Scholarship

Project will examine post-COVID 19 migrations among Filipino care workers

San Francisco State University Associate Professor of Sociology Valerie Francisco-Menchavez received a Fulbright U.S. Scholar Program award for a project titled “Migrant Care Workers and Multinational Migrations in the COVID-19 Global Context,” which considers how multinational migration strategies might shift in response to the demand for care workers globally and the restrictions that arise from the pandemic. During the Spring 2022 semester, Francisco-Menchavez will examine the effects of the COVID-19 pandemic on migration aspirations for Filipinos in the Visayas region of the Philippines. Her work will be based out of the University of San Carlos in Cebu.

The Fulbright project builds on Francisco-Menchavez’s previous research, including her award-winning 2018 book “The Labor of Care,” in which she explored how migration shapes the lives of Filipina migrants in the U.S. and their families in the Philippines. Her current research has focused on Filipino migrants working as caregivers in the Bay Area during the COVID-19 pandemic.

“My past research program is concerned about similar topics but has dealt with the matter after Filipinos have arrived to the U.S.,” Francisco-Menchavez said. “This study proposes to examine the various processes and institutions Filipinos interact with before they migrate, to consider how these factors shape their migratory journeys, especially within the conditions of a pandemic that is demanding their labor globally.”

While most migration research in the Philippines has focused on urban centers such as Metro-Manila, Francisco-Menchavez will conduct her research from Cebu City to explore the types of labor migration patterns that emerge from the Visayas, a region that is an emerging migration hub. She will study how mechanisms and processes of pre-migration decision-making and multinational migrations are made among Visayan families with overseas worker migration histories and in response to the global pandemic.

As she did in her earlier ethnographic study of Filipino transnational life, Francisco-Menchavez will use qualitative research methods including participant observation, interviews and what she calls “kuwentuhan,” a type of focus group that revolves around a Filipino cultural practice of exchanging important details through talk-story.

“The global COVID-19 pandemic has reorganized public health, care work and health services,” Francisco-Menchavez said. “Filipino care workers have been lauded as global essential workers while statistics show an unprecedented rate in deaths because of their work on the frontlines. In the United States, one out of four Filipinos work in the health care industry as nurses, caregivers to the elderly, and personal attendants. The unprecedented global pandemic will undoubtedly call on more Filipino migrants in the care industry all over the world. And while Filipino care workers have been a historic, formidable migratory population, the aftermath of the pandemic will surely reorganize their lives, as well.”

The Fulbright Program is the flagship international educational exchange program sponsored by the U.S. government. It is designed to forge lasting connections between the people of the United States and the people of other countries, counter misunderstandings and help people and nations work together toward common goals.

New research shows lack of labor protections for Filipino caregivers is exacerbated with COVID-19 crisis

San Francisco State University Associate Professor of Sociology Valerie Francisco-Menchavez recently authored a research paper with a personal story attached to it. “I attribute my grandmother’s early death to the stress she had as a caregiver,” she said.

This connection was one of the reasons Francisco-Menchavez decided to conduct research on caregivers for the elderly and their challenges, particularly during the COVID-19 crisis. Specifically, she wanted to look at the experiences of Filipino caregivers — like her grandmother — who largely make up the number of practitioners in the field. And there’s a reason why they do: The Philippines has a sophisticated system of exporting labor to other countries, Francisco-Menchavez explains.

Historically, many Filipinos who leave the Philippines do so for jobs that address labor shortages in other countries, acting as migrant workers. They often do this to earn higher wages abroad, allowing them to send money to their families in the Philippines. With the pressure to financially support their family members, many of these workers will take jobs without understanding the dangers they may present, Francisco-Menchavez says. Her research shows that this is a common story for Filipino caregivers in the U.S. during the pandemic.

“If they don’t work, they don’t have something to send home to the Philippines,” she said. “So they will walk willingly into a caregiving job with minimal personal protective equipment and without knowing the full extent of the pandemic or the virus because they have people who rely on them in the Philippines.”

Francisco-Menchavez and research collaborator Katherine Nasol, Ph.D. student at the University of California, Davis, interviewed and surveyed Filipino caregivers in the U.S. to get a deeper view of their experiences before and during the pandemic. The collaborators published their findings in the journal American Behavioral Scientist last month.

