TABLE 2.
The supportive strategies/services and implication with inclusion studies in review.
| Author/Study | Country | Supportive strategies/Service | Sample/Participants | Study Findings | Implication |
| Gower et al. (2018) | United States | Student-focused (e.g., GSA), staff-focused (e.g., professional development), and a combination (e.g., point person for LGBT student issues). These programs include some elements of professional development, classroom activities, more formal curriculum, and school-wide communication of inclusive norms through stickers and posters. | Student-level data: 8th (n = 121), 9th (n = 121), or 11th (n = 119) grades (n = 176 schools in total) completing the 2013 Minnesota Student Survey (MSS). Assuming a 5% LGBQ rate. School-level data: N = 31,183 students in 103 schools. |
This study provides promising evidence that school efforts to promote safe and supportive climates for LGBQ youth through multiple practices are associated with lower odds of student bullying involvement | Findings support school-wide efforts to create supportive climates for LGBQ youth as part of a larger bullying prevention strategy |
| Kosciw et al. (2013) | United States | Safe school policies, supportive school personnel, and gay–straight alliance (GSA) clubs | N = 5,7630 lesbian, gay, bisexual, and transgender students between the ages of 13 and 21 (M = 16.3 years) | School-based supports contributed to lower victimization and better academic outcomes | A hostile school climate has serious ramifications for LGBT students but institutional supports can play a significant role in making schools safer for these students |
| Woodford et al. (2018) | United States | Using SEM, indicate that antidiscrimination policies that enumerate both sexual orientation and gender identity (vs. only sexual orientation), offering at least one for-credit course on LGBTQ topics, and the ratio of LGBTQ student organizations to the student body size | N = 268, 58% undergraduates; 25% students of color; 62% gay/lesbian from 58 colleges completed an anonymous online survey addressing experiential heterosexism and psychological well-being | Colleges can work to decrease heterosexist discrimination on campus by utilizing multiple strategies: policies, formal educational resources, and by supporting LGBTQ student organizations | The results underscore the importance of particular structural initiatives on campus in protecting LGBQ+ collegians from discrimination and highlight the value of studying specific structural initiatives when investigating structural stigma and inclusion |
| Willging et al. (2016) | United States | “RLAS” (Implementing School Nursing Strategies to Reduce LGBTQ Adolescent Suicide), builds on the Exploration, Preparation, Implementation, and Sustainment (EPIS) conceptual framework and the Dynamic Adaptation Process (DAP) to implement EB strategies in U.S. high schools | Compared the LGBTQ students and their peers in RLAS intervention schools (n = 20) with those in usual care schools (n = 20) | The conceptual framework and methods for this novel nurse-led intervention are applicable to addressing LGBTQ youth suicide and the health-related concerns of other pediatric populations in schools as well | Through its collaborative processes to refine, improve, and sustain EB strategies in these systems, the RLAS represents an innovative contribution to implementation science that also addresses a pressing public health challenge |
| Konishi et al. (2013) | Canada | Gay-straight alliances and anti-homophobic bullying policies | A population-based sample of students in grades 8 through 12 from the British Columbia Adolescent Health Survey of 2008 (N = 21,708) | Gay-straight alliances and anti-homophobic bullying policies were linked to significantly lower odds of some but not all types of recent risky alcohol use and past-year harms from alcohol or drug use, but almost exclusively in schools where the policies or gay-straight alliances had been established for at least 3 years; and among lesbian, gay and bisexual adolescents, only for girls | Our findings suggest that these school-based strategies (gay-straight alliances and anti-homophobia policies) to reduce homophobia and foster school inclusion may be beneficial in reducing problem alcohol use among all students, not just sexual minority students |
| Heck et al. (2014) | United States | GSAs | N = 475, LGBT high school students (Mage = 16.79) who completed an online survey | LGBT youth attending a high school without a GSA evidenced increased risk for using illicit drugs and prescription drug misuse. GSAs help foster school environments where the burden of minority stressors is reduced | The importance of providing LGBT youth with opportunities for socialization and support within the school setting |
| Day et al. (2019) | United States | Sexual orientation and gender identity (SOGI) policy | 2013–2015 California Healthy Kids Survey (n = 113, 148) | The number of SOGI-focused policies in schools was associated with less victimization and SOG-based bullying for LGB youth and with higher grades for transgender youth. A greater number of SOGI-focused policies was associated with lower truancy for all students. The policies operate differentially for LGB and transgender youth, though are associated with positive school experiences for both | A “one size fits all” approach to school policy may support LGB youth more than transgender youth. Policies are directly responsive to the unique experiences and needs of transgender youth may be necessary to reduce these disparities |
