D R A F T: This is a draft of a proposed position paper of the National Association of School Psychologists.

It has not been approved by the NASP Delegate Assembly and, given its draft status, should not be disseminated, quoted, or cited by any person except as part of its review and revision with NASP governance Safe Schools for Transgender & Gender Diverse Students The National Association of School Psychologists supports efforts to ensure that schools are safe and inclusive learning environments for students, family members, and school staff who are transgender or gender diverse. NASP acknowledges that the terms transgender or trans includes persons identifying as female-to-male, male-to-female, two-spirit, gender queer, and other terms. Gender diverse individuals have a gender expression that does not fit cultural expectations for their gender assigned at birth and may or may not identify as trans. NASP respects a persons right to express their gender identity, and the right to modify their gender expression when necessary for their well-being. NASP acknowledges that neither having a trans identity nor being perceived as gender diverse are disorders, and that efforts to change a persons gender identity are ineffective, harmful, and discriminatory. NASP is committed to a policy of nondiscrimination and the promotion of equal opportunity, fairness, justice, and respect for all persons. NASP works to ensure that settings in which school psychologists work are safe and welcoming and provide equal opportunity to all persons regardless of actual or perceived characteristics, including . . . gender, gender identity, gender expression, sexual orientation, . . . or any other personal identity or distinguishing characteristics (NASP, 2010). Terminology Transgender, or trans, is an umbrella term for persons whose gender identity or gender expression does not meet expectations typically associated with the sex to which they were assigned at birth within ones cultural context (APA, 2011). People who are not transgender are referred to as cisgender. Someone is gender diverse if their gender expression does not match what is culturally expected for the sex they were assigned at birth. They may dress or act in ways that others believe is not feminine enough or masculine enough. Such individuals have also been called gender nonconforming or gender variant. Gender diverse people may or may not identify as transgender. Sex refers to a persons biological characteristics including chromosomes, hormones, and anatomy. Gender refers to the socially constructed roles, behaviors, activities, and attributes that a given society considers appropriate for boys/men and girls/women. While sex is a biological construct, gender is a social construct. As most peoples sex and gender align, the two terms are commonly conflated. Gender assignment is the process of assigning a legal gender (sex) to a child soon after birth, triggering a variety of social events and developmental tasks related to gender role. Gender identity is a persons internal sense of being male, female, both, or neither. Shortly after children begin to speak, most are able to state whether they are a boy or a girl, and this identity is stable and resistant to change. Gender identity typically forms between 2 and 5 years of age. For most people, gender identity is consistent with sex assigned at birth. Gender expression refers to how people express themselves through gestures, gait, clothing, hairstyles, voice, body characteristics, or other gendered expressions. Gender expression is visible, while gender identity is not. Some transgender people do not appear gender diverse: they may have transitioned to another gender and blend in well, or, they might not transition and have a gender expression consistent with their birth-assigned gender. Some people with diverse gender expression are happy with their sex assigned at birth and have no desire or intention to transition genders. Gender constancy is the understanding that a persons gender is an unchanging characteristic, and this understanding develops for most children around the age of seven. School entry presents greater pressure to conform to gender expectations. At this age, some children with a gender identity that is incongruent with their birth assigned sex may experience distress if they are not permitted to express and be witnessed as their gender. At clinically significant levels, this distress is called gender dysphoria. The degree of distress can vary from mild to severe, and can be lifelong, although not all trans people