Even before the pandemic, home care workers and their health were often at risk because of how physically strenuous it can be assisting patients with common daily activities, such as getting up out of bed, laying down or getting on and off the toilet. For example, 64% of respondents said they felt persistent pain in their bodies.

And when the pandemic first struck, residential care facilities for the elderly were common sites for COVID-19 outbreaks, putting caregivers’ health at more risk. A shortage of personal protective equipment (PPE) at the time also exacerbated the issue.

“Well, they provided us with PPE, but only very minimal,” one survey participant said. “Like four pieces only, and then ... they just told us to spray them with disinfectant and reuse it again.”

Findings also show that some participants did not seek government assistance during the pandemic because it could’ve jeopardized getting a green card.

“I cannot apply for a housing assistance because right now, if you are going to apply for any government aid or government assistance, you will not be granted a green card because of that,” another participant said. What she is describing is a U.S. Citizenship and Immigration Services rule enacted in 2019 that made it more difficult for immigrants to obtain a green card if they use public benefits.

SF State junior Alyssa Barquin helped conduct interviews for the study. A Filipina American, she said she was glad to take part in a project that amplifies the voices of the Filipino migrant worker community.

“They’re very much invisible frontline workers, and through the interviews we see that they experienced a lot of physical abuse and mental abuse,” Barquin said. “But they are not passive recipients of oppression. They very much want to use their voices, even if it looks like they can’t.”

Barquin, a Sociology and Asian American Studies double major, also said the research was a great learning experience for both disciplines. “This research is like the perfect marriage between Sociology and Asian American Studies because we’re taking a sociological analysis for an Asian American group,” she said. “I’m really glad that I found this project.”

Dean Alvin Alvarez began the program with welcoming remarks and spoke about the College’s RACE Initiative. This was followed by the panel discussion, moderated by Sherria Taylor, assistant professor of Child & Family Studies in the Family, Interiors, Nutrition & Apparel Department. Panelists were Maiya Evans, a lecturer in Holistic Health and Public Health; Supriya Misra, assistant professor of Public Health and Brandon Venerable, a member of the CHSS Race Collective.

Panelists

Sherria D. Taylor, Ph.D. (moderator)

Assistant Professor, Child & Family Studies

Sherria D. Taylor (she/her) is an assistant professor of Child & Family Studies in the Family, Interiors, Nutrition & Apparel Department at SF State. She earned her doctoral degree in 2013 from Loma Linda University in Family Studies with a concentration in Systems-Organizational Consultation. Her dissertation was titled, "A Family Resilience Model of Behavioral Health for Low-Income, Ethnic Minority Families." Taylor attained her M.A. in Counseling and Educational Psychology with an emphases in Marriage and Family Counseling and Community Counseling from the University of Nevada, Reno in 2003. Her research interests include family, community and cultural resilience, mental health, substance abuse prevention, the buffering effects of spirituality among ethnic minority families, and academic resilience among underrepresented college students. She has been involved in research funded by HUD and the Family Process Institute related to family resilience and family support services among low-income families.

As the former executive director of the nonprofit agency Access for Community & Cultural Education Programs & Trainings, Taylor was successful in securing over one million dollars in grant funding. She has produced peer-reviewed publications and reports related to low-income families, mental health, substance abuse, resilience and social justice pedagogy. Her work has been shared at various annual conferences focused on strengthening families and diversity and inclusion in higher education, including the National Council on Family Relations and the National Conference on Race and Ethnicity.

Taylor is one of the founding members of the CHSS RACE Collective at SF State, which was formed with the goal of overseeing and engaging the entire CHSS community in activities, trainings, and working groups that are designed to advance racial justice. The CHSS Reflections and Actions to Create Equity (RACE) Initiative is a college-wide, permanent commitment to dismantling racism systemically in the college and to advancing and embedding racial justice in its teaching, research, and service, as well as its policies, procedures, and operations.

