“Transphobia is child abuse,” Alex Roque, who runs the Ali Forney Center for homeless LGBTQ youth in New York City, asserted on a U.S. Department of Health and Human Services (HHS) webinar last fall.

In less than three minutes, he cast a vision for completely transforming child protective systems nationwide. Family rejection of a child’s gender identity cannot be dismissed as a personal view, he argued. Non-affirmation must be treated as abuse. “If they were denying them food or denying them access to school or denying other things, there would be headlines,” Roque continued. “There would be prosecution.”

Among gender activists the Biden-Harris administration has enlisted to shape its policies, Roque’s definition of abuse is not fringe, and his vision for reshaping the system is not hypothetical.

While crafting its foster care rule finalized in April, HHS officials took inspiration from social workers in Cuyahoga County, Ohio, who spent years pioneering a program that strong-arms parents into affirming whatever confused beliefs children express about their gender. Parents who decline risk losing a voice in their child’s life.

The program developed in Cuyahoga County using federal grant funds provided the HHS’ Administration for Children and Families (ACF) with an ideal model for infusing gender ideology into foster care and social services, the Daily Caller News Foundation discovered in reviewing hundreds of documents and emails obtained via public record requests.

The Biden-Harris administration’s new federal rule directs states to ensure foster children who identify as LGBTQ are placed in affirming homes. These “designated placements” must commit to creating an environment that supports a child’s “status or identity,” including through access to age-appropriate “resources, services, and activities.” To gender activists consulted by the Biden administration, being “affirming” means assuming the child knows best about his or her identity — even if what he or she claims to want is life-altering medical procedures like hormone blockers, cross-sex hormones and surgeries to appear more like the opposite sex.

To Cuyahoga County child protective services, being affirming often means providing kids access to items like chest binders or prosthetic packers that mimic a penis, according to an information sheet for caregivers on the Cuyahoga County Division of Children & Family Services (DCFS) website.

Frequent communications with federal officials indicate Cuyahoga County played a prominent role in shaping the rule, which was just one part of a broader effort to support LGBTQ youth the agency undertook at the direction of President Joe Biden. But voices of county social workers weren’t the only ones the agency heard.

ACF senior advisor for LGBTQI Initiatives Julie Kruse, who celebrated the Cuyahoga County team as “trailblazers,” reached out to dozens of other activists to weigh in on the agency’s efforts, emails obtained by the DCNF show.

When the rule was announced in September 2023, it quickly faced resistance. A coalition of 19 Republican states slammed the proposed rule, arguing it would infringe on religious liberty and free speech protections. Religious groups warned it would restrict faith-based providers.

Those concerns were well-founded: In states like Washington and Vermont, Christian couples have lost their foster care licenses due to similar state regulations. But as the activists consulted in the development of the federal rule show, these objections only scratch the surface of problems with the rule.

Parents in a handful of states have already sounded the alarm, claiming local authorities deemed them unfit guardians for refusing to allow their children to undergo a gender transition. In light of federally funded programs, like the one operating in Cuyahoga County, stories like these sound more like harbingers of an organized effort to undermine the family than one-off incidents.

Vernadette Broyles, president and general counsel of the Child and Parental Rights Campaign, told the DCNF there has absolutely been “an uptick in families that are having their custody of their child taken away, investigated or disrupted” because they believe in “biological reality.”

“The underlying premise of the rule is that it is mistreatment and abuse if you do not affirm a child’s self-selected identity,” Rachel N. Morrison, director of the HHS Accountability Project at the Ethics and Public Policy Center, told the DCNF. “This premise is dangerous and could extend outside the foster care context to adoption, custody disputes, and schools.”

‘Conceptual Flaws’

At the tail end of the Obama administration, a group of researchers at the University of Maryland received a five-year, $10 million federal grant to establish a center aimed at supporting LGBTQ children in foster care. The idea was to work with child welfare agencies in multiple locations to develop “interventions” that ensured “affirming” placements for LGBTQ youth.

