Building a comprehensive understanding of 2SLGBTQ+ youth homelessness: a scoping review

Abstract

Two-spirit, lesbian, gay, bisexual, transgender, queer, questioning, plus additional sexual and gender diverse (2SLGBTQ+) youth are overrepresented among youth experiencing homelessness. 2SLGBTQ+ youth experiencing homelessness are an understudied population, which has resulted in gaps in knowledge about youths’ needs and experiences. The purpose of this scoping review was to synthesize what is currently known about 2SLGBTQ+ youth and young adult homelessness internationally, using a search strategy that included both reviews and grey literature. This review was guided by the five-stage scoping review framework developed by Arksey & O’Malley. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Review checklist in the reporting of the methodology of this scoping review. The search strategy utilized a three-concept approach to capture research on 2SLGBTQ+ populations, homelessness, and adolescents/youth. Study selection and data extraction was conducted using Covidence Systematic Review Software. A total of 112 sources—including original research articles and review articles—met eligibility criteria and were included in the review. A majority of the articles focused on youths’ experiences with homelessness, highlighting issues such as family violence, conflict, and rejection; physical and sexual victimization; stigma and discrimination in housing programs; mental health and substance use challenges; engagement in survival sex; difficulties accessing and securing employment and education; and exclusion from community and social supports. Articles also discussed the barriers that youth face in trying to access shelter services, including homophobic, biphobic, and transphobic discrimination, and policies and regulations—such as gender-segregated housing—that make services non-gender-affirming. The reviewed articles highlighted strategies for services and programs to effectively address 2SLGBTQ+ youth homelessness, including training staff to be gender-affirming and inclusive, updating policies and data collection practices to be more transgender-inclusive, facilitating community connections, and adapting services to an intersectional framework. The most effective programs were characterized by five novel components: reliance on clinical evidence; trauma-informed approach; provision of safe, stable, and supportive housing; 2SLGBTQ+ peer providers; and opportunities for mutual learning between 2SLGBTQ+ youth and cisgender and heterosexual youth. As a comprehensive review of the existing literature, this scoping review can be leveraged to inform the development and implementation of targeted interventions for 2SLGBTQ+ youth experiencing homelessness across various care settings. The insights presented offer critical information for policymakers, researchers, and professionals seeking to understand and address the unique needs and challenges faced by 2SLGBTQ+ youth experiencing homelessness.

Introduction

To date, there is no internationally standardized definition or method for enumerating people experiencing homelessness. Understandings of what constitutes homelessness vary across countries and regions, and are shaped by local social, cultural, and policy contexts. Some definitions include individuals in insecure or temporary housing (e.g., couch surfing, transitional housing), while others count only those who are unsheltered or residing in emergency shelters. Reporting practices also differ internationally. Consequently, both the conceptualization and the measurement of homelessness vary across contexts; however, government reports estimate that young people experiencing homelessness make up approximately 20–33% of the homeless population in the United States, Canada, Ireland, and most European countries [1–4].

Homelessness encompasses a variety of living situations, such as living without shelter, staying in emergency shelters, being temporarily housed, or facing the risk of losing housing. A young person is considered to be experiencing homelessness when they are living independently of parents/caregivers, but are unable to secure stable, safe, or consistent housing [5, 6]. Similarly, a young person is considered to be at risk of homelessness when their housing situation is dangerously lacking security or stability, for example, a young person living in an unsafe home environment experiencing family conflict and rejection [7]. For the purposes of this scoping review, youth and young adults are defined as individuals between the ages of 13 and 29, consistent with definitions used by various services and government bodies, including the Government of Canada and the European Commission [8, 9].

Two-spirit, lesbian, gay, bisexual, transgender, queer, questioning, plus additional sexual and gender diverse (2SLGBTQ+) youth experiencing homelessness are an understudied population, which has resulted in gaps in knowledge about youths’ needs and experiences globally. Information pertaining to youths’ sexual orientation and gender identity (SOGI) is seldom collected outside of North America, making it especially challenging to identify 2SLGBTQ+ individuals in housing and support programs, and through local and national homeless counts, resulting in significant gaps in the literature. In contexts where SOGI data are collected, 2SLGBTQ+ youth are overrepresented among those youth experiencing homelessness, comprising an estimated 25–40% of the youth homelessness population despite only making up 5–10% of the general youth population [5, 10–12]. Although SOGI data are not routinely collected in a standardized way across Europe, existing research and literature on youth homelessness have similarly highlighted the disproportionate representation of LGBTQ+1 youth and the multiple barriers and challenges they face, including identity-based family rejection, discrimination in housing programs, and limited access to LGBTQ+ inclusive and affirming services [13–15]. In addition to limited large-scale data collection and the exclusion of SOGI questions on surveys and questionnaires, 2SLGBTQ+ youth homelessness has been difficult to study due to the hard-to-reach nature of this population—particularly those living outside of urban settings [12]. Identity-based family conflict resulting from a young person coming out as 2SLGBTQ+ is the most frequently cited cause of homelessness among 2SLGBTQ+ youth [12, 16–19]. 2SLGBTQ+ youth face an increased risk of homelessness, experience homelessness at younger ages, and endure longer episodes compared to heterosexual and cisgender youth [12, 18, 20]. Indigenous and racialized 2SLGBTQ+ youth experience increased risks of homelessness, discrimination, stigma, and violence [17, 21]. 2SLGBTQ+ youth experiencing homelessness often encounter high rates of stigma and identity-based violence in housing and support programs, and on the streets [12, 16, 22]. Compared to heterosexual and cisgender youth, 2SLGBTQ+ youth experiencing homelessness face an increased risk of physical and sexual exploitation, and experience significantly higher rates of mental health issues, due to stigma, discrimination, and identity-based rejection [17, 23]. 2SLGBTQ+ youth experiencing homelessness also face a greater risk of involvement in the criminal justice system and child protection services compared to cisgender and heterosexual youth, and youth who are securely housed [24]. Preventing, reducing, and ending 2SLGBTQ+ youth homelessness requires targeted strategies and prevention tactics that focus on the unique challenges and needs experienced by 2SLGBTQ+ youth, including population-based programs and services. For example, specialized 2SLGBTQ+ housing programs have found success internationally, and show promise in meeting the needs of 2SLGBTQ+ youth [15, 25–28].

The purpose of this scoping review is to synthesize existing knowledge on 2SLGBTQ+ youth and young adult homelessness internationally, identify evidence of the barriers and facilitators 2SLGBTQ+ youth face when trying to access services, and understand where there are knowledge gaps in implementing interventions [29, 30]. Guided by indicators for conducting a scoping review [29, 30], this review aims to identify the types of evidence available and map the key factors and gaps in existing knowledge. Although several studies have explored these topics, the evidence remains inconsistent and fragmented across disciplines and geographic contexts, underscoring the need for a comprehensive synthesis. To date, no review has consolidated international evidence on 2SLGBTQ+ youth homelessness, or included research on interventions, and only one recent scoping review [31] has examined related issues with a narrower scope focused on life course transitions in North American contexts. This review employs a search strategy that includes a wide variety of peer-reviewed literature, including empirical studies and review articles, as well as grey literature. Although grey literature is a valuable and frequently used source of information, recommendations, and resources, it has not been examined in previous reviews. Including grey literature enables the integration of knowledge generated by governments, communities, and organizations, extending beyond purely academic perspectives that may not be informed by hands-on experience. By incorporating an extensive range of search topics, this review captures an inclusive and diverse representation of homelessness experiences (e.g., hidden homelessness, at-risk of homelessness), and synthesizes a breadth of evidence-informed recommendations for programs, policies, and evaluations aimed at improving responses to 2SLGBTQ+ youth homelessness.

Research questions

1. What is currently known about the experiences of homelessness among 2SLGBTQ+ youth and young adults globally?

2. What are the barriers and facilitators to accessing housing and support services among 2SLGBTQ+ youth and young adults experiencing homelessness?

3. What interventions have been developed to support 2SLGBTQ+ youth and young adults in exiting homelessness?

Materials and methods

This scoping review was guided by the five-stage scoping review framework developed by Arksey & O’Malley [29]. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Review (PRISMA-ScR) checklist in the reporting of the methodology of this scoping review. The final study protocol was registered in the Open Science Framework (10.17605/OSF.IO/NPZG9) (protocol registration accessible via https://osf.io/npzg9).

