Affirming Care for Lesbian, Gay, Bisexual, Transgender and Questioning Clients

Date Issued: October 17, 2019


  • All Certified, Funded or Otherwise Authorized Providers
  • Local Governmental Units (LGUs)

This Local Service Bulletin (LSB) applies to all OASAS certified, funded, or otherwise authorized providers of gambling and substance use disorder treatment and prevention services who serve LGBTQ-identified clients.


The purpose of this LSB is to identify the obligations of OASAS certified, funded or otherwise authorized providers in the delivery of services to Lesbian, Gay, Bisexual, Transgender and/or Questioning (LGBTQ) clients.



Pursuant to Section 19.07(c) of the Mental Hygiene Law (MHL) the Office of Alcoholism and Substance Abuse Services shall have the responsibility for seeing that persons who abuse or are dependent on alcohol and/or substances and their families are provided with care and treatment, that such care, treatment and rehabilitation is of high quality and effectiveness, and that the personal and civil rights of persons receiving care, treatment and rehabilitation are adequately protected.

In 1945, New York State became the first state in the nation to enact anti-discrimination legislation with the NYS Human Rights Law (HRL). The HRL prohibits discrimination on the basis of age, race, creed, color, national origin, sexual orientation, military status, sex, marital status, or disability. In 2013, the Sexual Orientation Non-Discrimination Act (SONDA) became effective, adding sexual orientation to the existing list of protected classes in the HRL. In 2019, the Gender Expression Non-Discrimination Act (GENDA) was passed, adding gender identity or expression to the existing list of protected classes in the HRL. All clients admitted to, or served by, OASAS certified, funded or otherwise authorized providers or programs shall be free from discrimination based on their LGBTQ status. All individuals served in the OASAS system have the right to be treated with dignity and respect and in a manner that best serves their individual needs.



Gender identity or expression means a person’s actual or perceived gender-related identity, appearance, behavior, expression, or other gender-related characteristics regardless of the sex assigned to that person at birth, including, but not limited to, the status of being transgender. One’s gender identity may also innately reside somewhere in between the ends of the gender binary (male/female) or somewhere outside the boundaries of the gender binary and can be fluid for some individuals. Gender identity and expression are expressed in self-image, physical appearance, and with behavior.

A person that identifies as transgender or gender non-conforming (TGNC) has a gender identity different from the sex assigned to that individual at birth.

Gender dysphoria is a recognized medical condition related to an individual being distressed about having a gender identity different from the sex assigned at birth. Not every transgender/gender non-conforming person will have a diagnosis of gender dysphoria.

  • The Client Bill of Rights must explicitly ensure LGBTQ affirming service delivery.
  • Each program shall designate an LGBTQ liaison. The LGBTQ Liaison shall monitor staff compliance with required cultural competency trainings and serve as a resource person for both LGBTQ identified clients and staff.
  • Policies and Procedures shall be established that explicitly identify LGBTQ affirming client services.

Reporting of LGBTQ Client Admission Data

In 2014, the categories of sexual orientation and gender identity were added to the client admission report form completed upon client admission to OASAS treatment programs. It is essential that all programs complete the admissions data in full to ensure accurate collection of data for individuals treated within the OASAS system. Clients must be provided with services even if they opt not to provide answers to these questions.

Program Policies and Procedures

All OASAS certified, funded, or otherwise authorized programs are required to have written Policies and Procedures for the functioning of their program. Policies and Procedures must be updated to ensure LGBTQ affirming service delivery. Policies and procedures must include the following recommendations at a minimum but nothing prevents any provider or program from issuing policies and procedures that expand upon the minimum requirements set-forth here.


Client confidentiality shall be respected. Any decisions to identify an LGBTQ client to other members of the program, or for that individual to “come out” to staff or other clients as LGBTQ, shall be made conjointly with the client and the appropriate program staff. Disclosure will be crafted to the particular situation and education about privacy and confidentiality will accompany the disclosure.

