Gender-Affirming Caregiving Strategies for Foster Parents in British Columbia

Abstract

The recent Right to Thrive report by the Office of the Representative for Children and Youth (RCY) in British Columbia (BC) revealed that the BC child welfare system does not currently provide adequate supports for Two Spirit, Trans, Non-Binary, and Gender Diverse (2STNBGD) youth to experience safety, security, or belonging (RCY, 2023). As a result, 2STNBGD youth in care have been found to have increased risks of self-harm, suicidality, and housing instability relative to their cisgender peers. The RCY has called on the Ministry of Children and Family Development (MCFD) to implement mandatory gender-affirming caregiving training. This study aims to identify best practices for foster caregivers to support the safety and belonging of 2STNBGD children and youth in a BC child welfare context. Research participants identified caregiving strategies supportive of 2STNBGD youth in care to offer potential guidance to mitigate harm and provide affirmative support for 2STNBGD children and youth, thereby increasing their sense of security and belonging. An integrative theoretical framework drawing on the minority stress, postcolonial and family resilience theories was used to provide context for the consistently poorer outcomes experienced by 2STNBGD children and youth. Mental health disparities emerge from the reality that minority group members face more individual-level and societal-level stressors (Hunter et al., 2021). This is particularly salient for youth in government care who often navigate intersecting systems of ageism, cissexism and racism. Therefore, attending to this intersectional oppression is key to gender-affirming caregiving. Lastly, this framework explained that a resilient families may reconfigure its internal organization and communication practices in response to shared adversity by privileging the lived experience of the 2STNBGD child (Heiden-Rootes, 2024; Walsh, 2015). Participants were recruited with the support of the British Columbia Foster Parent Association (BCFPA). The sample included nine caregivers who identified as women, men, or gender diverse, were of European and/or Indigenous ancestry, and lived in both urban and rural regions of British Columbia. Most participants had over sixteen years of fostering experience, and the remaining participants ranged from four to nine years of experience. All participants had cared for at least one 2STNBGD child/youth aged six to nineteen, though most care occurred exclusively in the teenage years. Semi-structured interviews were conducted virtually with the participants to gather details on specific gender-affirming caregiving strategies. Guided by MCFD’s Aboriginal Practice and Policy Framework in British Columbia (2015), interview questions were reviewed by an Indigenous Elder and Trans Indigenous former youth in care to ensure appropriateness and sensitivity. Responses were transcribed, analysed through a thematic approach, and distilled into six key themes. Our analysis identified six themes that reflect gender-affirming strategies that emphasize the importance of ensuring caregiver behaviours embody self-awareness, advocacy, and building trust to support the well-being of 2STNBGD children and youth in care. A relational approach to caregiving that emphasizes advocacy and navigation of interpersonal and structural barriers helps address the unique stressors impacting 2STNBGD youth in care. A willingness to engage in self-reflection and proactive behaviours that address transphobia and protect children and youth is critical for an effective gender-affirming approach and foundation of safety, security, and belonging. This research suggests caregivers should prioritize relational caregiving practices focusing on fostering connection with youth as a pathway to gender affirming care. Additionally, caregivers should be supporting youth in accessing supports and services at an institutional level. Considerations for MCFD include support for gender-affirming caregiving through the development of formal education and training for caregivers highlighting relational caregiving practices and critical reflexivity skills. Formal advocacy support for caregivers of 2STNBGD youth is also indicated in the research findings. Finally, to support the representation of 2STNBGD youth voices in future studies, researchers should consider significant changes to study design to include this community. This study suggests that a multi-pronged and integrated use of intrapersonal, interpersonal and institutional strategies are most important for effective gender-affirming caregiving. This includes practicing critical reflexivity, cultivating a deeply present and responsive relationship with the youth, and supporting their navigation of oppressive institutions.