Search strategy

The following databases were searched to identify the published literature: Medline, EMBASE, CINAHL, LGBTQ+ Source, PsycINFO, Scopus, and Web of Science. The search strategy utilized a three-concept approach to capture research on 2SLGBTQ+ populations, homelessness, and adolescents/youth. The Medline search was developed first, and the MeSH headings and keywords from the Medline search were individually adapted to match the search syntax of the other databases (e.g., gender$ fluid$.mp., (couch$ adj3 surf$).mp.). The original search was conducted in November 2021; all of the database searches were re-run before the final analysis, in order to capture the most recently published literature, as of May 2023. Grey literature sources were searched to supplement the research identified by the bibliographic database searches. Several data sources provide information on homelessness, each capturing distinct aspects of the issue. To more comprehensively capture research on 2SLGBTQ+ youth homelessness, the evidence base was expanded to include grey literature sources. The grey literature search was limited to dissertations, preprints, reports, and statistical data. To ensure a clearly defined scope, the reports/statistical data component of the grey literature search was restricted to governmental agencies and not-for-profit organizations from the following geographical locations: Canada-nationally available data, all Canadian provinces/territories, municipal information from the five largest municipal population centres in Canada (Toronto, Vancouver, Montreal, Calgary, Edmonton), United States-nationally available data, District of Columbia, New York-state data, municipal information from NYC, Hawaii-state data, municipal information from Honolulu, California-state data, and municipal information from Los Angeles and San Francisco. We focused on the selected regions, as they all have a higher-than-average rate of homelessness—either per capita or overall—and have had local municipal/not-for-profit agencies attempt to calculate the size and demographics of their homeless populations [32, 33]. The grey literature search methods included searching databases/servers/portals with grey literature content, structured Google searching, use of custom Google Search engines, searching Google Scholar, and searching the websites of relevant governmental agencies and not-for-profit organizations. Employing multiple search methods aided in identifying information from diverse sources, achieving more data saturation [29].

Study selection

Study selection was conducted using Covidence Systematic Review Software [34]. The study selection process included two levels of screening: a title and abstract review, and a full-text review. Both stages were completed by research team members independently (AA, NE, NP, RS). Conflicts in the article selection process were resolved by the principal investigator (AA). Studies that met the following criteria were included: (1) Focused on 2SLGBTQ+ youth/young adults experiencing homelessness, and explicitly mentioned examining the 2SLGBTQ+ population in the context of homelessness and/or housing; (2) Full-text quantitative, qualitative, or mixed-methods study or review (evidence syntheses, systematic reviews, meta-analyses, scoping reviews, narrative reviews, rapid reviews, and realist reviews); (3) Published in English. Studies that did not focus on 2SLGBTQ+ youth experiencing homelessness, and/or were not available in full-text were excluded.

Data extraction and synthesis

Data extraction was conducted using Covidence Systematic Review Software [34]. The following information was extracted from each included source and entered into a data extraction table: title, lead author, country of study, study aim, study design, description of population and inclusion/exclusion criteria, recruitment method, number of participants, outcome measure(s), focus of study, and relevant findings [29]. Research team members conducted data extraction for each article (MM, NE, NP, RS); extraction was then reviewed by the principal investigator (AA). A narrative synthesis approach was selected to describe, summarize, and interpret the findings, as the included studies varied in design and methods (i.e., qualitative, quantitative, mixed methods). This approach enabled the systematic organization, comparison, and interpretation of findings across diverse study types. The synthesis was conducted in several stages. First, extracted data were entered into a table summarizing study characteristics and key findings (see Table 1). Next, results were examined across studies to identify commonalities and differences. Quantitative findings were described in narrative form and combined with qualitative insights to provide a comprehensive understanding of 2SLGBTQ+ youth homelessness. Article findings were assessed for relevance to the three research questions. Due to the volume of sources relevant to research question #1, these findings were further grouped into themes using thematic analysis as a guide [138, 139]. Two team members independently reviewed the data, and seven themes emerged. These themes were subsequently reviewed and refined to ensure consistency and consensus among team members.

Table 1.

Reviewed articles (year range: 2002 – 2023)