LGBTQ Cultural Competency Training

All providers and programs must provide cultural competency training for each individual staff member that will come into contact with clients/beneficiaries of programs. Such cultural competency training should be specific to the LGBTQ community. Training shall be mandated, at least once annually, for all employees. All incoming employees shall receive such training as part of their initial orientation to their employment. Addiction treatment programs that are adapted to address the cultural needs of the respective clients are more effective and successful. All staff should be encouraged to promote a safe, inclusive and affirming space.

Transgender and Gender Non-Conforming (TGNC) Affirming Policies

TGNC identified individuals are more likely to experience discrimination in their day-to-day lives and, studies have indicated a direct link between trans-specific discrimination and substance use.1.

All OASAS funded, certified, or otherwise authorized programs should provide TGNC inclusive policies and procedures that respect, validate and support the needs of TGNC identified clients. Proactively creating policies and procedures that address these topics, at minimum, will allow for seamless integration of all clients into treatment programs. Furthermore, the individual client must be consulted and included in the decision-making process regarding all personal accommodations (including placement in gender specific settings).

For example, clients must be consulted, and client preference respected, for preferred name and gender pronouns, preferred placement in gender segregated facilities and use of gender segregated bathroom facilities, and personal grooming, clothing and dress.

Programs shall ensure access to gender affirming healthcare. TGNC identified clients may or may not be receiving gender affirming care from a medical provider. If they are receiving medically appropriate care (such as prescribed hormones), the medication(s) shall be continued. For individuals accessing medication without a prescription, immediate referral to competent healthcare practitioners is required. Having such practitioners identified in advance for referral is preferred. If an individual is not engaged in gender affirming treatment upon admission, but later requests such care, referrals to the appropriate practitioner(s) shall be made.

Addressing Harassment and Discrimination

All OASAS funded, certified or otherwise authorized programs must develop policies and procedures to identify staff responsibilities in responding to threats of violence, disrespectful and/or suggestive comments, or gestures toward an LGBTQ identified client. In order to support a safe, affirming, discrimination-free environment, staff should be trained on recognizing the signs of harassment and intervening in all instances of harassment.

Gender Markers

Several states and localities, including New York City, offer a third gender on birth certificates of “X” (instead of “F” or “M”) or may leave the gender marker blank for individuals that identify as transgender and/or gender non-conforming. If an individual arrives at your program with such identification, ensure them of their right to receive services from your program. If your electronic health record and billing systems require a gender marker, inform the client of that requirement and ask that they identify an appropriate gender marker for that purpose only. Assure the client that the systems gender marker will not appear on any public facing document and will not impact their ability to access services. Ensure that affirming service provision is provided in accordance with the LSB and all other OASAS laws, rules, regulations and guidance.


1. Glynn Tiffany R. and van den Berg Jacob J.. Transgender Health. A Systematic Review of Interventions to Reduce Problematic Substance Use Among Transgender Individuals: A Call to Action. March 2017, 2(1): 45-59.

OASAS also provides opportunities for professional development through ‘Learning Thursdays’ which are webcasts designed to increase provider knowledge on specific topics. The ‘Learning Thursdays’ webcasts which focus on LGBTQ issues:

  • Issues Faced by Transgender/Gender Non-Conforming People (June 28, 2018): The presentation will focus on issues specific to the Transgender/Gender Non-Conforming Population. One focus will be on concerns encountered when seeking or attending SUD treatment.

  • Engaging LGBTQ+ Youth and Creating Safe Spaces: How to be an Ally (June 15, 2017): This training will provide participants with an understanding of LGBTQ+ youth experiences and identifies the unique challenges that this at-risk population faces.

  • LGBT-The Coming Out Process (August 25, 2016): Coming out (of the closet) is not an event; it is a life-long process of the development of a positive gay, lesbian, bisexual, or transgender identity. It can be a struggle for people due to homophobic attitudes and discriminatory practices they encounter along the way.

    • To “be out” does not mean someone is out in all areas of a person’s life. People choose who to be out to and when to come out in that area of their life.

    • This presentation presents an overview of this process.


Questions regarding this bulletin should be directed to the OASAS Counsel’s Office ([email protected]) or the Regional Office. OASAS cannot provide legal advice to agencies. Please contact your agency counsel for questions requiring legal advice.