The group established through the grant, cumbersomely known as the National Quality Improvement Center on Tailored Services, Placement Stability and Permanency for Lesbian, Gay, Bisexual, Transgender, Questioning, and Two-Spirit Children and Youth in Foster Care (QIC-LGBTQ2S), selected four implementation sites: Allegheny County in Pennsylvania, Cuyahoga County in Ohio, the state of Michigan and Prince George’s County in Maryland.

The Cuyahoga County site became particularly important, as federal officials drafting the rule later looked to it as model for infusing gender ideology into foster care and social services.

As Cuyahoga County Health and Human Services special project coordinator Jennifer Croessmann explained in a podcast interview quoted by the county, the aim was to “develop practices that inform everyone that understanding a youth’s SOGIE (and we all have one) is critical to determining their safety, stability, and service needs.” SOGIE is an acronym for Sexual Orientation, Gender Identity and Expression used frequently throughout the program’s materials.

When the four-year grant project concluded in 2022, the agency boasted that their program had “provided a blueprint for Health and Human Services divisions throughout the nation to follow.” (RELATED: EXCLUSIVE: Mandatory State Training Steers Judges To Question Fitness Of Parents Who Don’t Affirm Gender-Confused Kids)

The county’s “AFFIRM.ME” model included four interventions: the first identifies LGBTQ youth, the second convinces parents to affirm their children, the third helps LGBTQ kids locate affirming adults in their circles and the fourth trains prospective foster parents to become affirming. Though the grant has now ended, a county spokesperson confirmed elements of the program, including the Safe Identification and Youth Acceptance Project, are still used.

“Programs like Affirm Me take for granted that affirmation is consistent with promoting the health and general welfare of a child, and conversely, that non-affirmation is akin to a form of emotional or psychological abuse,” Manhattan Institute Policy Analyst Joseph Figliolia told the DCNF.

These kinds of programs “are used to try and establish the intellectual architecture needed to advance policies that promote affirmation as the default intervention for gender dysphoria by linking it with the mental and emotional welfare of children,” Figliolia said.

Yet, many studies cited in the federal foster care rule “rely on self-report surveys that cannot determine causality and often have other methodological or conceptual flaws,” Figliolia added.

Identification

The first intervention is the “Safe Identification Initiative,” which is designed to identify LGBTQ youth.

All youth over 13 years of age — along with some as young as three — are to participate in a SOGIE conversation with their caseworker. The disclosure form walks the child through a series of leading questions about pronouns, feelings of gender and expressions of gender.

“Do you have crushes on boys, girls or other kinds of people?” one question asks.

Another asks children to tell their social worker whether they “feel more like a boy or more like a girl, some other gender or maybe somewhere in between?”

“The original goal was to serve LGBTQ+ youth, ages 12–21 in agency care, but the age range was later changed to 5–21 years old to account for younger children disclosing diverse gender identity or expression and to include youth involved with DCFS, not just those in the care of DCFS,” the county’s AFFIRM.ME guide states.

Acceptance

Once LGBT youth are identified, the Youth Acceptance Project (YAP) can be implemented to persuade hesitant parents to affirm their child’s gender dysphoria.

In an overview of YAP, the program’s creator, the California-based nonprofit Family Builders, touts the “success” story of a family who became involved with the system because they “struggled to accept their child as a transgender girl.”

“After several months of work, there were significant improvements,” the document states. “The father consented to gender affirming medical care for Salima. The father gave Salima a purse for her birthday. And the father once helped Salima put on a wig.”

The program is designed to help parents and caregivers of children already in the welfare system, or “at risk” of entering, become affirming, according to the AFFIRM.ME guide. The program also pushes families to “reconcile” their values, including their faith, to accept their child’s identity.

