Family-Centered Care for LGBTQ+ Parents of Infants in the Neonatal Intensive Care Unit: An Integrative Review.

BACKGROUND: Having an infant in the Neonatal Intensive Care Unit (NICU) can disrupt parent well-being, the transition to parenthood, and the typical trajectories of infant and child health. For lesbian, gay, bisexual, transgender, queer, or other sexual and gender minority identity (LGBTQ+) parents, this stress may be compounded by health disparities and fear of stigma and discrimination; however, research is lacking about LGBTQ+ parents of infants in the NICU. OBJECTIVES: The purpose of this integrative review was to better understand the experiences of LGBTQ+ parents of NICU infants, with a focus on experiences of stigma and discrimination, sources of strength and resilience, and provision of family-centered care. METHOD: We searched EBSCOHost, ProQuest, Web of Science, and Google Scholar between 30 May 2023 and 18 September 2023 for empirical studies published in English in peer-reviewed scholarly journals in which LGBTQ+ parents shared their experiences with having infants admitted to the NICU. RESULTS: We identified six articles that met inclusion criteria, all of which were qualitative studies that included 12-14 LGBTQ+ parents of NICU infants. CONCLUSIONS: LGBTQ+ parents in all studies reported instances of perceived stigma and discrimination while their infants were in the NICU, whereas parents in two studies mentioned strength and resilience, and parents in three studies described elements of family-centered care. There is a need for rigorous research on family-centered NICU care that includes questions about sources of strength and resilience in addition to challenges. We propose that future researchers use community engaged methods to center perspectives of LGBTQ+ parents.

Microaggression and discrimination experiences among diverse youth with LGBTQ+ parents in the United States.

Family-based microaggressions and discrimination experienced by youth with LGBTQ+ parents are important to understand from their perspectives. Using mixed methods, we examined such experiences among 12- to 25-year-old youth (N = 51) with at least one LGBTQ+ parent in the United States. Youth were diverse in race/ethnicity, family structure, gender and sexual identities, socioeconomic status, and geographic region. Using interviews, we explored LGBTQ+ family-based microaggressions (reported through scale items with feedback) and discrimination (assessed via thematic analysis). Microaggressions and discrimination based on having LGBTQ+ parents were common, yet there were distinctions in direct and indirect stigma across the quantitative items and qualitative themes. These results underscore the value of mixed methods research with youth and implications for future research, practice, and policy.

Stigma and lesbian, gay, bisexual, transgender, and queer (and additional identities) (LGBTQ+) parent socialization self-efficacy: Mediating roles of identity and community.

In the United States, cultural forces have led to the stigmatization of lesbian, gay, bisexual, transgender, and queer (and additional identities) (LGBTQ+) parenthood. However, pushing back against this stigmatization, developing a positive LGBTQ+ identity, and investing in one's LGBTQ+ community may inform empowering narratives of future parenthood and related constructs, such as LGBTQ+ parent socialization. Perceived self-efficacy related to preparation for bias (i.e., discussions of discrimination, prejudice, or bias-based bullying) socialization is likely associated with an individual's own perceptions or experiences of stigmatization given the conceptual overlap of bias and stigma. However, other constructs related to stigmatization and socialization self-efficacy, such as positive LGBTQ+ identity or community connectedness, have yet to be simultaneously considered (to our knowledge). Further, previous research has rarely included different assessments of stigma (i.e., perceived and enacted) and/or dimensions of positive LGBTQ+ identity (i.e., authenticity and self-awareness). Thus, this study aimed to rectify these gaps and provide a greater understanding of sexual stigma and LGBTQ+ parent socialization self-efficacy. Using data from a survey-based, online, cross-sectional study of LGBTQ+ childfree adults (N = 433; Mage = 29.85 years old) in the United States, we found that experiences of enacted or perceived sexual stigma were differentially associated with LGBTQ+ parent socialization preparation for bias self-efficacy. Further, positive LGBTQ+ identity authenticity and self-awareness, as well as LGBTQ+ community connectedness played distinct roles as mediators of the relationships between sexual stigma and LGBTQ+ parent socialization self-efficacy. These findings have implications for how we might understand the role of stigma, identity, community, and socialization among future LGBTQ+ parents. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Birth mothers' experiences of support before, during, and after adoptive placement.