Maiya Evans, MPH

Lecturer, Holistic Health & Public Health

Maiya Evans (she/her) teaches courses in Holistic Health Studies and Public Health at SF State, where she earned her Master of Public Health in Community Health Education in 2015. She also holds a Bachelor of Arts  in Film/Cinema/Video Studies and Sociology from the University of California, Santa Barbara. Much of her work examines the intersection between holistic health, public health and social justice.
Evans has worked as a health educator at the UCSF Osher Center for Integrative Medicine, is a consultant for the anti-racism organization, The Mosaic Project, and was awarded the 2020-2021 EPIC Community College Fellowship at Stanford University for her work on globalizing the public health curriculum. She is the founder of Hey Girl Health, a health, wellness and culture brand that puts women of color at the center of the health conversation, and host of the health and wellness podcast, the Hey Girl Health Show. She is currently working on a project entitled, “Celebrating Diversity and Culture in the Virtual Space,” which demonstrates the benefits of creating an inclusive and diverse classroom space in the virtual realm.

Supriya Misra, Sc.D.

Assistant Professor, Public Health

Supriya Misra’s (she/her) research focuses on mental health inequities among socially marginalized communities, particularly racial and ethnic minority groups. She uses mixed methods to understand the roles of discrimination, stigma, and trauma on the onset and experience of mental distress and to promote dignity and justice for those living with mental illness. She completed her B.A. and M.A. in Psychology at Stanford University, her Sc.D. in Social and Behavioral Sciences at the Harvard T.H. Chan School of Public Health and a Provost’s Postdoctoral Fellowship at New York University. She also worked for several years in nonprofit management to develop and implement evidence-based health education resources.

Brandon Venerable, MPA

CHSS RACE Collective

Brandon Venerable (he/his) is a Black Queer born and raised in Sacramento. His passion for public health/administration and social justice stems from his own experiences navigating public and health care services as a young person, and he strongly believes in the importance of equipping underserved populations with the tools to not only survive but thrive. He is one of the founding members of the CHSS RACE Collective at SF State, which was formed with the goal of overseeing and engaging the entire CHSS community in activities, trainings and working groups that are designed to advance racial justice. 

Venerable holds a B.S. in Nutrition and Food Sciences from Sacramento State University and a Master’s in Public Administration from SF State. His academic and professional interests center on organizational development, specifically, centering equity in the design of organizational structures, processes and values. He currently serves as a senior global programs manager for a global health nonprofit, where he focuses on program management, organizational development and strategy. In his free time he enjoys reading, attending local drag shows, cooking new vegetarian and vegan recipes, and watching movies and documentaries.  

Associate Professor Emma Sanchez-Vaznaugh (Photo by Jim Block)

Trained as a preschool teacher in Mexico, Sanchez-Vaznaugh, now an SF State associate professor of health education, immigrated to the U.S. to join family members and had only recently learned English herself, through City College’s ESL program. But with her education and growing language fluency, she was able help more recent migrants tackle immediate needs, including health issues like locating affordable doctors and vaccines. The resources her clients needed weren’t always available.

As soon as she’d help one family, there was always another family, a new crisis. The endless cycle of need might have driven some people to burn out, but Sanchez-Vaznaugh — who understood the isolation of not knowing the language — loved the work and was inspired by the resiliency of the people she served. She started thinking about how she might make a bigger impact.

That impact turned out to be a public health career launched, and later anchored, at SF State’s College of Health & Social Sciences. Public health policy, she soon discovered, was her path to a broader impact: How could society — schools and communities, cities and states — narrow the health disparities she’d observed between the low-income, minority communities like the migrant families she served and the broader population? What levers could be pulled to narrow the gap between rich and poor on key health indicators like high obesity rates and low physical activity rates — and the litany of health problems that can accompany those indicators?

While she didn’t start out with a plan, her widely published and often cited research has already impacted generations of students, programs and policies focused on health disparities. From co-writing a seminal paper that helped get snack machines removed from public schools to serving on the National Institute of Medicine’s Committee on Physical Activity and Physical Education in the School Environment, Sanchez-Vaznaugh is a thought leader in the field.

An SF State connection blossoms

The bridge from direct service to policy research arrived in the person of Zoe Cardoza Clayson, an SF State health education professor who’d been assigned to conduct an evaluation of the migrant-family agency where Sanchez-Vaznaugh worked. The two worked closely on a survey of client satisfaction, and a public health researcher was born.