D R A F T: This is a draft of a proposed position paper of the National Association of School Psychologists. It has not been approved by the NASP Delegate Assembly and, given its draft status, should not be disseminated, quoted, or cited by any person except as part of its review and revision with NASP governance experience gender dysphoria. The child with gender dysphoria may demonstrate symptoms of depression, anxiety, self-harm, or oppositionality. Transgender is an umbrella term which includes diverse identities and modes of expression. A person may adopt a gender expression that is inconsistent with cultural expectations associated with their birth assigned sex permanently, temporarily, or situationally. They may adopt an appearance that is perceived to be both masculine and feminine (androgynous), or they may mix masculine and feminine elements (gender queer). Some may alternate expressed genders day to day (gender fluid). The trans umbrella includes those assigned female at birth who are or who wish to be living as men (trans men), and those assigned male at birth who are or who wish to be living as women (trans women). Many trans people are indistinguishable from cisgender people of the same gender. They may or may not desire body modifications to express their affirmed gender. Body modifications may be temporary (e.g., shaving, hair style, binding, hormone blockers) or permanent (hormones, electrolysis, surgeries). Many trans people prefer to live their lives without revealing their gender transition history to anyone (colloquially, living stealth). Trans women typically identify as women, and trans men typically identify as men. Some trans people may perceive being trans as a passage, something that describes their history, but not their present. The process of changing gender expression from that of one gender to another is called transition. The gender they transition to is called their affirmed gender. Social transition can include changes in clothing, grooming, name and/or pronoun changes and more. Medical transition can include hormones and surgeries. Some transgender adults transition genders. Many do not transition and do not desire to do so. Some students arrive at kindergarten already living in their affirmed gender, while others may express a desire to transition genders while in elementary or in secondary school. The majority of children under age 9 identifying as the opposite gender do not persist in doing so in adolescence and early adulthood. The majority of youth age 11 and older identifying as the opposite gender persist in their identity throughout adolescence and adulthood. For children under age 9, only reversible social transitions occur (adopting clothing, hair styles, toy/game preferences). The difference between those who persist in identifying as the opposite gender and those who do not persist appears to be related to the degree of disgust or satisfaction with bodily changes brought about by puberty for the students birth gender. Many such changes are irreversible, such as the extended growth spurt, lengthening of arms, beard growth, and voice deepening in trans women, or widening hips, breast development, menstruation, and early fusion of bone growth plates leading to shorter stature in trans men. These changes precipitate an emotional crisis with risk of self-harm for many persistently trans youth. Medical treatment involving the administration of a gonadotropin-releasing hormone agonist (GnRH) can put puberty on hold for several years, allowing the child time to cognitively mature. The puberty-delaying effect is completely reversible when treatment stops, puberty associated with the youths birth gender resumes. The youth can make an informed decision to receive hormones for their affirmed gender at age 16 or older, avoiding irreversible signs of their birth sex and avoiding expensive and painful corrective procedures. A persons gender identity is distinct from their sexual orientation. Sexual orientation refers to an enduring pattern of emotional, romantic, and/or sexual attractions to men, women, both sexes, transgender people, none, or all genders (APA, 2008). Ones sexual orientation identity label is typically derived from their gender identity, and not their assigned sex. For example, a female-to-male trans man who is primarily attracted to men is likely to identify as gay. A male-to-female trans woman who is primarily attracted to men is likely to identify as straight. Trans people are more likely to also identify as LGBQ than cisgender people.

D R A F T: This is a draft of a proposed position paper of the National Association of School Psychologists. It has not been approved by the NASP Delegate Assembly and, given its draft status, should not be disseminated, quoted, or cited by any person except as part of its review and revision with NASP governance Being transgender is not related to erotic preferences. The confusion of eroticism and trans identities in popular culture leads to disbelief that children could declare an identity different than their birth assigned sex. Rationale Trans and gender diverse students are uncommon, but not rare. It is difficult to get reliable estimates of prevalence. Early trans prevalence estimates of 1 in 30,000 persons born male and 1 in 100,000 born female were based on the number of adults seeking surgeries in Europe in the 1960s, but are still presented as current in a number of texts, including DSM-5 (American Psychiatric Association, 2013). Medical and social support for gender transition has become more widely accessible since the 1960s. Transgender adults in the USA, based on five recent health surveys, have been estimated as 0.3% of the general population (Gates, 2011), but this may be an underestimate. Adults, who can undergo all medical and social aspects of transition, may not identify as trans after transition and may not be counted in population surveys. In 2010-11, 1.3% of San Francisco middle school students and 2.7% of high school students identified as transgender on an annual health survey (Shields, 2009). This likely does not include all gender diverse students. Nor does it include trans students who are reluctant to identify as such on a survey: in a city known for gender tolerance, students report high rates of harassment on the basis of gender expression. Given that adult trans people report they knew they identified with a different gender at a median age of 5 (Kennedy and Hallen, 2010), its likely that in any one school, 3% of students are transgender, gender nonconforming, or gender questioning. As transgender children become adults, they are at risk for an array of unfortunate outcomes. Nearly half of trans adults (41%) report attempting suicide at least once in their lives, compared to 1.6% for the USA population as a whole. Suicide attempts were more prevalent among those who had been harassed at school (55%), who had been physically assaulted at school (61%), or who had been sexually assaulted at school (64%). Three quarters (76%) of those assaulted by school staff attempted suicide. Suicide attempts were 51% among those whose families rejected them, but only 32% among those with accepting families (Grant, Mottet, & Tanis, 2011). There are relationships between school events and later adult outcomes. Half of the relationship between gender nonconformity in adolescence and adult life satisfaction/depression is mediated by the experience of school victimization (Toomey, Ryan, Diaz, Card, and Russell, 2010), while gender nonconformity alone had no direct effect on these adult outcomes. Harassment and assault lead to anxiety about school, leading to missing days of school. Nearly half (46%) of trans students report missing at least one school day in the previous month because they felt unsafe (Greytak, Kosciw, & Diaz, 2009). If a trans student retaliates against harassment, they are likely to be suspended. Gender diverse children are at higher risk of physical, emotional, and sexual abuse and are at higher risk of post-traumatic stress disorder in adulthood, with about a third of the higher risk of PTSD mediated by being abused as a child (Roberts, Rosario, Corliss, Koenen and Austin, 2012). Coming out to family members often results in physical assault and expulsion from the family home (Ray, 2006). Most homeless shelters are segregated by gender and turn away trans youth. With few employable skills, desperate for shelter and money, trans youth may turn to sex work. Sex work may be superficially affirming of their gender identity, but puts them at high risk of arrest, of contracting HIV and other STDs, of physical assault, sexual assault, and homicide. Intersectionality compounds risk factors: 47% of black transgender adults report having done sex work and25% are HIV positive. This compares to 2.64% for trans people of all races and 0.6% for the US population being HIV positive. Transgender youth are often desperate to transition. Even if they have health insurance, psychotherapy and medical procedures related to gender transition are specifically excluded from most health insurance plans at this time. Hormones are relatively inexpensive, but lab work and physician