Birth mothers, or women who have relinquished parental rights of their child, are an understudied and stigmatized population. Prior literature has suggested that protective factors, such as supports (e.g., practical, emotional, peer, informational), are beneficial for birth mothers. This study qualitatively explored perceptions and experiences of support before, during, and after placement among 51 birth mothers whose children were adopted as infants via private adoption in the United States 8 months to 50 years (M = 15.39 years) from the time of data collection. Thematic analysis revealed six overarching themes: (a) impact of lived circumstances, (b) importance of early adequate support, (c) an emotionally complex process, (d) access to timely information, (e) feeling ready to utilize resources, and (f) coping with ongoing adjustment needs. Prevalence of Themes pre-, during, and postplacement were shared among participants. Time since placement and adoption openness (e.g., contact with adoptive families) were also important factors related to these themes. We discuss implications of these results for policy and practice related to birth mothers' well-being and adjustment. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Birth relatives' perspectives about same-gender parent adoptive family placements.

Little research exists about the experiences of birth relatives connected to lesbian and gay (LG) parent adoptive families. Using mixed methods, we examined the perspectives of birth relatives and other adoption triad members (adoptive parents, adoptees). First, from interviews with birth relatives (N = 62) in the USA, we explored openness to same-gender parent adoptive placements. Next, we conducted a thematic analysis from interviews with a subsample (n = 24) whose child was placed with LG adoptive parents about why LG parents were chosen. Finally, eight (of these 24) were connected to seven LG adoptive parent families who were participants in a larger study. Among these adoption triads, we investigated how members described their contact experiences. Results showed that most birth relatives were open to placements with same-gender couples, and those who had done so often made this decision intentionally for various specific reasons. Birth relatives tended to be satisfied with adoptive family contact and desired more in the future. Adoption triad members generally reported warm feelings toward each other and commitments to continued contact. These findings provide insight about diverse conceptualizations of kinship, how contact can be effectively navigated across complex family relationships, and implications for adoption practice and policy.

Contextualizing the Well-being of Asexual Youth: Evidence of Differences in Family, Health, and School Outcomes.

Despite increasing efforts to better understand sexual and gender minority youth (SGMY), asexual youth remain understudied. This study examines differences in health, family support, and school safety among asexual youth (n = 938) from a national study of SGMY (N = 17,112) ages 13-17. Compared to non-asexual youth, asexual youth were more likely to identify as transgender and report a disability, and less likely to identify as Black or Hispanic/Latino. Transgender (versus cisgender) asexual youth fared worse on most study outcomes. Cisgender asexual (versus cisgender non-asexual) youth fared worse on all study outcomes. Transgender asexual (versus transgender non-asexual) youth reported lower sexuality-related family support. These findings underscore the role of gender identity in understanding the experiences of asexual youth.

Development of the Conceptual Future Parent Grief (CFPG) Scale for LGBTQ+ people.

Parenthood is highly valued around the world. Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) people, however, have faced a history of discrimination and challenges related to becoming parents (e.g., legal and/or practical barriers to adoption or biological parenthood). As such, LGBTQ+ youth may believe that certain pathways to parenthood (or parenthood itself) are unavailable to them. These feelings could prompt experiences of ambiguous loss related to a future idealized self. No quantitative research, however, has been conducted to capture these possible experiences; scale development is an important step to attempt to quantify them. Here, we report results from two studies using exploratory and confirmatory factor analysis to investigate the factor structure of a new scale reflecting conceptual future parent grief (CFPG) among LGBTQ+ individuals. Participants also responded to several measures to explore validity with the CFPG scale. Following model respecification, a 9-item one-factor solution resulted, reflecting ambiguous loss, complex grief, and sexual stigma-all of which could contribute to difficulties in reconciling one's LGBTQ+ and future parenthood identities. Significant associations with greater authenticity of LGBTQ+ identity, depressive symptoms, and sexual stigma provided evidence of convergent and divergent validity with the CFPG scale. Thus, ambiguous loss among LGBTQ+ people may connect to aspects of identity, mental health, and parenthood goals. Developing this scale represents a first step toward an assessment for LGBTQ+ individuals regarding future parenthood. Understanding more about CFPG among LGBTQ+ individuals could inform prevention efforts to reduce negative mental health symptoms and enhance positive LGBTQ+ identity development. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Stigma Experiences, Mental Health, Perceived Parenting Competence, and Parent-Child Relationships Among Lesbian, Gay, and Heterosexual Adoptive Parents in the United States.