“I loved the whole process of designing the survey, collecting the data, analyzing it, and writing up a report,” Sanchez-Vaznaugh recalls of the collaboration. The project became the basis for her undergraduate thesis at the University of San Francisco, and the bond she formed with Clayson, who died in 2010, led to a job working for Clayson at SF State.

One part of Sanchez-Vaznaugh’s new job was administering a partnership program with city’s Department of Public Health – her first real peek behind the policy curtain. She also coordinated a partnership between the SF Department of Public Health and SF State’s new master of public health (MPH) program designed to serve students who worked day jobs.

Mary Beth Love, a health education professor who, together with Clayson, wrote the grant for the new MPH program and supervised Sanchez-Vaznaugh’s work, says SF State’s program emphasized community-based research, “working closely with the people who will be affected both by the research and its outcomes, involving them as full stakeholders. It's really a partnership.”

When the MPH program launched, Sanchez-Vaznaugh entered its inaugural cohort as a student. It was clear that the program’s community-based focus was right for her. Professor Lisa Moore’s class on the theories of social production of disease was particularly eye-opening.

“That class really blew my mind… that what I saw in the Mission — the cycles, the poverty, the health issues, the housing — that all of that was related. It was the enactment of disparities, the production of disease,” she observed in hindsight. “I learned that there was a science around it, and I immediately became passionate about doing this work, because I knew a lot about it in practice but I didn't know that this whole scientific perspective on disparities existed.”

Love became Sanchez-Vaznaugh’s advisor, and says the new student brought her thoughtful, insightful demeanor from the office to the classroom. For their culminating project, Sanchez-Vaznaugh and another student, Celia Graterol, developed an online course on the social determinants of health. “These days, ‘social determinants of health’ rolls off everybody's tongue just like ‘online learning’ rolls off everybody's tongue,” Love says, but in back 2000, the research was not widely known, and online learning was still novel. “So this course Emma and Celia developed — it was brilliant. It was way ahead of its time. We still teach it.”

Research that informs policy

Seeking to deepen her knowledge and scientific skills, Sanchez-Vaznaugh followed her MPH with a doctoral degree at Harvard, where faculty members were leaders in the field of social epidemiology. There, she focused on methodologies, diving into biostatistics — which numbers are important and how to crunch them — and learning how to structure studies that would stand up to rigorous peer review.

With her top-notch resume and research skills, Sanchez-Vaznaugh would have had many opportunities available to her. Why did she choose to come back to SF State?

“We had very meaningful conversations about disparities in a very innovative way — intellectual ideas about how you studied disparities,” she says, adding that some colleagues and many students across the University come from diverse populations. “We have a rich experience here.”

In her research, Sanchez-Vaznaugh continues that innovative approach, investigating, for example, not just the policies that lead to good outcomes, but how those policies get enacted. In a current study, her team is surveying schools serving immigrant and low-income populations to better understand why they’re effective in supporting physical activity among students. Much is known about the benefits of physical activity for health and for learning, “But we don't know a lot about how successful schools make decisions about how to implement physical activity for their students. What stimulated those decisions? If we understand that process perhaps other schools across the nation and maybe the world can replicate that success,” she says.

Next, Sanchez-Vaznaugh launches a $3.2 million, five-year National Institutes of Health (NIH) study that was awarded this February. With partners at the University of Michigan, she’ll be analyzing 16 years of health data to understand the effects of nutrition policies and community environments on childhood health disparities. It’s an enormous undertaking, but one thing that motivates Sanchez-Vaznaugh to take it on is that the research can actively inform policy — it won’t sit on the shelf gathering dust.

“It's very important to monitor, reduce and maybe even eliminate child health disparities now, because if they continue unabated, they will have a domino effect on a lot of segments of society.”

That’s important for everyone, she points out, not just for the populations at the disadvantaged end of the social spectrum. A sick childhood population will impact all of society in the future — including employment, work productivity, health care costs, the military and, by association, national security. Given that children are the most diverse segment of the population, she says, “It's very important to monitor, reduce and maybe even eliminate child health disparities now, because if they continue unabated, they will have a domino effect on a lot of segments of society.”