Author	Year	Title	Study Country	Study Design	Themes	Age Range
Abramovich [35]	2012	No safe place to go LGBTQ youth homelessness in Canada: reviewing the literature	Canada	Literature review	Service delivery, housing programs, lack of services, discrimination	16–26
Abramovich [16]	2016	Preventing, reducing and ending LGBTQ2S youth homelessness: the need for targeted strategies	Canada	Policy/issue brief	Policy change, social inclusion, service delivery improvement, intersectionality	16–29
Abramovich [36]	2017	Understanding h ow policy and culture create oppressive conditions for LGBTQ2S youth in the shelter system	Canada	Qualitative, cross-sectional	Service delivery, housing programs, policy, critical action research, service access/barriers	16–21
Abramovich & Kimura [25]	2021	Outcomes for youth living in Canada’s first LGBTQ2S transitional housing program	Canada	Mixed-methods, longitudinal	Housing program evaluation, population-based housing, mental health, well-being	16–24
Abramovich & Pang [22]	2020	Understanding LGBTQ2S youth homelessness in York Region	Canada	Mixed-methods, cross-sectional	Service delivery, pathways into homelessness, lack of services, family connectedness, community, mental health, substance use	13–26
Abramovich et al. [37]	2020	A transgender refugee woman experiencing posttraumatic stress disorder symptoms and homelessness	Canada	Case study, longitudinal	Service delivery, discrimination, mental health	23
Abramovich et al. [38]	2021	Investigating the impacts of COVID-19 among LGBTQ2S youth experiencing homelessness	Canada	Mixed-methods, cross-sectional	Mental health, substance use, health service use, lack of access to services	14–29
Abramovich et al. [39]	2022	Experiences of family violence among 2SLGBTQ + youth at risk of, and experiencing, homelessness before and during the COVID-19 pandemic	Canada	Mixed-methods, cross-sectional	Identity-based rejection, family violence	14–29
Aguirre Montes [40]	2021	Analysis of LGBTQ homeless youth in Los Angeles County	United States	Literature review	Mental health, substance use, victimization, discrimination, HIV, survival sex	10–24
Alessi et al. [41]	2021	Victimization and resilience among sexual and gender minority homeless youth engaging in survival sex	United States	Qualitative, cross-sectional	Service delivery, victimization, resilience, lack of resources, lack of protection, employment	13–21
Bowers et al. [42]	2022	Homeless youth shelters and services for transgender and gender non-conforming (TGNC) clients: results from a nationwide survey	United States	Quantitative, cross-sectional	Service delivery, policy	N/A
Burwick et al. [43]	2014	Identifying and serving LGBTQ youth: case studies of runaway and homeless youth program	United States	Mixed-methods, cross-sectional	Service delivery, housing programs, risk and protective factors	Up to 24
Cochran et al. [44]	2002	Challenges faced by homeless sexual minorities: comparison of gay, lesbian, bisexual, and transgender homeless adolescents with their heterosexual counterparts	United States	Quantitative, cross-sectional	Pathways into homelessness, victimization, mental health, substance use, sexual behaviour	13–21
Coolhart & Brown [45]	2017	The need for safe spaces: exploring the experiences of homeless LGBTQ youth in shelters	United States	Qualitative, cross-sectional	Service delivery, pathways into homelessness, lack of services, substance use, source of support/resilience, survival sex	14–21
Côté & Blais [46]	2019	Between resignation, resistance and recognition: a qualitative analysis of LGBTQ+ youth profiles of homelessness agencies utilization	Canada	Qualitative, cross-sectional	Housing programs, service use, cisheteronormativity	16–25
Côté & Blais [47]	2020	“The least loved, that’s what I was”: a qualitative analysis of the pathways to homelessness by LGBTQ+ youth	Canada	Qualitative, cross-sectional	Pathways into homelessness	17–25
Côté et al. [48]	2023	I didn’t want to be noticed: discrimination and violence among LGBTQ+ youth experiencing homelessness	Canada	Qualitative, cross-sectional	Discrimination, intersectionality, violence, racialized youth	17–25
Cray et al. [18]	2013	Seeking shelter: the experiences and unmet needs of LGBT homeless youth	United States	Literature review	Policy, lack of 2LSGBTQ+ supports	12–25
Daniel & Cukier [49]	2014	The 360 project: addressing the discrimination experienced by Somali Canadians & racialized LGBTQ homeless youth in Toronto.	Canada	Qualitative, cross-sectional	Discrimination, intersectionality, racialized youth	14–29
DeChants [50]	2022	“I just want to move forward”: themes of resilience among LGBTQ young adults experiencing family rejection and housing insecurity	United States	Qualitative, cross-sectional	Family rejection, coping, connection	18–26
DeChants et al. [51]	2021	Homelessness and housing instability among LGBTQ youth	United States	Quantitative, cross-sectional	Family rejection, mental health, victimization	13–24
Dempsey et al. [52]	2020	Family relationships and LGB first homelessness in Australia: what do we know and where should we go?	Australia	Quantitative, cross-sectional	Family violence, family conflict	N/A
Dettlaff et al. [53]	2017	3/40 blueprint: needs assessment	United States	Qualitative, cross-sectional	Safety, service provision	N/A
Dettlaff et al. [54]	2017	Factors contributing to outcomes of stable housing, permanent connections, education, employment, and well-being for lesbian, gay, bisexual, transgender, and questioning youth experiencing homelessness: a systematic review	United States	Systematic/scoping review	Housing programs, factors impacting likelihood of experiencing homelessness, well-being, education, employment	Up to 24
DiGuiseppi et al. [55]	2022	Perceived safety in community and service settings among young adults experiencing homelessness: differences by sexual and gender identity	United States	Mixed-methods, cross-sectional	Service delivery, ecological momentary assessment, perceived safety	18–25
Dolamore & Naylor [56]	2018	Providing solutions to LGBT homeless youth: lessons from Baltimore’s Youth Empowered Society	United States	Qualitative, cross-sectional, records data	Service delivery, housing programs	14–25
Dunne et al. [57]	2002	Young, gay, homeless and invisible: a growing population?	UK	Mixed-methods, cross-sectional, records data	Housing programs	16–25
Ferguson & Maccio [26]	2015	Promising programs for lesbian, gay, bisexual, transgender, and queer/questioning runaway and homeless youth	United States	Qualitative, cross-sectional	Service delivery, housing programs	N/A
Flatley et al. [58]	2022	Adolescent homelessness: evaluating victimization risk based on LGBT identity and sleeping location	United States	Quantitative, cross-sectional	Victimization	Grades 9–12
Forge et al. [59]	2018	Out of the system and onto the streets: LGBTQ-identified youth experiencing homelessness with past child welfare system involvement	United States	Quantitative, cross-sectional	Child welfare, mental health, sexual health	14–25
Fraser et al. [60]	2019	LGBTIQ+ homelessness: a review of the literature	New Zealand	Literature review	Service delivery, intersectionality, discrimination, pathways into homelessness, racialized youth	N/A
Frederick et al. [61]	2011	Exploring gender and sexual minority status among street-involved youth	Canada	Quantitative, cross-sectional	Mental health, substance use, victimization	16–21
Gangamma et al. [62]	2008	Comparison of HIV risks among gay, lesbian, bisexual and heterosexual homeless youth	United States	Quantitative, cross-sectional	HIV, mental health, sexual health	14–22
Gattis [63]	2009	Psychosocial problems associated with homelessness in sexual minority youths	United States	Literature review	Policy, mental health, substance use, sexual behaviour	N/A
Gattis [64]	2013	An ecological systems comparison between homeless sexual minority youths and homeless heterosexual youths	Canada	Quantitative, cross-sectional	Substance use, mental health, sexual behaviour, discrimination, stigma	16–24
Grafsky et al. [65]	2011	Comparison of treatment response among GLB and non-GLB street living youth	United States	Quantitative, longitudinal	Service delivery, mental health, substance use	14–22
Greenfield et al. [66]	2021	Learning to endure: a qualitative examination of the protective factors of homeless transgender and gender expansive youth engaged in survival sex	United States	Qualitative, cross-sectional	Protective factors, resilience, survival sex	17–26
Hackett et al. [67]	2022	Safe, stable, long-term: supporting 2SLGBTQ+ youth along the housing continuum	Canada	Mixed-methods, cross-sectional	Service delivery, policy	Under 30
Hail-Jares et al. [68]	2021	Queer homelessness: the distinct experiences of sexuality and trans-gender diverse youth	Australia	Quantitative, cross-sectional	Family violence, intimate partner violence, mental health, substance use	12–25
Hao et al. [69]	2021	Comparing substance use and mental health among sexual and gender minority and heterosexual cisgender youth experiencing homelessness	United States	Quantitative, cross-sectional	Mental health, substance use	18–24
Hein [70]	2010	Where did you sleep last night? Homeless male adolescents: gay, bisexual, transgender and heterosexual compared	United States	Qualitative, cross-sectional	Pathways into homelessness	14–20
Hill et al. [71]	2021	An examination of housing interventions among youth experiencing homelessness: an investigation into racial/ethnic and sexual minority status	United States	Quantitative, longitudinal, records data	Housing stability, intersectionality, racism	15–24
Hussey [72]	2015	Beyond 4 walls and a roof: addressing homelessness among transgender youth	United States	Literature review	Housing programs, policy, risk behaviours	N/A
Hussey [73]	2015	Expanding ID card access for LGBT homeless youth	United States	Literature review	Policy	N/A
Hyatt [74]	2011	Struggling to survive: lesbian, gay, bisexual, transgender, and queer/questioning homeless youth on the streets of California	United States	Policy/issue brief	Policy	N/A
Kattari et al. [75]	2017	Social networks and sexual risk factor differences between cisgender heterosexual and cisgender LGBQ homeless youths	United States	Quantitative, cross-sectional	Sexual risk factors, substance use, protective factors	14–24
Keuroghlian et al. [76]	2014	Out on the street: a public health and policy agenda for lesbian, gay, bisexual, and transgender youth who are homeless	United States	Literature review	Policy, mental health, substance use, HIV	10–28
Kidd et al. [77]	2017	The 2015 national Canadian homeless youth survey: mental health and addiction findings	Canada	Quantitative, cross-sectional	Mental health, substance use	12–27
Kidd et al. [78]	2019	A national study of Indigenous youth homelessness in Canada	Canada	Quantitative, cross-sectional	Indigenous youth, substance use, mental health, violence, pathways into homelessness	12–26
Lykes et al. [79]	2017	Assessing the needs of transgender and gender expansive (TGE) runaway and homeless youth (RHY): supplemental report on recommended responses and strategies for providing affirming supportive services	United States	Qualitative, cross-sectional	Service delivery, housing programs, healthcare, education, employment	N/A
Maccio & Ferguson [80]	2016	Services to LGBTQ runaway and homeless youth: gaps and recommendations	United States	Qualitative, cross-sectional	Service delivery, housing programs	N/A
Marshall et al. [81]	2010	Survival sex work and increased HIV risk among sexual minority street-involved youth	Canada	Quantitative, cross-sectional	Survival sex, HIV	14–26
McCann & Brown [82]	2019	Homelessness among youth who identify as LGBTQ+: a systematic review	UK	Systematic/scoping review	Stigma, discrimination, mental health, substance use, sexual behaviour, social exclusion	13–24
McCarthy & Parr [83]	2022	Is LGBT homelessness different? Reviewing the relationship between LGBT identity and homelessness	UK	Literature review	Pathways into homelessness	N/A
Milburn et al. [84]	2006	Discrimination and exiting homelessness among homeless adolescents	United States	Quantitative, longitudinal	Discrimination, intersectionality, mental health, HIV	12–20
Mirza & Baker [85]	2016	The impact of the Affordable Care Act on LGBTQ youth experiencing homelessness	United States	Policy/issue brief	Policy, healthcare access	Up to 26
