter that she gave to the coach to take to the
competition in case officials at the competition questioned the team's participation in the all-girls'
portion of the event. The letter explained: "Student, Jane Smith, is a transgender girl who has been a
member of the girls' team since (date). Jane has a sincerely held female gender identity and, therefore,
according to state law must be permitted to participate as a girl on the girls' cheerleading team." The
team participated in the regional competition without incident.

Other Gender-Based Activities, Rules, Policies, and Practices

As a general matter, schools should evaluate all gender-based policies, rules, and practices and
maintain only those that have a clear and sound pedagogical purpose. Gender-based policies, rules,
and practices can have the effect of marginalizing, stigmatizing, and excluding students, whether
they are gender nonconforming or not. In some circumstances, these policies, rules, and practices
may violate federal and state law. For these reasons, schools should consider alternatives to them.
Whenever students are separated by gender in school activities or are subject to an otherwise
lawful gender-specific rule, policy, or practice, students must be permitted to participate in such
activities or conform to such rule, policy, or practice consistent with their gender identity.

The new law on gender identity provides a good opportunity for schools to review their gender-
distinct policies. For example, some schools require students to wear gender-based garb for
graduation or have gender-based dress codes for prom, special events, and daily attire. Schools
should eliminate gendered policies and practices such as these. For example, one school that
previously had blue graduation gowns for boys and white ones for girls switched to blue gowns for
all graduates. The school also changed its gender-based dress code for the National Honor Society
ceremony, which had required girls to wear dresses.

Similarly, some classroom teachers may routinely include gender-based practices in the
classroom. For example, some teachers may have boys and girls line up separately to leave the
classroom to go to lunch, the gymnasium, restrooms, or recess, and may never have considered
the educational value of non-gendered alternatives, such as having students line up in the order of
their birthdays, or alphabetically by name, or in the order in which they are sitting.11

Education and Training

In order to further a safe and supportive school environment for all students, schools should
incorporate education and training about transgender and gender nonconforming students into
their anti-bullying curriculum, student leadership trainings, and staff professional development.

As with other efforts to promote a positive school culture, it is important that student leaders and
school personnel, particularly school administrators, become familiar with the gender identity
law, regulations, guidance, and related resources, and that they communicate and model respect
for the gender identity of all students.

Professional development for school staff could include topics on gender identity and gender
nonconformity such as: the Massachusetts Student Anti-discrimination Law and Regulations; the
DESE Guidance on Notifying Parents When a Student Has Been Bullied Based on Sexual
Orientation or Gender Identity/Expression; key terms related to gender identity and expression;
the development of gender identity; the experiences of transgender and other gender
nonconforming students; risk and resilience data regarding transgender and gender
nonconforming students; ways to support transgender students and to improve the school
climate for gender nonconforming students; gender-neutral language and practices; and this
guidance.

Communication with School Community and Families

Superintendents and principals need to review existing policies, handbooks, and other written
materials to ensure that they are updated to reflect the inclusion of gender identity in the student
antidiscrimination law, and may wish to inform all members of the school community, including
school personnel, students, and families, of the recent change to state law and its implications for
school policy and practice.
This could take the form of a letter that states the school's commitment to being a supportive,
inclusive environment for all students, as well as the school's legal obligation to provide equal
educational opportunities for all students. Such a letter might include the definitions provided at the
beginning of this document and some basic information about transgender and gender
nonconforming youth; a link to the school's anti-bullying and anti-harassment policies; a link to this
guidance; and other resources, including individuals to contact with additional questions.

Conclusion

This guidance cannot anticipate every situation in which questions may come up in the
implementation of this law, and the needs of each transgender or gender nonconforming student
should be assessed and addressed on a case-by-case basis. The Department will continue to provide
assistance, support, and resources as we work together to create a safe and supportive school
environment for all students.

For further information or questions about the content of this guidance, please contact the Safe
Schools Program for LGBTQ Students via Safeschoolsprogram@doe.mass.edu
MORE RESOURCES FOR THE YOUTH
Q Chat Space is a bully-free online community of LGBTQ teens that can chat with
other LGBTQ teens and trained staff from LGBTQ centers around the country. You
can access Q Chat Space at www.qchatspace.org
Gender Spectrum Lounge is a global online community for gender-expansive
teens, their families and support professionals to connect, collaborate and find
resources. You can access the Gender Spectrum Lounge at
genderspectrum.org/lounge
National Runaway Safeline is a federally designated national communication
system for runaway and homeless youth, availalbe 24/7/365, providing access to
resources and listening professionals. You can call NRS at 1-800-RUNAWAY or at
1800runaway.org
The Validation Station is a free texting service that sends daily gender-affirming
and uplifting text messages to trans and non-binary youth in lockdown. You can
access The Validation Station at validationstation.net
Trans Lifeline Hotline is a peer support service run by trans people located all
over the US and Candada, for trans and questioning callers. You can call Trans
Lifeline Hotline at 877-565-8860
The LGBT National Help Center offers a talkline and weekly chatrooms for youth,
providing confidential peer-support, information, local resources and community.
You can call the LGBT National Youth Talkline at 800-246-7743
You can access the Weekly Youth Chatrooms at glbthotline.org/youthchatrooms
True Colors United has created an online COVID-19 Action & Resource center
providing the most up-to-date resources for youth and adults experiencing
homelesness. They include resources for folks working in the field, advocates
making a difference, and young people looking for help. You can access the Action
& Resource Center at truecolorsunited.org/coronavirus-action-resource-center/
Many PFLAG chapters are meeting virtually or providing 1:1 virtual support as
requested for parents/guardians or LGBTQ youth. Go to pflag.org/find to look up
the PFLAG chapter in your area and reach out by phone, email or on social media
to learn more about their virtual support options.
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