Universities play a key role

Love says Sanchez-Vaznaugh’s ability to land major grants like the NIH study is highly unusual in the Cal State system, where the focus is on teaching more than research. “She’s getting highly competitive grants that support her insightful queries of large data sets,” Love says. “Her work is game-changing — it’s the result of her passion for both health and social justice. She’s receiving state and national attention for her knowledge and expertise.”

Sanchez-Vaznaugh acknowledges that the enormous support she’s received at the College of Health & Social Sciences has made pursuing research like this possible. She says universities play a central role in reducing economic- and race-based health disparities: they produce research that informs policies; train practitioners for hands-on programmatic work; and train new generations of leaders.

Her own story is just one example, she says. In addition to supporting her research on disparities, “[SF State] trained me and shaped me so that I could be competitive for a Harvard application, and has faculty who really care about their students.”

She’s gratified, both personally and professionally, to continue that cycle, seeing her students discover themselves and the field of health disparities. “It's just wonderful that I get to see that same flourishing that I went through,” she says, adding that for universities to close the health gap, “they must continue to train people who deeply care about this work — that it's not just a job, but it is something that we really need to do to have a better society, a better country and a healthier population.”

Kristal Osorio and Aya Francisco-Menchavez table to collect surveys at Kasayahan Filipino American History Month celebration in Daly City in 2019.

“Under COVID-19, we have a new angle,” says Francisco-Menchavez. “So many Filipinos are on the front lines right now — as caregivers in home health care and nursing homes.”

The team had completed 102 surveys and eight interviews, and drafted a manuscript for publication. Now, while they wrap up the manuscript on their initial study, they are conducting new research on how the global pandemic has affected front line Filipino caregivers, especially since Filipino Americans make up a large percent of California’s health care workforce. While many work as nurses in hospitals, where they are unionized and receive benefits, others work in nursing homes and extended care facilities, or for home health agencies, where they have less protection and can experience different types of stress. For example, Francisco-Menchavez and her research team found that while many caregivers reported in written surveys that they were not experiencing stress or anxiety associated with their work, during oral interviews they revealed the opposite: many of them worried about their families in the Philippines, and experienced fears related to their immigration status and working conditions. “We need to give more attention to the precariousness of these caregivers,” says Francisco-Menchavez.

Thought partners and collaborators

As her group moves forward despite the new challenges they face, the relationship between Francisco-Menchavez and her assistants continues to strengthen and grow, even as their in-person meetings have switched to Zoom and email. “I view the students more as collaborators than research assistants,” Francisco-Menchavez explains. “They really have been thought partners and collaborators in terms of how we analyze the data we have collected. We are all working with a community we know very intimately — we all have relatives who are caregivers. So I think knowing that puts so much of my trust into them.”

Osorio, a senior who is also a community organizer, says she appreciates Francisco-Menchavez’s community organizing background and the fact that she doesn’t focus on mistakes, but constantly pushes her assistants to become better researchers. “She’s very straightforward in what she wants and asks really intentional questions,” says Osorio. “She’s very intentional in how she gets you to think about things you don’t normally think about, in expanding how you think about things.”

Celemen, who first met Francisco-Menchavez at the University of Portland while she was a student there, says she appreciates how the professor followed up with her, kept in touch when Celemen moved back home to the Bay Area, and offered to include her in her research project this summer. Like Osorio, Celemen says Francisco-Menchavez’s organizational skills and attention to detail have helped her understand how to take on large, seemingly overwhelming projects.

“She has such a clear idea of what we are doing; it’s all about organizing lists and agendas. Even at the beginning of our project in the early stages she set forth a whole five-month plan,” Celemen says. “She shows us how to break things down into smaller goals, in order to get to the larger goal. Seeing it piece by piece really helps when there are so many things to do, and you’re thinking, ‘what do I even start with?’”

Both students see Francisco-Menchavez as a mentor and an inspiration. “Working with her made me realize how much work goes into becoming a professor, especially for a Filipina professor in sociology, and how much work it takes to get our stories out there,” says Osorio. Celemen says she is in awe of Francisco-Menchavez but also realizes that she is a genuine person who cares about her students as people first. “I really like how before we meet — at the beginning of every meeting — she asks how we’re doing. She cares about our well-being first.” Celemen says she was inspired by Francisco-Menchavez’s personal story, which she first learned about during the professor’s Labor of Care book tour in 2018. “I really identify with her experiences growing up as Filipino-American. She’s someone I look up to, and she’s given me opportunities to work in academia and helped me step into the real world.”