Adoptive parents often face stigma related to "non-traditional" family structures. Lesbian and gay (LG) adoptive parents often face additional stigmatization based on sexual identity, which in turn may negatively affect parents' mental health. Despite controversy about LG parenting, research demonstrates that family processes are more strongly associated with individual outcomes than family structure. Thus, family systems and minority stress theories provided our conceptual foundation in examining how adoptive LG parents' stigma experiences were associated with mental health, parenting competence, and parent-child relationships. Participating families (N = 106; n = 56 LG parent families) were originally recruited from five US domestic private infant adoption agencies and completed two waves of data collection (W1, W2; 91% retention) when children were preschool-age (M age = 3.01 years) and school-age (M age = 8.36 years), respectively. Data for the current study are largely drawn from W2. Via Qualtrics, parents completed assessments of mental health symptoms, adoption stigma, and perceived childcare competence. LG parents also reported on their experiences of homonegative microaggressions, and children responded to a measure about their relationships with parents. No significant differences emerged as a function of parental sexual orientation and gender except that lesbian mothers, heterosexual mothers, and gay fathers all reported higher parenting competence than heterosexual fathers. Although parents' mental health did not significantly predict parent-child relationship quality, parents' perceived competence and LG parents' current homonegative microaggression experiences did (e.g., greater competence, greater closeness; more microaggressions, lower closeness). Consistent with our conceptual framework, our results-derived from parent and child reports-demonstrate that although adoptive and LG parent families experience stigma, family processes (rather than structure) are most associated with individual outcomes. Researchers, policy makers, and practitioners should work together to employ identity-affirming practices to reduce stigma and support adoptive family functioning and well-being.

Longitudinal associations between coparenting and child adjustment among lesbian, gay, and heterosexual adoptive parent families.

This longitudinal study examined coparenting and child adjustment during early and middle childhood (Ms = 3 and 8 years, respectively) among 106 lesbian, gay, and heterosexual parent adoptive families. When children were in middle childhood, no differences emerged as a function of parental sexual orientation in observations or self-reports of coparenting; in addition, parents and teachers described children as well-adjusted overall. After controlling covariates, including couple relationship adjustment, more supportive coparenting in early childhood predicted fewer parent-reported child internalizing and externalizing problems in middle childhood. Within middle childhood, stronger parenting alliance was associated with fewer parent-reported child externalizing problems. These findings indicate the value of considering family processes among diverse families in contributing to child outcomes over time. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Introduction to the special issue: Social science perspectives on contemporary lesbian family life, 2009-2019.

It has been over ten years since the last special issue regarding lesbian family lives appeared in the Journal of Lesbian Studies (volume 12, issue 2-3). In my introduction to this special issue, I offer perspectives on contemporary lesbian family lives from 2009-2019, considering three key questions: (1) What important social and legal changes have occurred over the last decade? (2) What have we learned about lesbian family lives during this time period? (3) What do we still not yet know?

Family conflict observations and outcomes among adopted school-age children with lesbian, gay, and heterosexual parents.

Children's externalizing problems are associated with family conflict among children and their biological parents, yet these linkages have remained unexamined among adoptive or lesbian and gay parent families. Investigating family processes facilitative of adjustment among adoptees, who face unique developmental challenges, is warranted. This multimethod study of 96 (26 lesbian, 29 gay, 41 heterosexual parent) adoptive families examined observations of adoptive family conflict and associations with child adjustment and feelings about adoption (children's Mage = 8 years). The sample was recruited from 5 private, domestic infant adoption agencies across the United States. Parents and children reported about children's externalizing problems and feelings about adoption, respectively. Observations of family conflict interaction were rated from videotaped family discussions. Family interactions were associated with children's behavioral and adoption-specific adjustment, yet analysis of variance and hierarchical linear modeling analyses revealed no differences by parental sexual orientation in family dynamics (i.e., negativity/conflict, positive affect, cohesiveness) or child outcomes. Parents generally reported children to have few externalizing behaviors. Children reported positive feelings, moderate preoccupation, and low negativity about their adoption. These findings extend the family systems literature about conflict and child development among diverse families with sexual minority parents and adopted children. Practitioners who work with adoptive and sexual minority parent families can encourage positive and cohesive family interactions in supporting children's adjustment. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Theory in Highly Cited Studies of Sexual Minority Parent Families: Variations and Implications.