D R A F T: This is a draft of a proposed position paper of the National Association of School Psychologists. It has not been approved by the NASP Delegate Assembly and, given its draft status, should not be disseminated, quoted, or cited by any person except as part of its review and revision with NASP governance monitoring are not. Many trans youth and adults take hormones they buy from the internet and are not under medical supervision. Impatient for changes, some trans youth may take higher doses of hormones than they are prescribed, risking blood clots, liver failure, and prolactinomas. Trans youth may be attracted to pumping parties (injecting industrial silicone in an attempt to develop curves), which can lead to disfigurement and life threatening emergencies. Many trans youth are resilient, and there are a number of factors which may inoculate students against the worst outcomes. Resilience in children and youth appears to depend on personal characteristics like being outgoing; resourceful; having a positive self-concept; having an emotional bond with at least one adult over a period of time; and having a supportive community (Werner, 1995). Specifically for trans and gender non-conforming children, attention has focused on family acceptance and school acceptance. These are still emerging areas of research. Parents must allow their childs personality to unfold while simultaneously protecting them from harm (Ehrensaft, 2011). Families go through a developmental process in accepting a trans or gender non-conforming child. Much depends on parents beliefs and understanding of child development and gender. Some children have unexpected gender behavior at an early age, which persists in spite of parent attempts to divert the child to gender conforming behavior. Parents may be embarrassed or ashamed of their childs behavior, depending on conformity pressures coming from extended family members, neighbors, clergy, daycare providers, and others. Parents may fear the future for their child, as well as their own future as they are judged by other adults. These pressures may lead to conflict between parents and may lead to parental separation. The parent who is the same sex as the child may question their own effectiveness as a role model. There is much information currently online to assist parents in understanding their child. Children and youth are more likely to have successful outcomes if parents work to create safe and supportive spaces for their child within the home, if parents are able to avoid detrimental spaces, require others to respect their child, and express love for their child (Brill and Pepper, 2008). An older child or youth may come out suddenly, taking parents by surprise, before parents have had time to develop acceptance of their childs affirmed gender. This surprise may result in harmful events, such as assault or expulsion from the family home. As transgender people become more apparent in mass media, many parents in this situation may avoid sudden harm to their child. Schools must also go through a process of allowing students to develop while keeping them safe. Educational persistence of trans and gender non-conforming students may depend on their sense of belonging. The climate of school needs to be one where LGBT students feel safe. Staff must avoid homophobic and transphobic language and be vigilant and intervene when such language is used by students. Schools need comprehensive anti-harassment policies that enumerate gender, gender identity, and gender expression as unacceptable. The presence of a Gay-Straight Alliance (GSA) in school leads to greater feelings of safety and of belonging, better attendance, and lower rates of harassment. Participation in GSA clubs during adolescence is associated with better self-esteem, lower depression and higher educational attainment in LGBT young adults (Toomey, Ryan, Diaz, and Russell, 2011). LGBT students need to be able to find resources related to LGBT lives, such as biographies in libraries or access to resource web sites. School districts need to have written policies and procedures addressing the needs of trans and gender diverse students (e.g., GLSEN/NCTE, 2011, Massachusetts DOESE, 2012), Ethical and Legal Implications NASPs Principles for Professional Ethics (NASP, 2010) provides guidelines for conduct and practices that are consistent with expectations of the school psychology profession. A few issues are highlighted here as they pertain to gender diverse and transgender individuals: Privacy and Confidentiality - Standard I.2.6 requires school psychologists to safeguard information about a students gender identity, sexual orientation, and transgender status.