Morrow & McGuire [86]	2023	A qualitative inquiry of associations between family environment and suicidality for transgender youth experiencing homelessness	United States	Qualitative, cross-sectional	Mental health, coping, community	15–26
Mottet & Ohle [87]	2006	Transitioning our shelters: making homeless shelters safe for transgender people	United States	Literature review	Housing programs, inclusive policy	N/A
National LGBTQIA+ Health Education Center [88]	2020	Supportive housing and health services for LGBTQIA+ youth experiencing homelessness: promising practices	United States	Review of promising practices	Service delivery	Up to 25
Norman-Major [89]	2018	Thinking outside the box: using multisector approaches to address the wicked problem of homelessness among LGBTQ youth	United States	Literature review	Service delivery, housing programs	Up to 24
Norris & Quilty [90]	2021	Unreal, unsheltered, unseen, unrecorded: the multiple invisibilities of LGBTQI+ homeless youth	UK	Qualitative, cross-sectional	Lack of population-specific programs, safety, exclusion	18–30
Oakley & Bletsas [91]	2017	The experiences of being a young LGBTIQ and homeless in Australia: re-thinking policy and practice	Australia	Qualitative, cross-sectional	Service delivery, policies, healthcare, discrimination	16–25
Oliveira & Mulligrav [92]	2010	All our children: strategies to prevent homelessness, strengthen services and build support for LGBTQ youth	United States	Review of promising practices	Service delivery, policies	13–24
Ormiston [93]	2022	LGBTQ youth homelessness: why we need to protect our LGBTQ youth	United States	Literature review, policy review	Policy, health disparities	Up to 24
Pannella Winn et al. [94]	2011	Learning from the field: programs serving youth who are LGBTQI2-S and experiencing homelessness	United States	Qualitative, cross-sectional	Service delivery, housing programs	12–25
Pearson et al. [95]	2017	Consequences of runaway and thrownaway experiences for sexual minority health during the transition to adulthood	United States	Quantitative, longitudinal	Mental health, substance use, transition to adulthood, long-term health outcomes	12–21, 25–34a
Poirier & Rummell [96]	2016	Review of the LGBTQ youth homelessness prevention initiative planning phase	United States	Mixed-methods, cross-sectional	Service delivery, housing programs, policy, community, family, education, employment, child welfare, juvenile justice, healthcare	N/A
Powell et al. [97]	2016	iTEAM: outcomes of an affirming system of care serving LGBTQ youth experiencing homelessness	United States	Quantitative, cross-sectional	Service delivery, mental health, substance use, HIV, life skills	15–24
Price et al. [98]	2019	At the intersections: a collaborative resource on LGBTQ youth homelessness	United States	Literature review	Child welfare, family, violence, survival sex, substance use, intersectionality	12–24
Prock & Kennedy [28]	2017	Federally-funded transitional living programs and services for LGBTQ-identified homeless youth: a profile in unmet need	United States	Quantitative, cross-sectional	Service delivery, housing programs	N/A
Prock & Kennedy [99]	2020	Characteristics, experiences, and service utilization patterns of homeless youth in a transitional living program: differences by LGBQ identity	United States	Quantitative, cross-sectional, records data	Housing programs, victimization, mental health	16–21
QSAPP (Queer Students of Architecture, Planning, and Preservation) [100]	2019	Safe space: housing LGBTQ youth experiencing homelessness	United States	Review of promising practices	Housing programs, service delivery	N/A
Quilty & Norris [101]	2022	Queer/y/ing pathways through youth homelessness: becoming, being and leaving LGBTQI+ youth homelessness	Ireland	Qualitative, cross-section	Pathways into/out of homelessness, family, friendships, education	19–30
Quintana et al. [11]	2010	On the streets: the federal response to gay and transgender homeless youth	United States	Literature review	Policy	12–24
Ray [20]	2006	An epidemic of homelessness	United States	Literature review	Policy, family conflict, mental health, substance use, sexual behaviour, victimization	N/A
Ream & Forge [102]	2014	Homeless lesbian, gay, bisexual, and transgender (LGBT) youth in New York City: insights from the field	United States	Literature review	Service delivery, pathways into homelessness, survival sex, HIV, substance use, intersectionality	N/A
Reck [103]	2009	Homeless gay and transgender youth of color in San Francisco: “no one likes street kids”—even in the Castro	United States	Qualitative, cross-sectional	Safety, family rejection, sexualization, discrimination	15–23
Rew et al. [104]	2005	Sexual health risks and protective resources in gay, lesbian, bisexual, and heterosexual homeless youth	United States	Quantitative, cross-sectional	Family conflict, sexual health, sexual behaviours, HIV, STIs, access to healthcare	16–20
Rhoades et al. [105]	2018	Homelessness, mental health and suicidality among LGBTQ youth accessing crisis services	United States	Quantitative, cross-sectional	Service access, mental health	12–24
Rice et al. [106]	2013	Homelessness experiences, sexual orientation, and sexual risk taking among high school students in Los Angeles	United States	Quantitative, cross-sectional	Sexual behaviour, risk taking, STIs	Grades 9–12, excluding > 18
Rice et al. [107]	2015	Homelessness and sexual identity among middle school students	United States	Quantitative, cross-sectional	Shelter-seeking, risky behaviours	10–15
Robinson [19]	2018	Conditional families and lesbian, gay, bisexual, transgender, and queer youth homelessness: gender, sexuality, family instability, and rejection	United States	Qualitative, longitudinal	Family conflict, family rejection, discrimination	13–25
Rosario et al. [108]	2012	Homelessness among lesbian, gay, and bisexual youth: Implications for subsequent internalizing and externalizing symptoms	United States	Quantitative, longitudinal	Mental health, interpersonal relationships, stress	14–21
Rosario et al. [109]	2012	Risk factors for homelessness among lesbian, gay, and bisexual youths: a developmental milestone approach	United States	Quantitative, cross-sectional	Risk factors, childhood sexual abuse, substance use	14–21
Rosenberg [110]	2019	Young, queer, and on the streets: homeless LGBTQ2 youth in Toronto’s gay village	Canada	Qualitative, longitudinal	Community, discrimination, survival	18–28
Saewyc et al. [111]	2008	Moving upstream: aboriginal marginalized and street-involved youth in B.C.	Canada	Quantitative, cross-sectional	Indigenous youth, racial discrimination	12–18
Schmitz & Tyler [112]	2018	The complexity of family reactions to identity among homeless and college lesbian, gay, bisexual, transgender, and queer young adults	United States	Qualitative, cross-sectional	Family rejection, family acceptance, pathways into homelessness	19–26
Schmitz & Tyler [113]	2018	LGBTQ+ young adults on the street and on campus: identity as a product of social context	United States	Qualitative, cross-sectional	Identity development, social environment navigation	19–26
Schmitz et al. [114]	2022	“Companion, friend, four-legged fluff ball”: the power of pets in the lives of LGBTQ+ young people experiencing homelessness	United States	Qualitative, cross-sectional	Mental health, companion animals	18–25
Sellers [115]	2018	Absent inclusion policies: problems facing homeless transgender youth	United States	Qualitative, cross-sectional, policy review	Policy	N/A
Semborski et al. [116]	2021	Burden, belonging, and homelessness: disclosure and social network differences among LGBTQ youth recruited from a suicide crisis service provider	United States	Quantitative, cross-sectional	Family relationships, romantic relationships, social support, social networks	12–24
Shelton [117]	2015	Transgender youth homelessness: understanding programmatic barriers through the lens of cisgenderism	United States	Qualitative, cross-sectional	Service access, cisgenderism, barriers to access	18–25
Shelton [118]	2016	Reframing risk for transgender and gender-expansive young people experiencing homelessness	United States	Qualitative, cross-sectional	Identity affirmation, victimization	18–25
Shelton & Bond [119]	2017	“It just never worked out”: how transgender and gender expansive youth understand their pathways into homelessness	United States	Qualitative, cross-sectional	Pathways into homelessness, family conflict, child welfare	18–25
Shelton et al. [120]	2018	I’m more driven now: resilience and resistance among transgender and gender expansive youth and young adults experiencing homelessness	United States	Qualitative, cross-sectional	Resilience, discrimination	18–25
Shelton et al. [121]	2018	Reversing erasure of youth and young adults who are LGBTQ and access homelessness services: asking about sexual orientation, gender identity, and pronouns	United States	Mixed-methods, cross-sectional	Service delivery	18–26
Shelton et al. [122]	2018	Homelessness and housing experiences among LGBTQ young adults in seven U.S. cities	United States	Quantitative, cross-sectional	Pathways into homelessness, family rejection	18–26
Siconolfi et al. [123]	2020	Health, homelessness severity, and substance use among sexual minority youth experiencing homelessness: a comparison of bisexual versus gay and lesbian youth	United States	Quantitative, cross-sectional	Health, substance use, mental health	13–25
Srivastava et al. [124]	2019	Exchange and survival sex, dating apps, gender identity, and sexual orientation among homeless youth in Los Angeles	United States	Quantitative, cross-sectional	Survival sex, HIV	14–24
Stablein [125]	2017	Estimating the status and needs of homeless LGBT adolescents: advocacy, identity, and the dialectics of support	United States	Literature review	Pathways into homelessness, risk factors	N/A
T et al. [126]	2005	Findings and recommendations from the Youth Empowerment Team (YET)	United States	Mixed-methods, cross-sectional	Youth engagement, needs assessment, education, employment, substance use, healthcare	13–26
Tierney & Ward [127]	2017	Coming out and leaving home: a policy and research agenda for LGBT homeless students	United States	Literature review	Policy	N/A
Tyler [128]	2008	A comparison of risk factors for sexual victimization among gay, lesbian, bisexual, and heterosexual homeless young adults	United States	Quantitative, cross-sectional	Childhood sexual abuse, sexual victimization, trading sex	19–26
Tyler & Ray [129]	2019	Risk and protective factors for substance use among youth experiencing homelessness	United States	Quantitative, cross-sectional	Substance use, childhood sexual abuse, sexual victimization, trading sex	16–26
Tyler & Schmitz [130]	2018	A comparison of risk factors for various forms of trauma in the lives of lesbian, gay, bisexual and heterosexual homeless youth	United States	Quantitative, cross-sectional	Trading sex, sexual victimization,	19–26
Van Leeuwen [131]	2006	Lesbian, gay, and bisexual homeless youth: an eight-city public health perspective	United States	Quantitative, cross-sectional	Substance use, mental health, survival sex, risk behaviours, HIV	14–24
Walls & Bell [132]	2011	Correlates of engaging in survival sex among homeless youth and young adults	United States	Quantitative, cross-sectional	Survival sex	10–25
Walls et al. [133]	2007	Differentiating the social service needs of homeless sexual minority youths from those of non-homeless sexual minority youths	United States	Quantitative, cross-sectional	Mental health, substance use, service use, victimization, abuse	12–21
Walls et al. [134]	2009	Where risks and protective factors operate differently: homeless sexual minority youth and suicide attempts	United States	Quantitative, cross-sectional	Child welfare, survival sex, mental health	Up to 25
Whitbeck et al. [135]	2004	Mental disorder, subsistence strategies, and victimization among gay, lesbian, and bisexual homeless and runaway adolescents	United States	Quantitative, cross-sectional	Mental health, victimization, survival strategies	16–19
Youngbloom et al. [136]	2021	Characteristics associated with housing loss among youth in a rapid rehousing program	United States	Quantitative, cross-sectional, records data	Child welfare, mental health, housing loss	18–24
Yu [137]	2010	Shelter and transitional housing for transgender youth	United States	Literature review	Policy, violence, victimization	N/A