This article includes a systematic review and citation analysis of the literature regarding sexual minority parent families, particularly attending to what theories have been used, and how. We consider the importance of theoretical frameworks for future research and implications for policy, practice, and law related to sexual minority parent families. Our review targets 30 highly cited studies located through Google Scholar (as an interdisciplinary search engine) and published within a specific timeframe (2005-2010). We highlight the dominant theoretical models employed across disciplines studying sexual minority parent families. Although the majority of studies reviewed referred to theoretical models or perspectives, explicit theoretical grounding was frequently lacking. Instead, the empirical work reviewed appeared to have a predominantly applied focus in addressing public debates on sexual minority parent families. We provide recommendations for how theory might be more fully integrated into the social science literature on sexual minority parents and their children.

Does parental sexual orientation matter? A longitudinal follow-up of adoptive families with school-age children.

Controversy continues to surround parenting by lesbian and gay (LG) adults and outcomes for their children. As sexual minority parents increasingly adopt children, longitudinal research about child development, parenting, and family relationships is crucial for informing such debates. In the psychological literature, family systems theory contends that children's healthy development depends upon healthy family functioning more so than family structure. From the framework of family stress theory, it was expected that longitudinal outcomes for school-age children adopted in infancy could be distinct among those with same-sex versus other-sex parents (N = 96 families). Similar findings were hypothesized in terms of parent adjustment, couple relationships, and family functioning in comparing same-sex and other-sex parent families. Results indicated that adjustment among children, parents, and couples, as well as family functioning, were not different on the basis of parental sexual orientation (lesbian, gay, or heterosexual) when children were school-age. Rather, children's behavior problems and family functioning during middle childhood were predicted by earlier child adjustment issues and parenting stress. These findings are consistent with and extend previous literature about families headed by LG parents, particularly those that have adopted children. The results have implications for advancing supportive policies, practices, and laws related to adoption and parenting by sexual minority adults. (PsycINFO Database Record

Factors associated with relationship dissolution and post-dissolution adjustment among lesbian adoptive couples.

Same-sex adoptive couples are increasingly visible, yet few studies have addressed relationship stability and dissolution among these couples. In this study, using a theoretical framework based on Investment Models and Vulnerability-Stress-Adaptation Theory, factors associated with dissolution and post-dissolution adjustment among 27 lesbian adoptive couples were examined across two points. At Wave 1, all 27 couples were together; children were on average 3 years old. Results revealed that nearly one third broke up over 5 years (between Waves 1 and 2). Factors related to shorter relationship length and undermining coparenting at Wave 1 distinguished women who later broke up versus stayed together. Worse mental health at Wave 2 characterized women in dissolved rather than sustained relationships, even with comparable individual adjustment at Wave 1. Weaker parenting alliance and greater dissatisfaction with childcare divisions were reported by women no longer with their partners at Wave 2 as compared with those in enduring partnerships. This research has implications for understanding lesbian relationship dynamics and associations with individual adjustment.

Social support and coparenting among lesbian, gay, and heterosexual adoptive parents.

In this study, we examined associations between qualities of families' social contexts and experiences of coparenting. In a sample of 92 adoptive families, we assessed perceived social support among 23 lesbian, 28 gay, and 41 heterosexual adoptive parent families and its association with parents' perceptions of their coparenting alliances. Results showed that parents in same- and other-sex couples reported receiving similar amounts of social support from family, friends, and significant others. Perceived social support was positively associated with stronger coparenting alliance among all family types. Perceived support from family members explained more variance in parenting alliance than did support from friends or significant others. These findings add to knowledge about fundamental family processes and enhance understanding of parenthood among lesbian and gay adoptive couples. (PsycINFO Database Record

Microaggressions, Feelings of Difference, and Resilience Among Adopted Children with Sexual Minority Parents.

Limited research exists about the unique experiences and possible marginalization of children with sexual minority parents. From a larger longitudinal project of diverse adoptive families, we examined cross-sectional data using mixed methods from interviews with 49 adopted children (M age = 8 years; 47% female) in 27 two-father and 22 two-mother families. Using thematic analysis, we coded themes of awareness of difference, microaggressions, and resilience (i.e., coping and positive family conceptualizations). Children experienced "feeling different" and microaggressions from peers, but generally at a low to medium intensity and with neutral (not negative) emotion. More instances of resilience and positive family conceptualizations were reported than microaggressions or feelings of difference, suggesting that children develop positive perceptions of their family and navigate experiences of difference with resilience. Filling important gaps in the literature, we discuss implications of our results for practice and policy.