With Francisco-Menchavez’s guidance, Celemen recently began working for CREGS as a research assistant on the Together Study; she is balancing the two research projects while she takes a gap year before possibly going to grad school in public health.

Supporting and learning from each other

Francisco-Menchavez sees herself less as a mentor and more as helping two Filipinas navigate the academic world and gain skills they will need. “I’m just transferring my skills to them. I see it more as democratizing the research process. They’ve always been part of a community that looks for information systemically, that tries to answer questions in a deep and profound way. Our community has always done that and always will. We all come to the research table with strengths; I’m not the only person with skills and expertise. When I ask Kristal and Elaika, ‘What are your thoughts on this?,’ they are both empowered enough to say, ‘I think this is happening,’ or to question whether our approach is right or wrong.” She says both women are brilliant. “I really believe in them and I appreciate working with and learning from them. The experience they bring as Filipina American immigrants helps me be a better scholar, teacher, mother, parent, friend.”

Francisco-Menchavez emphasizes that her philosophy is to make sure that everyone understands that they all come to the table with unique strengths — and that together they will make the research project better. “I have skills I can train them in as a professor — academic writing and the research process, for example—but in our research group I try to break those vertical power lines and redistribute them horizontally a little more.” She says she constantly learns from her students and that their collaboration makes her work sharper and more dynamic. “I think the biggest impact is that it helps the research I do have more relevance than just being in an academic journal. Research should really belong to communities and organizations and young people and teachers; everyone should be able to access knowledge and participate.”

All three team members feel very strongly that their research not wither in academia. Some of the research Francisco-Menchavez and her students have done helped inform a report that led to state Senate Bill 1257, which gives domestic workers increased health and safety protections. Says Osorio, “Our objective is to help our community have this data and to have a better picture of how we can serve our community better or advocate for them better in terms of policy and services.”

Despite having spent her whole life in a church culture that rejects gay people, Montgomery says her first instincts as a mother were to protect her son. “I never for one minute loved him any less,” she says. And, importantly, she let him know.

The Montgomerys tell their story in “Families Are Forever,” an award-winning video produced by the Family Acceptance Project, an SF State-based research, intervention, education and policy initiative. The project educates and counsels families on how to prevent serious health risks to their LGBT children and promote their kids’ well-being by supporting them — even if they believe that being gay or transgender is wrong. The foundation of all of the project’s work is rigorous peer-reviewed research led by Family Acceptance Project Director Caitlin Ryan.

Amid tragedy, hope

“Before we did this [research] the perception was that all families rejected their LGBT children and were incapable of learning to support them,” Ryan says. She knew that wasn’t the case. In her 40 years of working with LGBT young people as a clinical social worker, program director and researcher, Ryan had observed a wide range of family reactions to their LGBT children, from very accepting to highly rejecting.

From the beginning of the AIDS epidemic, when Ryan ran the first AIDS service organization in the South, she stood at the bedsides of young gay and bisexual men, supporting devastated parents as they learned for the first time that their son was gay and was dying of AIDS. She saw parents and families who realized too late the cost of pushing their child away. “I knew there had to be a way to bring LGBT young people and families together to strengthen bonds and increase acceptance and support,” Ryan says.

But the existing peer-based LGBT services excluded families, she says, and her own research documented widespread lack of family services or engagement. Until Ryan and colleague Rafael Diaz launched the Family Acceptance Project in 2002 with a major grant from The California Endowment, no one had put the two together before — studying LGBT adolescents and their families. So Ryan and her team pursued the questions: How do parents and caregivers react to their LGBT children, and how do those behaviors contribute to their children’s risk and well-being as young adults? She assembled a multilingual, multicultural research team and conducted an in-depth qualitative study across California. The study involved interviews with families, foster families and guardians from a wide range of backgrounds who were accepting, ambivalent, or rejecting of their LGBT and gender non-conforming children.