^a This study was longitudinal and followed the same group of youth (ages 12–21) into adulthood (ages 25–34)

The language used when describing a given study or finding reflects the terminology used in the original articles. For example, when describing studies that focused on sexual orientation, we use acronyms such as GLB (gay, lesbian, bisexual) or LGB (lesbian, gay, bisexual) depending on the terminology used in the original article.

Results

Article selection and characteristics

A total of 112 articles were reviewed, 74.1% of the studies were conducted in the United States, 18.8% in Canada, 3.6% in the United Kingdom, 2.7% in Australia, and 0.8% in Ireland. The majority of articles were cross-sectional (n = 76), and used either quantitative (n = 42), or qualitative (n = 31) approaches. All the articles are summarized in Table 1. Many articles did use multiple methodologies, such that an article and/or report may fit more than one of the aforementioned categories. Notably, the term “article” is used throughout the review as a general term to describe the material reviewed, including grey literature (See Fig. 1).

Fig. 1.

PRISMA-ScR flow chart

Experiences of 2SLGBTQ+ youth homelessness

A total of 85 articles focused on the experiences of 2SLGBTQ+ youth homelessness. Among those articles, several key themes emerged, which have been broken down, and described in detail below.

Family environments

Most of the articles in our review addressed the influence of family dynamics on 2SLGBTQ+ youth homelessness, and over 30 explicitly discussed how family conflict contributes to homelessness among 2SLGBTQ+ youth. Some of the most common findings across articles included family conflict and low satisfaction with family communication [20, 63, 64, 86], experiences of homophobia and transphobia from family members [19, 41, 103], a history of physical, sexual, and emotional abuse by caretakers [19, 39, 52, 68, 135], being kicked out of the family home [47, 59, 112, 119, 121], and leaving home due to identity-based rejection [86, 101, 112]. One study reported that family dynamics and conflict—as opposed to housing status—predicted risk of suicidality among transgender youth [86]—emphasizing the impact of family dynamics on 2SLGBTQ+ youths’ mental health and well-being. Optimistically, one study did report that grandparents often exceeded youths’ expectations for acceptance [112].

Peer and community connections

Several studies emphasized the critical role of peer support in empowering 2SLGBTQ+ youth experiencing homelessness to safely express and explore their identities [54, 103]. However, these youth often struggled to maintain supportive relationships due to housing insecurity, which regularly forced them to relocate based on shelter availability [54]. Identity-based discrimination also results in higher rates of negative peer relationships among LGB youth experiencing homelessness compared to their heterosexual counterparts [64]. Further, youth experiencing homelessness report feeling excluded within 2SLGBTQ+ communities, noting that the needs of affluent gay white men are often prioritized over those with marginalized identities by services, events, and commercial spaces [103, 110]. Youth noted that most community gathering spaces are commercial, and thus, those who are unable to afford to participate in commerce are excluded [103]. Additionally, many of these spaces—such as clubs, bars, and events—are marketed through imagery that centers predominantly white, cisgender, and physically fit men, contributing to feelings of invisibility and exclusion among youth who do not fit these archetypes, particularly transfeminine youth [110].

Employment and education

Significant barriers to obtaining and maintaining employment were highlighted by numerous studies. Homophobia and transphobia were reported as major barriers to securing employment, whereas recognition/acknowledgment and use of TGD youths’ self-identified gender was emphasized as a key factor in supporting their access to employment [48, 53]. Additionally, studies found that youth anticipated negative judgments from potential employers, which impacted the types of jobs they sought and/or accepted [41, 53]. Lastly, T et al. [126] found that for many 2SLGBTQ+ youth experiencing homelessness, their work availability was often dictated and constrained by the fixed schedules of food banks and shelter services; the need to secure food and shelter each day left limited time for job applications, interviews, or educational pursuits. As emphasized by Dettlaff et al., research on education and positive outcomes for 2SLGBTQ+ youth experiencing homelessness is scarce [53].

Shelter experiences

2SLGBTQ+ youth report experiencing victimization, stigma, and discrimination in housing programs, including emergency shelters [20, 22, 45, 53, 101, 102, 125, 137]. Unsafe and discriminatory experiences in shelters often cause 2SLGBTQ+ youth to avoid using these services, leading to experiences of hidden homelessness [140]—such as sleeping in public spaces, parks, vehicles, motels/hotels, or staying with friends or romantic partners. Some articles found that population-based housing programs provide a safer and more inclusive environment for 2SLGBTQ+ youth compared to mainstream programs [137] and are often better at meeting their basic needs [117]; however, shelter experiences and needs among 2SLGBTQ+ youth vary. Transgender and gender diverse (TGD) youth tend to experience greater barriers when accessing services compared to cisgender youth [117], including misgendering, and gender/sex segregation within shelters. TGD youth report transphobia, verbal harassment, and physical and sexual violence while staying at shelters [36, 45, 120, 121].

Victimization

Within the reviewed articles, victimization was broadly understood as the process of becoming a victim of mistreatment, whether it be physical, sexual, or psychological in nature [41, 58, 59, 135]. While one article found that 2SLGBTQ+ youth were at no greater risk for victimization compared to their heterosexual and cisgender counterparts [75], the majority of literature reviewed reported that 2SLGBTQ+ youth experiencing homelessness are at a unique and increased risk for victimization [20, 39, 48, 51, 99, 132, 135]. Articles described a wide range of ways that 2SLGBTQ+ youth experience victimization. Some articles broadly referred to victimization as experiences of homophobia, transphobia, and/or fetishization (the dehumanizing sexual objectification of a person for a given mundane trait) [110], while other articles categorized victimization into specific experiences of physical, psychological, and/or sexual violence/harassment [41, 101, 128]. Moreover, the perpetrators of harassment and violence were commonly discussed, which helped to contextualize the severity of the victimization. 2SLGBTQ+ youth experiencing homelessness are subjected to victimization that is instigated by school bullies, staff, and residents at shelter programs, and for those engaging in survival sex, by the individual’s providing food, a place to sleep, etc. in exchange for sex [20, 41, 48, 101]. In an attempt to evade victimization, 2SLGBTQ+ youth may avoid accessing housing and support programs, conceal their 2SLGBTQ+ identity, and in some cases, do not report their experiences to police, as a means of protecting themselves from further victimization, violence, and harassment [48, 66].

Mental health and substance use

Numerous articles reported that 2SLGBTQ+ youth experiencing homelessness are disproportionately impacted by poor mental health outcomes, including anxiety, depression, substance use, self-harm, and suicidality [59, 68, 77, 125]. Namely, Dettlaff et al. [53] reported higher rates of depression, self-harm, and suicidality among 2SLGBTQ+ youth compared to heterosexual youth experiencing homelessness. Another article reported that depression, anxiety, self-harm, and suicidality were two-to-four times higher among 2SLGBTQ+ youth experiencing homelessness than their stably housed counterparts [51]. Additionally, 2SLGBTQ+ youth experiencing homelessness experience reduced quality of life, are more likely to engage in substance use, and to attempt suicide compared to cisgender and heterosexual youth [78]. Further, an article by Abramovich et al. [38] reported that 2SLGBTQ+ youths’ mental health concerns worsened during the COVID-19 pandemic, with additional restrictions to health and social support services. These articles serve as a prime example of how the intersection between one’s socioeconomic status, sexual orientation, and gender identity are social determinants of their mental health.