The role of siblings in adoption outcomes and experiences from adolescence to emerging adulthood.

In many families, siblings play important roles in shaping each other's outcomes and experiences across development. In adoptive families, siblings may affect adoptees' feelings about adoption and birth family contact. Among "target adoptees" (i.e., 1 participating adopted individual within adoptive families) with siblings who may have also been adopted or the biological children of the adoptive parents, we examined how adoption experiences and individual adjustment from adolescence into emerging adulthood were associated with sibling relationship dynamics. We present 3 studies using longitudinal, mixed method data within the same overarching sample of adoptive families. Study 1 was a follow-up to Berge et al.'s (2006) study of adolescent adoptees and their adopted siblings with birth family contact; we found evidence of changes in the status of contact collectively experienced by 26 adopted sibling pairs when target adoptees were emerging adults. In Study 2, we found that target adoptees (n = 91) with siblings (adopted or not) who were more involved with target adoptees' birth family contact demonstrated more favorable behavioral outcomes than target adoptees who had uninvolved siblings. Finally in Study 3, for target adoptees with siblings who were also adopted (n = 51), results showed that target adoptees felt more positively about their own adoption when siblings expressed similar positive feelings about individual adoption experiences. Implications of our findings are discussed in terms of the enduring contributions of sibling relationships from childhood into adulthood and the unique ways in which adoptive siblings are important in shaping one another's experiences of adoption.

Contact Between Birth and Adoptive Families During the First Year Post-Placement: Perspectives of Lesbian, Gay, and Heterosexual Parents.

Despite growing visibility of lesbian- and gay-parent adoption, only one qualitative study has examined birth family contact among adoptive families with lesbian and gay parents (Goldberg, Kinkler, Richardson, & Downing, 2011). We studied adoptive parents' (34 lesbian, 32 gay, and 37 heterosexual; N = 103 families) perspectives of birth family contact across the first year post-placement. Using questionnaire and interview data, we found few differences in openness dynamics by parental sexual orientation. Most reported some birth mother contact, most had legally finalized their adoption, and few described plans to withhold information from children. We discuss implications for clinical practice, policy, and research.

Female same-sex sexuality from a dynamical systems perspective: sexual desire, motivation, and behavior.

Fluidity in attractions and behaviors among same-sex attracted women has been well-documented, suggesting the appropriateness of dynamical systems modeling of these phenomena over time. As dynamical systems modeling offer an approach to explaining the patterns of complex phenomena, it may be apt for explaining variability in female same-sex sexuality. The present research is the first application of this analytical approach to such data. Dynamical systems modeling, and specifically generalized local linear approximation modeling, was used to fit daily diary data on same-sex attractions and behaviors over a 21 day period among a group of 33 sexual minority women characterized as lesbian, bisexual or "fluid" based on their identity histories. Daily measures of women's reported same-sex attractions were fit using a linear oscillator model and its parameters estimated the cyclicity in these attractions. Results supported the existence of a "core sexual orientation" for women in this sample, regardless of how they identified and despite a high degree of variability in daily same-sex attractions. Thus, modeling individual differences in the variability of attractions and behaviors of sexual minority women may be critical to furthering our understanding of female same-sex sexuality and human sexual orientation more broadly.

Adoptees' contact with birth parents in emerging adulthood: the role of adoption communication and attachment to adoptive parents.

As adoptees transition to adulthood, their roles in the family may shift, providing them with opportunities to have increasing autonomy in their decisions about contact and initiating conversations about adoption. Research has often focused more on adoptees as children, yet in emerging adulthood, there are important shifts in the life roles and relationships of adoptees during which adoptive parents continue to be meaningful. This study examined associations among attachment and communication within the adoptive family during adulthood with emerging adult adoptees' experience of birth family contact (frequency of and satisfaction with birth family contact), in a sample of 167 emerging adults with varied contact with birth family (from no contact to frequent contact). Results suggest that perceptions of secure parent-child attachment relationships, as well as sensitive and open communication with adoptive parents about adoption, continue to be important for emerging adult adoptees and lead to greater satisfaction for adoptees with birth parent contact-regardless of whether adoptees actually have birth family contact. In particular, positive family communication about adoption during adulthood was predictive of satisfaction with birth parent contact. Limitations and implications are discussed.