D R A F T: This is a draft of a proposed position paper of the National Association of School Psychologists. It has not been approved by the NASP Delegate Assembly and, given its draft status, should not be disseminated, quoted, or cited by any person except as part of its review and revision with NASP governance Specifically, privacy and confidentiality should be respected and information about an individuals sexual orientation, gender identity, or transgender status is not shared with others without the individuals permission (NASP, 2010). Addressing personal biases - Standard II.1.2 expects school psychologists to pursue knowledge and understanding that is affirming of individuals diverse characteristics, and to obtain training and supervision when needed to provide effective services (NASP, 2010). Promoting safe and welcoming school climates - School psychologists are expected to promote school climates that are safe and welcoming to all individuals regardless of actual or perceived characteristics. These characteristics include gender, sexual orientation, gender identity, and gender expression (Principle I.3; NASP, 2010). A commitment to fairness and justice includes taking steps to foster school climates that are safe, accepting, and respectful of all persons and ensuring equal access and opportunity to participate and benefit from all school programs (NASP, 2010). Many school districts have board policies which prohibit discrimination and harassment on the basis of gender identity or gender expression, and many districts have issued guidelines for providing accommodations for transgender and gender diverse students. There are at this writing 16 states and the District of Columbia that have state laws specifically protecting transgender students in public schools from harassment and/or discrimination. Several of these states have issued guidelines clarifying what students must do to accommodate transgender students. There is, as yet, no federal law prohibiting discrimination on the basis of gender identity/expression, although two laws have been introduced in the current US Congress: The Employment Non-Discrimination Act (H.R. 1755) and the Student Nondiscrimination Act (H.R. 1652, S.1088). Title IX of the Education Amendment Act of 1972 prohibits harassment of students on the basis of gender expression. Role of the School Psychologist School psychologists advocate for the civil rights of all students, including those who are transgender or gender diverse. School psychologists are equipped with skills necessary to promote a safe, respectful and supportive school environment for transgender and gender-diverse youth and adults. They seek to protect students from harassment and discrimination in schools. They advocate for gender-neutral spaces and help establish safe zones for transgender students. The school psychologist models acceptance and tolerance. They provide staff training to increase awareness regarding transgender issues in the schools, and actively respond to bullying, intimidation, and other forms of harassment whether perpetrated by students or staff. They seek knowledge and skills necessary to be effective advocates for students who are transgender or gender diverse, and contribute to knowledge about effective practices. School psychologists strive to minimize bias by using non-gender specific phrasing and pronouns and by avoiding gender stereotypes. School psychologists provide counseling and attend to the socialemotional needs of transgender and gender-nonconforming students in school within the scope of their training. They seek to acquire and to provide information on community agencies that provide services and supports to the transgender community. The school psychologist is in tune to the needs of parents and staff, and can provide evidence-based information to adults who seek to understand transgender issues. The school psychologist is welcoming and supportive of transgender staff and parents, and is able

D R A F T: This is a draft of a proposed position paper of the National Association of School Psychologists. It has not been approved by the NASP Delegate Assembly and, given its draft status, should not be disseminated, quoted, or cited by any person except as part of its review and revision with NASP governance to foster a climate of acceptance and security for all. Whenever a school psychologist finds their understanding of or sensitivity to transgender issues limited, they will seek additional training or seek the aid of a colleague who is sensitive to the plight of the transgender individual. In all cases, the school psychologist will be sensitive to the needs and welfare of all individuals at their school sites(s), including transgender and gender-diverse students and staff.

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D R A F T: This is a draft of a proposed position paper of the National Association of School Psychologists. It has not been approved by the NASP Delegate Assembly and, given its draft status, should not be disseminated, quoted, or cited by any person except as part of its review and revision with NASP governance Shields, J.P. (2009). SFUSD Demographics. Youth Risk Behavior Survey. (Report from Student, Family, and Community Support Department to San Francisco Unified School District Board, 2009). Toomey, R.B., Ryan, C., Diaz, R.M., Card, N.A., and Russell, S.T. (2010). Gender-nonconforming lesbian, gay, bisexual, and transgender youth: School victimization and young adult psychosocial adjustment. Developmental Psychology, 46, 1580-1589. Toomey, R.B, Ryan, C., Diaz, R.M., and Russell, S.T. (2011). High school GayStraight Alliances (GSAs) and young adult well-being: An examination of GSA presence, participation, and perceived effectiveness. Applied Developmental Science, 15, 175185. Travers, R. (2012). Mental Health. In Improving the health of trans communities: Findings from the Trans PULSE Project. Ottawa: Rainbow Health Ontario Conference Werner, E. E. (1995). Resilience in development. Current Directions in Psychological Science, 4 8185