| Tollemache et al. (2021) | United Kingdom | LGBT teaching within the undergraduate curricula of United Kingdom medical schools | 37 United Kingdom Medical Schools with students currently enrolled in a primary undergraduate medical training course were asked between December 2019–March 2020 to complete a cross-sectional online survey comprised of 30 questions | A significant variation in the amount and breadth of content within the undergraduate curricula of United Kingdom medical schools, which is a good degree of coverage in topics that serve to address the areas identified by Stonewall as being important to LGBT patients | The study provides suggestions for undergraduate curriculum development leads about how to improve the level and range of LGBT-associated content in their course |
| Ybarra et al. (2015) | Canada | LGBTQ-inclusive education strategies | They present quantitative and qualitative results of a national survey of more than 3,700 Canadian high school students undertaken in order to investigate what life is like at school for sexual and gender minority students | The findings show that even modest efforts to shift the balance of heteronormative discourse on behalf of LGBTQ students can have profound effects on the experiences and perceptions of sexual and gender minority youth, which we argue would go a long way in reducing incidents of suicidality among LGBTQ youth. In many jurisdictions across Canada, LGBTQ-inclusive policies have attempted to improve school climates and reduce the effects of homophobia and transphobia in schools | These initiatives, along with the work done by Eagle Canada to create a National Youth Suicide Prevention Strategy, are important steps in addressing the needs of LGBTQ youth |
| Kull et al. (2016) | United States | Antibullying policies that explicitly prohibit bullying based upon a student’s sexual orientation, gender identity, and/or gender expression (SOGIE; i.e., SOGIE-inclusive policies) | Data from a national survey of LGBT students’ school experiences (7,040 LGBT students from 2,952 unique school districts) | LGBT students in districts with SOGIE protections in their policies reported greater school safety, less victimization based on their sexual orientation and gender expression, and less social aggression than students with generic policies or no/unidentified policies | Antibullying policies explicitly enumerating SOGIE protections can improve LGBT school experiences and that generic policies may not sufficiently protect LGBT students from bullying and harassment |
| Proulx et al. (2019) | United States | Gay-straight alliances (GSAs) | N = 62,923 participants in 15 primary studies | GSA presence is associated with significantly lower levels of youth’s self-reports of homophobic victimization, fear for safety, and hearing homophobic remarks | The findings of this meta-analysis provide evidence to support GSAs as a means of protecting LGTBQ+ youth from school-based victimization |
| Lessard et al. (2020) | United States | Gay-straight alliances (GSAs, also referred to as gender-sexuality alliances) | A sample of diverse sexual and gender minority adolescents (N = 17,112; Mage = 15.57) | Lower levels of multiple forms of bias-based bullying (based on body weight, gender, religion, disability, gender typicality, and sexuality) at schools with versus without GSAs, and in turn higher perceived school safety, as well as higher grades and reduced school suspension (due to less weight- and sexuality-based bullying) | The findings shed light on the broad-reaching stigma-reduction potential of GSAs |
| Hackman et al. (2020) | United States | Curriculum and a Gay-Straight Alliance | N = 1415 students in 28 high schools in California from the Preventing School Harassment (PSH) Survey | When schools included lesbian, gay, bisexual, transgender, and queer (LGBTQ) issues in the curriculum and had a Gay-Straight Alliance, students perceived their schools as safer for gender nonconforming male peers | The findings suggest that school administrators, teachers, and other school personnel who implement safe schools policies and practices need to be intentionally inclusive to the needs of gender nonconforming students |
| Hatzenbuehler et al. (2014) | United States | School climates | Data on sexual orientation and past-year suicidal thoughts, plans, and attempts were from the pooled 2005 and 2007 Youth Risk Behavior Surveillance Surveys from 8 states and cities. | School climates that protect sexual minority students may reduce their risk of suicidal thoughts | |
| Denny et al. (2016) | New Zealand | Supportive school environments | A nationally representative sample of students (N = 9,056) and teachers (N = 2,901) from 96 high schools in 2007 |
Teacher reports of more supportive school environments for GLBT students were associated with fewer depressive symptoms among male sexual minority students but not for female sexual minority students. Students reported a more supportive school environment, male sexual minority students reported fewer depressive symptoms, and less suicidality than in schools where students reported less favorable school climates | Schools play an important role in providing safe and supportive environments for male sexual minority students |
| Van Bergen et al. (2013) | Australia | School belonging | Data from an Australian national probability sample of 14–15-year olds (Longitudinal Study of Australian Children, n = 3204) | The support and belonging variables were responsible for 49–70% of the associations between sexual minority status and the health/well-being outcomes, with school belonging being the most important mediator | These findings have important implications for health equity policy and practice |