Substance use was commonly described as a coping mechanism for 2SLGBTQ+ youth who have experienced high levels of stress, emotional distress, and trauma [54]. While tobacco and alcohol use were similar across unhoused and stably housed 2SLGBTQ+ youth, unhoused 2SLGBTQ+ youth were more likely to have used cocaine and methamphetamines [133]. Moreover, studies reported that 2SLGBTQ+ youth experiencing homelessness face greater challenges with substance use—both in the past month and in their lifetime—than non-2SLGBTQ+ youth [64, 131]. Notably, the distinction between problematic and non-problematic substance use was not clearly defined in the articles reviewed.

Sexual health and behaviour

2SLGBTQ+ youth are more likely than cisgender and heterosexual youth to engage in sexual risk taking behaviours—sexual behaviours which make youth susceptible to harm (e.g., substance use during sex, unprotected sex, sex with strangers, high number of sexual partners)—and quasi-legal or illegal activities to survive, including sex work—exchanging sexual services for money or goods—and/or survival sex—a form of sex work done by someone in extreme need of basic necessities (e.g., exchanging sex for shelter, food, transportation, etc.) [49, 64, 75, 81, 104, 126, 130, 132]. Engaging in higher levels of sexual risk-taking behaviours increases the likelihood of contracting HIV and/or other sexually transmitted infections (STIs) [53]. Additionally, an article by Walls et al. [133] reported that engaging in survival sex was associated with an increased risk of attempted suicide. Much of the literature regarding sexual health and behaviours among 2SLGBTQ+ youth experiencing homelessness has focused on the negative outcomes of engaging in survival sex; however, there were a few articles that highlighted the protective factors for sexual health that are unique to 2SLGBTQ+ individuals. Specifically, LGB youth got tested for STIs more frequently than non-LGB youth, and 2SLGBTQ+ youth had a greater number of people in their social network who talked openly about safe sex [75, 131].

Barriers for 2SLGBTQ+ youth accessing support services

A total of 17 articles discussed barriers that 2SLGBTQ+ youth experiencing homelessness face when trying to access support services. The main barriers to accessing services reported by 2SLGBTQ+ youth experiencing homelessness are summarized in Fig. 2. On a structural level, there is a lack of population-based services for 2SLGBTQ+ youth experiencing homelessness [35, 67]. Additionally, 2SLGBTQ+ youth underutilize existing services for a variety of reasons—including a lack of awareness and/or intentional avoidance—and may conceal their 2SLGBTQ+ identities when accessing services, resulting in what Dunne et al. [57] called the “invisibilization” of 2SLGBTQ+ youth in service provision [22, 46, 67, 99].

Fig. 2.

Barriers to accessing services for 2SLGBTQ+ youth experiencing homelessness

The most commonly reported barrier to accessing services was the experience and/or expectation of homo/bi/trans-phobic discrimination and harassment from staff or fellow service users [20, 36, 45, 46, 53, 57, 67, 91, 101, 102, 110, 125]. Quilty and Norris [101] additionally identified a lack of privacy as a barrier to safely accessing services. TGD youth reported a lower sense of safety when accessing services compared to both cisgender heterosexual and cisgender LGB youth [55]. Most articles on services focused on housing and related social services; however, Rosenberg [110] reported that mainstream 2SLGBTQ+ organizations may be unwelcoming to youth experiencing homelessness and/or TGD youth.

Policies, eligibility criteria, and institutional regulations present substantial barriers for 2SLGBTQ+ youth accessing services. The most frequently cited barriers include gender-segregated housing programs—such as sleeping corridors and washrooms—and unclear service processes that are rooted in transphobic practices [20, 36, 45, 91, 125]. In numerous articles, youth reported experiencing confusion and aversion towards programs with unclear and/or strict rules regarding length of stay and eligibility requirements, including age, substance use, employment status, and school involvement [36, 45, 53, 67]. Accessibility of services for 2SLGBTQ+ youth were also impacted by service location, hours, and application processes [67, 110]. Rosenberg [110] observed in real time how organizational changes at programs serving 2SLGBTQ+ youth experiencing homelessness impacted youth. Youths’ service use decreased markedly following a combination of changes to service location, restrictions on drop-in program access, and staff education requirements that decreased the number of racialized and TGD program staff. Abramovich [36] outlined how services are often negatively impacted by both excessive regulation and a lack of regulation, for example, the overwhelming amount of bureaucratic paperwork for service users, alongside an absence of monitoring status of staff training.

Facilitators for 2SLGBTQ+ youth accessing support services

A total of 35 articles discussed ways to improve access to services for 2SLGBTQ+ youth experiencing homelessness—often by providing evidence-based recommendations. This section includes articles and reports that focused on identifying facilitators of service access, and/or provided recommendations on how to improve service access facilitation. A summary of recommendations for services is provided in Fig. 3.

Fig. 3.

Recommendations to improve service access for 2SLGBTQ+ youth

Frameworks and approaches

The included articles identified several frameworks and approaches to service provision, which both youth and providers emphasized as being important for providing affirming and effective support. Empowering, strengths-based, and trauma-informed approaches—which focused on youths’ skills and abilities, while acknowledging the prevalence and impact of trauma in their lives—fostered trust and mutual respect between youth and providers [67, 76, 88, 91, 94]. Relatedly, engaging youth service users as experts and stakeholders when designing programs, and making service decisions, contributed to the creation and delivery of effective services [53, 74, 88, 94]. Numerous sources identified a clear need for services to take an intersectional approach to address the distinct needs of subgroups of 2SLGBTQ+ youth experiencing homelessness, including TGD youth, racialized youth, and Indigenous youth [16, 42, 76, 79, 83, 92, 111, 132]. Recommended approaches also included holistic care that addressed youths’ diverse needs as interconnected [37, 67], low barrier services, such as drop-in and/or mobile programs [88], and evidence-informed practices and programs [67].

Service integration

Many articles advocated for the integrated delivery of services through co-location and/or community partnerships; recommendations included co-locating housing services, physical and mental health care, substance use services, employment/education supports, and legal assistance [56, 67, 76, 79, 80, 88, 92, 100]. Key recommendations included that all programs serving 2SLGBTQ+ youth experiencing homelessness provide basic essentials for service users, such as food, hygiene supplies, and transit fare [53, 88]. Additional recommendations included co-located initiatives such as public education and awareness strategies [80], community partnerships with 2SLGBTQ+ organizations and 2SLGBTQ+ mentors [45, 67, 74, 92], and family support programs aimed at preventing or shortening the duration of 2SLGBTQ+ youth homelessness [11, 18, 67, 74, 80, 92].

Staff and training

The most commonly cited recommendation across studies was the implementation of 2SLGBTQ+ inclusion training for all staff, with an emphasis on 2SLGBTQ+ identities, and their intersections with marginalization and stigma [16, 20, 45, 56, 63, 80, 91, 94, 127]. The importance of adequately training and supporting youth peer workers was also emphasized [88]. Another frequently cited recommendation was to hire staff with lived experience, particularly individuals who identify as 2SLGBTQ+ and/or have experienced homelessness, to help foster relatable service provision [45, 56, 67, 79].

Rules and policies

Organizational rules and policies were frequently discussed, especially for housing programs and shelters. Youth expressed a need for clear, transparent, and universally enforced rules [53]. The reviewed articles and reports recommended that organizations serving 2SLGBTQ+ youth experiencing homelessness establish policies addressing gendered language, confidentiality, harassment, and accountability [63, 79, 87, 91]. Of particular importance were the implementation of transgender-affirming policies in binary, gender-segregated housing programs, which would allow TGD youth to be housed with youth of the same gender identity, or to be provided the choice of being housed with the gender that they are most comfortable [80].

Structural Considerations

Several articles noted considerations for the physical design and usage of 2SLGBTQ+ youth housing programs. The need for privacy was paramount, as demonstrated by recommendations for gender-inclusive bathrooms, private shower facilities, and private, locked bedrooms and/or lockers for personal belongings [63, 87, 100]. Queer Students of Architecture, Planning, and Preservation (QSAPP) [100] also noted the importance of communal spaces for socializing, private and soundproof spaces for counselling, kitchen facilities, computer access, and discreet entrances.

