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GOVERNMENT OF THE DISTRICT OF COLUMBIA

Child and Family Services Agency

OFFICE OF THE DIRECTOR

October 19, 2018

The Honorable David Grosso
Chairperson, Committee on Education
Council of the District of Columbia
John A. Wilson Building
1350 Pennsylvania Avenue N.W., Suite 402
Washington, D.C. 20004

The Honorable Brianne K. Nadeau
Chairperson, Committee on Human Services
Council of the District of Columbia
John A. Wilson Building
1350 Pennsylvania Avenue N.W., Suite 102
Washington, D.C. 20004

Dear Councilmembers Grosso and Nadeau:

Thank you for your correspondence dated October 4, 2018, seeking information regarding the
Child and Family Services Agency’s (CFSA) provision of medical and mental health services to
transgender youth in foster care. I appreciate the opportunity to provide this information.

CFSA issued a Position Statement in Support of the D.C. Human Rights Act of 1977 Concerning
all Children, Youth, Adults, and Employees Engaged in Care, Services, and/or Resources
Available through the Child and Family Services Agency (CFSA). This Position Statement is
available on the CFSA website at https://cfsa.dc.gov/page/cfsa-non-discrimination and enclosed.
The Statement reflects CFSA’s commitment that children and youth in foster care who are, or
who are perceived to be lesbian, gay, bisexual, transgendered or questioning (LGBTQ) deserve
loving and permanent families and must be afforded the same rights, privileges, services, and
protections as all children and youth. Furthermore, CFSA strongly opposes the use of conversion
or reparative therapies that are claimed to change the sexual orientation of youth.

In the District of Columbia, youth in the care of CFSA have a right to be provided with timely,
adequate, and appropriate medical and mental health services from health care professionals,
which includes medical care, behavioral health care, and counseling. Our youth have a right to
ask medical professionals treating them to explain matters related to their health, including
sexual orientation, gender identity, therapy treatment, and reassignment surgery.

Headquarters: 200 I Street, SE Washington, D.C. 20003 202-442-6100
www.cfsa.dc.gov http://dc.mandatedreporter.org
CFSA’s practice is to support and ensure that transgender youth obtain and have access to
gender-affirming healthcare, gender affirming mental healthcare, and any other support and
services they might need. Should a youth express an interest in undergoing gender reassignment
surgery with their social worker, health care professional, or foster parent, CFSA would treat
such request as we would any medical request. The agency will refer the youth to the appropriate
medical and mental health services, establish what is medically covered, and determine the best
way forward to ensure that all medical needs are met.

If a youth requests reassignment surgery, CFSA must ensure that the youth receives the
appropriate mental health support. The Department of Health Care Finance (DHCF) will cover
sex reassignment procedures for beneficiaries with an established diagnosis of gender dysphoria
(See DHCF’s Gender Reassignment Surgery Policy, No.: OD-001-17 enclosed).

CFSA is committed to supporting youth to obtain the proper medical and mental health
requirements that facilitate gender affirming healthcare. Currently, CFSA is in the process of
developing administrative guidance to ensure youth are aware of their rights. CFSA plans to
have an Administrative Issuance developed and related requirements integrated into practice
guidance and our training curriculum by September 30, 2019. The guidance will also allow
social workers and foster parents to have another tangible resource in supporting youth who have
questions about gender-affirming care.

Thank you for bringing this matter to my attention and your continued support to CFSA.

Sincerely,

Brenda Donald
Director

Enclosures

cc: Alana Intrieri, Director, Office of Policy and Legislative Affairs
Jay Melder, Chief of Staff, Deputy Mayor for Health & Human Services
Heather Stowe, CFSA Principal Deputy Director
Rachel Joseph, CFSA Chief of Staff
Cory M. Chandler, CFSA General Counsel
GOVERNMENT OF THE DISTRICT OF COLUMBIA
Child and Family Services Agency

Non-Discrimination Statement
Position Statement in Support of the D.C. Human Rights Act of 1977 Concerning all Children, Youth,
Adults, and Employees Engaged in Care, Services, and/or Resources Available through the Child and
Family Services Agency (CFSA).
In accordance with the D.C. Human Rights Act of 1977, as amended, D.C. Official Code § 2-1401.01 et seq.,
the Child and Family Services Agency (CFSA) does not discriminate on the basis of actual or perceived:
race, color, religion, national origin, sex, age, marital status, personal appearance, sexual orientation,
gender identity or expression, familial status, family responsibilities, matriculation, political affiliation,
genetic information, disability, source of income, or place of residence or business. Sexual harassment is a
form of sex discrimination which is prohibited by the Act. Any harassment based on or due to any of the
above protected classes, is prohibited by the Act. Discrimination in any form is a violation of the Act and
will not be tolerated under any circumstances by CFSA or its affiliated private contracted agencies or
anyone else doing business with CFSA. All staff, including children and youth shall be treated with respect
and dignity.
CFSA is committed to treating all persons, regardless of age, with respect, valuing and affirming
differences, and preventing discrimination, harassment, or biases of any kind in the provision of services
to the community. It is the philosophy of CFSA that children and youth in foster care who are, or who are
perceived to be lesbian, gay, bisexual, transgendered or questioning (LGBTQ) deserve loving and
permanent families and must be afforded the same rights, privileges, services, and protections as all
children and youth. CFSA strongly opposes the use of conversion or reparative therapies that are
purported to change the sexual orientation of youth. A parent has the right to use conversion or
reparative therapy for their child, unless that right has been severed. Examples of a parent not being able
to exercise their discretion is if Termination of Parental Rights has been granted, a Court Order has been
issued by the Family Court preventing the parent from exercising their right to use conversion or
reparative therapy or a court order taking away the parent’s discretion.
Fair and equal access will be provided to all children, youth and adults engaged in the receipt of or
application for care, services and/or resources available through CFSA, including but not limited to
placement, treatment, benefits, housing and other appropriate referrals. Equal consideration will also be
provided for anyone seeking employment with CFSA.
Complaints of harassment of any kind will be investigated and addressed. Any CFSA staff found to be in
violation will be subject to disciplinary action up to and including termination of employment. All private
contracted agencies and/or anyone else doing business with CFSA must abide by this position statement
as a condition of continued service.
All employees, immediate and prospective family members, congregate care providers and contractors
must receive appropriate and adequate training and or notification at prescribed intervals concerning
CFSA's position on their responsibilities to engage in fair and equal access to available care, services and
resources, and its zero-tolerance policy concerning the above mentioned protected classes.
The Agency considers the aforementioned provisions for fair and equal access a right and not a privilege.

D.C. Child and Family Services Agency 200 I Street SE, Washington, DC 20003 (202) 442-6100
www.cfsa.dc.gov http://dc.mandatedreporter.org ▪ www.fosterdckids.org ▪ Facebook/CFSADC ▪ Twitter@DCCFSA