What emerged from that work, Ryan says, was “a solid empirical foundation for increasing family involvement and support.” The research team cataloged more than 100 specific ways in which caregivers responded to their child — with either accepting behaviors, such as standing up for them when others mistreat them or finding a positive role model — or rejecting behaviors, such as preventing them having an LGBT friend, physical and verbal abuse, and using religion to try to change or discourage their LGBT identity.

Ryan led a follow-up quantitative study and found that the way LGBT adolescents were treated by their families had a major impact on their health and well-being as young adults. The numbers were staggering. LGBT young people who were highly rejected by their families reported an eight times greater likelihood of attempted suicide, a six times greater likelihood of high levels of depression, and a more than three times greater likelihood of using illegal drugs or engaging in high risk sexual behavior that significantly increased their risk for HIV and STDs, compared to LGBT peers who were not rejected by their families.

A new model

Building on this research, the Family Acceptance Project developed the first family intervention model to help parents and caregivers learn to support their LGBT children. The goals were to prevent serious health risks, prevent removal or ejection from the home and reconnect fractured families when LGBT young people end up out-of-home. Ryan is now implementing the project’s family support model beyond the Bay Area in other parts of the country.

Over the years, Ryan has received many awards for her work, including the American Psychiatric Association’s John E. Fryer Award for major contributions to the mental health and well-being of LGBT people and the Distinguished Scientific Contribution Award from the American Psychological Association, Division 44, for groundbreaking research on LGBT youth and families.

A cornerstone of Ryan’s work is communicating research findings and messaging in culturally specific ways, so families struggling with a clash in values can embrace core beliefs like love, compassion and protecting their child’s health — in contexts that make sense to them. In addition to “Families Are Forever,” Ryan has produced other family education videos such as “Always My Son,” which documents the journey of a Mexican-American family who went to 15 churches before they found one to support their gay child. Ryan and her team have also developed a “Best Practice” family education booklet series in English, Spanish, and Chinese and a faith-based series that show families how to support their LGBT children. “We have to meet people where they are,” she says.

Eliminating Solomon’s Choice

When Wendy Montgomery couldn’t get answers from Mormon church-based materials that advised “it’s just a phase” and referred her to mental health providers who offered “conversion therapy,” she sought help outside her community. She reached out to Mitch Mayne, who blogs about being openly gay and Mormon, and has collaborated with Ryan on curricula and training for Mormon religious leaders. Mayne connected the two women, and Montgomery found the information she had been desperately searching for.

After Jordan came out, Montgomery learned from the Family Acceptance Project that many of the things parents do out of care and concern to help their child be accepted by others — such as trying to change their child’s sexual orientation — were experienced by their LGBT child as rejection. So it was a revelation to see the project’s research showing that such behaviors were linked with serious health consequences, like the suicidal thoughts and depression Jordan expressed as the family struggled to find its way. She wishes she’d had that information when Jordan first came out.

Montgomery says Ryan’s work removes that choice from the conversation. “That’s what the genius of the Family Acceptance Project is. It shows you a way to keep your conservatively held religious beliefs… but still love and accept and support your LGBT child.”

That’s the core of the Family Acceptance Project’s work: keeping the focus on behavior and family bonds and aligning the project’s approach with the family’s underlying values. “We’re not saying to people, ‘You have to change your doctrine.’ We’re saying that if you want to protect your child from harm, you need to change or engage in these supportive behaviors,” says Ryan. “That’s enabled us to work with families from all sorts of backgrounds, including very religiously and socially conservative families.”

Since making the video and helping to found LGBT-supportive Mormon organizations like Mama Dragons, Montgomery can barely keep up with the 100 or more messages she receives each week — many of them gut-wrenching pleas for help — from fellow church members trying to navigate similar circumstances. She always sends back the link to the project’s booklet or video. “If a Mormon parent watches that, they will see themselves reflected,’ she says. “It is giving them permission to still love their child and keep their faith,” adding, “It’s silly that we need permission, but sometimes we do.”

The real beauty of the Family Acceptance Project, Montgomery says, is that “it goes upstream.” Help the parents to understand, she says, echoing the lessons of Ryan’s work, and you save the child. “If I have to choose between helping the child and helping the parents, I’ll help the parents. Because I can help the child for a minute when I’m talking to him, but the parents can help him for his lifetime.”