Intake and administration

The need for accurate collection of sexual orientation and gender identity data during intake processes also emerged as an important service consideration [79, 87, 91, 121]. Lykes et al. [79] and Shelton et al. [121] emphasized that for the disclosure of personal information to be affirming, 2SLGBTQ+ must feel safe, trust staff, and not perceive risk associated with disclosing their identity. Confidentiality, privacy, and transparency about how personal information is used were also identified as important considerations [67, 79].

Research and policy

In addition to providing recommendations for services and programs, a number of articles outlined recommendations for research and policy. Numerous sources called for increased research on 2SLGBTQ+ youth homelessness overall [11, 16, 18], and noted priorities for future research, including further exploration of family conflict and other pathways into and out of homelessness, and intersectional research that attends to the diversity among 2SLGBTQ+ youth experiencing homelessness [74, 76, 83, 93]. Tierney and Ward [93] identified theoretical frameworks—such as critical theory and participatory action—and methodological approaches—such as critical geography and critical quantitative methods—that are promising for further research on 2SLGBTQ+ youth homelessness.

Policy recommendations aimed to reduce homelessness rates and/or increase support for 2SLGBTQ+ youth experiencing homelessness. High-level recommendations included anti-discrimination laws specifically addressing sexual orientation and gender identity and creating or amending legislation—such as the US Runaway and Homeless Youth Act—to specifically address 2SLGBTQ+ youth homelessness [18, 93]. Funding priorities broadly included youth emergency shelters, 2SLGBTQ+ population-based youth housing programs, and family-based interventions [11, 16, 18, 92, 93]. Family-based interventions are increasingly recognized as promising approaches for addressing and preventing youth homelessness [141]. These interventions aim to engage youth and their families in services that intervene in a family crisis to prevent youth from becoming homeless, strengthen family relationships, and promote stability [142]. Such interventions may include family mediation, support with financial literacy, and access to counselling or therapy when appropriate and safe to do so. For 2SLGBTQ+ youth, these interventions are particularly impactful when they acknowledge and address identity-based rejection, offering families tools to rebuild trust, improve communication, and foster acceptance.

A key recommendation repeated throughout the literature was the need for consistent standards across organizations serving youth experiencing homelessness, including requirements for 2SLGBTQ+ inclusion training and anti-discrimination policies [16, 20, 63, 92, 93]. The need for schools, and physical and mental health services to be well-funded, coordinated, and affirming for 2SLGBTQ+ youth was also highlighted [11, 18, 92, 93, 127]. Other articles addressed topics such as the need to improve access to legal ID cards [73], the need for multi-sectoral private, public, and non-profit contributions [89], and specific legislation, such as the US Affordable Care Act, or piecemeal policies that have potential to benefit 2SLGBTQ+ youth experiencing homelessness [43, 115].

Interventions targeting 2SLGBTQ+ youth experiencing homelessness

Of the included articles, 15 addressed and described service interventions that target 2SLGBTQ+ youth experiencing homelessness, 10 described specific programs (via case studies, model programs, program evaluations) [20, 25, 43, 56, 65, 88, 89, 97, 100, 136], and 6 reviewed programs to characterize services and service gaps [26, 28, 67, 80, 100, 137]. All but two of the 15 articles on interventions were US-based, with the exception coming from Canada [25, 67].

QSAPP identified shelter typologies present in New York City, including emergency shelters, supportive housing, and transitional housing [100]. Other articles reported additional categories of interventions for 2SLGBTQ+ individuals experiencing homelessness, namely different types of housing programs (e.g., Housing First, rapid re-housing) [20, 25, 136, 137], and non-housing supports (e.g., drop-in centers, mental health supports, homelessness prevention) [65, 89]. Youth-serving organizations often offer several types of interventions that are co-located and integrated. The case studies and model programs described in articles were a combination of 2SLGBTQ+ population-based programs [20, 25], broader programs with some 2SLGBTQ+ services [26, 28, 43, 80, 100], and programs that do not have 2SLGBTQ+ specific services but serve 2SLGBTQ+ youth and/or can be used as models to integrate 2SLGBTQ±inclusive practices into programs that are not population-based [56, 67, 88, 97, 100, 136]. Table 2 provides examples of each type of intervention.

Table 2.

Examples of interventions targeting 2SLGBTQ+ youth experiencing homelessness

Type of Intervention	Program	Location	Target Population	Program Description
Drop-in center	Ruth Ellis Center [88]	Detroit, Michigan, USA	2SLGBTQ+ youth of colour at risk of, or experiencing, homelessness	Drop-in center co-located with a health & wellness center (primary care, gender-affirming healthcare, substance use and mental health services) and a residential foster care program. The Family Preservation Program aims to prevent homelessness by supporting families.
Emergency shelter	Sylvia’s Place [100]	New York City, New York, USA	2SLGBTQ+ youth experiencing homelessness	Drop-in services, including meals, medical support, and legal aid, and emergency overnight housing (10+ beds, maximum stay 90 days).
Supportive or transitional housing	YMCA Sprott House [25]	Toronto, Ontario, Canada	2SLGBTQ+ youth (aged 16–24) experiencing homelessness and/or living in unsafe situations	Transitional housing (25 beds, maximum stay 2 years), residents have access to case manager, outreach counselor, and youth workers and participate in house activities.
Other housing	LifeWorks rapid rehousing program [136]	Austin, Texas, USA	Youth (aged 18–24) experiencing literal homelessness	Scattered-site, independent living program providing rental assistance and case management (for maximum 36 months), optional additional supports include mental health services and education/employment support.
Other non-housing	iTEAM (My Treatment Empowerment for Adolescents on the Move) [97]	Tucson, Arizona, USA	2SLGBTQ+ youth near or experiencing homelessness or near homelessness 2SLGBTQ+ youth and straight/heterosexual allies	Comprehensive systems approach for alcohol and substance use, and mental health treatment (6–12+ months). Five community-based agencies provided the following services: 2SLGBTQ+ youth drop-in center, mental health services, housing-focused intensive case management, sexual health education and testing.

Four articles focused on program evaluations, including one transitional housing program [25], one rapid re-housing program [136], and two mental health and substance use programs [65, 97]. There were no published evaluations of drop-in centers or emergency shelters. All program evaluations emphasized the centrality of mental health concerns for 2SLGBTQ+ youth experiencing homelessness. While interventions generally improved youths’ mental health, youth staying in housing programs continuously reported unmet mental health needs, and that their poor mental health was associated with their loss of housing [25, 136]. Two program evaluations compared 2SLGBTQ+ youth with cisgender and heterosexual youth: Grafsky et al. [65] found that GLB youth experienced greater improvements in a mental health and substance use program compared to heterosexual youth, while Youngbloom et al. [136] reported that 2SLGBTQ+ identity was a risk factor for loss of housing in a rapid re-housing program.

Articles that reviewed larger numbers of interventions targeting 2SLGBTQ+ youth experiencing homelessness identified types of services and common characteristics, as well as gaps in services. Ferguson and Maccio [26] identified programs for 2SLGBTQ+ youth experiencing homelessness that spanned the areas of health, mental health and substance use, case management, education and employment, family, legal, and housing. These programs were characterized by five novel components: reliance on clinical evidence; trauma-informed approach; provision of safe, stable, and supportive housing; 2SLGBTQ+ peer providers; and opportunities for mutual learning between 2SLGBTQ+ youth and cisgender and heterosexual youth. Yu [137] additionally noted that emergency shelters and transitional housing programs often incorporate mental health and medical services—specifically regarding education and employment, trauma, substance abuse, and sexual health. Service gaps included an overall insufficient number of beds—despite the high rate of 2SLGBTQ+ youth experiencing homelessness—and lacking or limited services in the areas of education and employment support, family services, 2SLGBTQ±affirming medical/mental health/case management services, 2SLGBTQ+ inclusion training, and advocacy in smaller and rural communities [80, 137]. Consistent with these findings, Prock and Kennedy [99] reviewed federally-funded transitional housing programs across the US, and found that fewer than half of the participating programs offered 2SLGBTQ±based services. Both Prock and Kennedy [99] and Hackett et al. [67] noted the inequitable distribution of services, with most 2SLGBTQ+ youth services located in major cities and/or particular regions in the US and Canada.

Discussion

This scoping review synthesized data from 112 articles to advance understanding of 2SLGBTQ+ youth homelessness internationally. While the results provide a rich description of the lived experiences of youth—illustrating how identity-based marginalization, structural barriers, and service inequities intersect to shape both the pathways into, and experiences of homelessness—this section provides a critical reflection on the literature, highlighting the dominant theoretical perspectives informing this work, key gaps in existing research, and the implications for policy, practice, and future research.

The literature on 2SLGBTQ+ youth homelessness has largely been grounded in public health frameworks, emphasizing risk factors, health outcomes, and service utilization. Many of the reviewed articles conceptualize homelessness primarily as a health risk, focusing on individual outcomes such as mental health, substance use, and sexual health [47, 54, 143, 144]. While this framework has generated valuable insights into the health-related risks and consequences of homelessness, it often overlooks the structural factors—such as the lack of affordable housing, systemic discrimination, and socioeconomic exclusion—that perpetuate homelessness among 2SLGBTQ+ youth. Applying an intersectional framework provides a more comprehensive understanding of homelessness, which is experienced differently across social identities, including race, ethnicity, gender identity, sexual orientation, and socioeconomic status. However, few studies explicitly integrate intersectionality as a guiding framework. Research that does, demonstrates how TGD, Indigenous, and racialized youth face multiple barriers across housing, healthcare, and justice systems [17, 21]. Future studies should move beyond categorical comparisons (e.g., between 2SLGBTQ+ and non-2SLGBTQ+ youth) to examine how structural oppression functions within these intersecting systems.

Another critical gap is the geographical distribution of knowledge. The majority of research—and nearly all of the program evaluations—originate from North America, particularly Canada and the United States [22, 25, 28]. While this mainly reflects where 2SLGBTQ±specific programming has been most developed, it limits the global applicability of these findings. Expanding research across different countries can provide deeper insights into how varying sociocultural and policy environments shape both the vulnerabilities and resilience among 2SLGBTQ+ youth.

Across the reviewed articles, experiences of family rejection and identity-based victimization were consistently reported as contributing factors to homelessness among 2SLGBTQ+ youth. These same factors were also reported as barriers within service systems, suggesting that the pathways into homelessness are often replicated within the programs meant to support youth [36, 37, 91]. For example, identity-based stigma, rejection, and violence encountered within housing and support programs can resemble the exclusion youth experience in their families and communities. Consequently, 2SLGBTQ+ youth often avoid formal services altogether, and describe feeling as though they have nowhere to turn, instead relying on informal, unsafe, and hidden living arrangements—such as couch surfing or survival sex—where their safety may depend on concealing their identity [140].

A key implication of these findings is that effective responses must move beyond surface-level inclusion. While 2SLGBTQ+ inclusion and cultural competency training for staff in housing and support programs are essential, they remain insufficient if organizational policies, intake processes, and program environments continue to perpetuate exclusion (e.g., binary gender options on intake forms, assigning rooms by sex assigned at birth). Meaningful inclusion requires the integration of affirming and intersectional practices throughout all aspects of service delivery. Frequent reports of discrimination and victimization from peers and staff, along with exclusionary institutional practices [36, 37, 91], highlight the urgent need for population-based housing programs that are inclusive, affirming, and tailored to the unique needs of 2SLGBTQ+ youth [35, 67]. To reduce barriers and improve access to services, institutional rules and policies—such as those related to staff recruitment and hiring, intake, and administrative processes—should be critically reassessed to ensure they do not perpetuate homophobic or transphobic discrimination [16, 36].

There is extensive evidence on the value of peer-based interventions for youth experiencing homelessness, with studies linking peer involvement to improved engagement, housing stability, and mental health outcomes [145–148]. Strong peer and community connections also act as protective factors, suggesting that programs fostering supportive social networks—both within shelters and through community-based initiatives—may reduce the negative impacts of homelessness [53, 103].

While family rejection is widely recognized as a key determinant of poor mental health and housing instability among youth [121], few services currently offer family-based interventions designed to support reunification or reconciliation for 2SLGBTQ+ youth. Developing and expanding programs that foster safe family reconnection—when desired and appropriate—could play an important role in strengthening youths’ social support networks and facilitating pathways out of homelessness. Even when full reintegration is not possible or desired, interventions aimed at improving communication, repairing strained relationships, or reducing family conflict may help to mitigate isolation, and enhance stability. Given the well-established relationship between family conflict and youth homelessness—among 2SLGBTQ+ youth as well as their heterosexual and cisgender peers—it is imperative that governments, education systems, and service providers adopt preventative, upstream approaches. Such efforts should include early identification of risk factors, and the provision of accessible resources (e.g., family counselling, rent subsidies, food vouchers), information (e.g., where to find services, how to access them), case management, and system navigation support for both youth and their families. Promising models—such as family acceptance programs and family mediation interventions tailored to 2SLGBTQ+ youth—have shown potential to reduce conflict and improve communication when implemented early, particularly before housing loss occurs [39, 118]

Limitations

This review offers a comprehensive overview of the existing research and evidence on 2SLGBTQ+ youth and young adult homelessness globally, incorporating a systematic search of both published and grey literature. However, several limitations should be noted. First, our search strategy captured studies that included youth-related terms in the searchable database fields (e.g., title, abstract, subject headings); consequently, studies that only discussed youth populations in the full text of the article would not have been captured. Second, in an effort to provide a comprehensive understanding of the experiences of 2SLGBTQ+ youth homelessness—and acknowledging that research on this topic is relatively recent—we did not establish a specific start date for the review. While this is not uncommon, and highlights the prolonged persecution, discrimination, and victimization that 2SLGBTQ+ youth have endured while unhoused, it had other implications. Specifically, some of the articles included are outdated. Third, although this review synthesized international evidence on 2SLGBTQ+ youth homelessness, certain under-researched aspects—such as detailed pathways into homelessness, and involvement in child protection services/child welfare and the criminal justice system—were beyond its scope. The literature on 2SLGBTQ+ youth homelessness is evolving rapidly, with significant changes in both the discourse surrounding 2SLGBTQ+ youth, and the broader social climate over the past 20 years. This is reflected in the acronyms used throughout this review, the diverse populations they encompass, and the prioritization of certain sub-groups, particularly, lesbian, gay, and bisexual individuals. Future researchers should consider refining their search timeline to better understand the literature as it is currently and remain attentive to ongoing changes in discourse and social climate.

Future directions

The research gaps identified in this review offer valuable insights for future studies, policy development, and efforts to improve services for 2SLGBTQ+ youth experiencing homelessness. There remains a pressing need for inclusive and affirming services that adequately address the needs of 2SLGBTQ+ youth, alongside rigorous program evaluations, and investigations into evidence-based interventions aimed at preventing, reducing, and ending 2SLGBTQ+ youth homelessness. Advancing this work will require a continued commitment to community-based and intersectional approaches that prioritize the lived experiences of 2SLGBTQ+ youth.

Conclusions

The findings of this review provide a foundational understanding of 2SLGBTQ+ youth homelessness, emphasizing the distinct and nuanced experiences of this population. Homelessness among 2SLGBTQ+ youth is not solely a housing issue but also reflects broader social and structural inequities. Addressing these challenges will require moving beyond descriptive studies, and towards theoretically informed, intersectional, and action-oriented research. Services and policies must recognize the cyclical relationship between identity-based discrimination, homelessness, and barriers to care, and work to break down the structural conditions that perpetuate these inequities. Achieving meaningful change will also depend on developing and sustaining meaningful collaborations among researchers, policymakers, service providers, and 2SLGBTQ+ youth themselves, ensuring that future interventions are both evidence-informed and grounded in lived experience [149].

Abbreviations

2SLGBTQ+

Two-spirit, lesbian, gay, bisexual, transgender, queer, questioning, plus additional sexual and gender diverse

PRISMA-ScR

Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Review

GLB

Gay lesbian, and bisexual

LGB

Lesbian, gay, and bisexual

TGD

Transgender and gender diverse

STIs

Sexually-transmitted infections

QSAPP

Queer Students of Architecture, Planning, and Preservation

Author contributions

Conceptualization, A.A.; Methodology, A.A., N.P.; Formal Analysis, N.E., N.P., R.S.; Investigation, S.B.; Resources, S.B.; Data Curation, A.A., N.E., N.P., R.S; Writing – Original Draft Preparation, A.A., N.E., N.P., R.S.; Writing – Review & Editing A.A., N.E., M.S., N.P., R.S., S.B.; Visualization, M.S., N.P., R.S.; Supervision, A.A; Project Administration, A.A.; Funding Acquisition, N/A.

Funding

This study was not funded through any institution or funding body.

Data availability

The data included in this scoping review are peer-reviewed publications and research reports and are publicly available.

Declarations

Ethical approval

Not applicable.

Competing interests

The authors declare no competing interests.