Many caregivers are referred to the program because they are “not allowing their youth to express themselves fully in public (hairstyles, clothing, hygiene/ beauty products)” or resist using preferred pronouns and names, according to the Family Builders overview. (RELATED: EXCLUSIVE: Top Pediatric Org Quietly Colluded With Trans Ideologues To Push Child Sex Changes, Emails Show)

YAP is currently being implemented in California, New York, Pennsylvania and Missouri, along with Ohio, according to the SOGIE Center. Of the 34 Cuyahoga County families who started the program between 2018 and 2021, seven cases were successfully “closed” when parents stopped opposing their child’s gender-bending desires, according to SOGIE Center data.

“I mean, they don’t say anything to my face anymore about it and they stopped being super religious around me because they used to,” said one young person who was part of the program in Spring 2021, according to the data sheet. “I don’t know what was their problem, but they used to try to push a lot of weird religion stuff on me.”

Another adolescent reported having a “very conservative” family approve of transitioning after going through YAP. “So I could start testosterone and things of that sort soon,” the youth said. “And [mom is] helping me with the name change.”

The Ohio-based nonprofit Kinnect, which received a contract from the state worth nearly $24 million, helped implement YAP in Cuyahoga County while the program was ongoing.

“During the Affirm Me program, YAP was used as a prevention tool for young people who were at risk of leaving their caregiver’s home because of rejection,” Kinnect explains. When the grant ended, Frontline Services, a nonprofit that contracts with Cuyahoga County to provide homeless and trauma support services, “embedded the program as part of their existing work with the support and partnership of Family Builders,” according to Kinnect.

Kinnect did not respond to the DCNF’s request for comment.

A Cuyahoga County spokesperson told the DCNF the program works with LGBTQ youth or families who have an open case with DCFS and desire additional support.

“As with other supportive services offered by DCFS, this service is available to youth in county custody and those who remain in their homes in order to prevent them from coming into custody,” Cuyahoga County HHS deputy communications director Deonna Kirkpatrick told the DCNF.

Family Finding

A third intervention helps foster children find adults who will affirm their identity and potentially become their legal caretaker, in some cases instead of their parents.

Chosen Affirming Family Finding (CAFF) model, developed by Kinnect, helps LGBTQ youth “locate” affirming family members from existing connections, who can include “family, chosen family, or other important people that the young person has a relationship or contact with.” The ultimate goal is building “committed, life-long, and positive connections,” even if this is with “chosen family” and not blood relatives.

“These connections lead to a robust network of affirming individuals who provide emotional and potentially legal permanency for LGBTQ+ young people,” the practice manual explains.

During a first meeting, social workers ask questions, including who a young person “feel is their family,” would like to have in their lives and are “current safe and affirming connections.”

A report on the use of CAAF in Cuyahoga County from 2019-2021 states that 12 youth completed the program, having an average of five identified connections joining their “network of support.”

When the Affirm Me program ended in 2021, two other Ohio foster youth programs, Kinnect to Family and Youth-Centered Permanency Roundtables, have since integrated CAFF into their programs “as a cultural adaptation to their work,” according to Kinnect’s website.

Preparing Foster Parents

The fourth program, called “AFFIRM Caregiver,” is designed to increase the number of homes available to LGBTQ youth already in the system by preparing foster parents to support kids in their care who desire to live as another gender, even if that means providing access to irreversible medical procedures.

“The AFFIRM Caregiver model recognizes that pervasive exposure to homo/bi/transphobic attitudes, beliefs, and behaviors at multiple levels in society impacts the way caregivers may view and understand their child’s LGBTQ+ identity,” the Cuyahoga County guide states. “Through a variety of didactic and interactive activities delivered over seven sessions, the AFFIRM Caregiver model helps caregivers adopt an affirming approach toward their youth’s identity as a critical step toward creating safe and healthy environments for their LGBTQ+ youth.”

A pre-test given to caregivers prior to the training asks them to rate their ability in areas like creating a “safe space” for LGBTQ youth or making “affirmative statements,” according to material obtained by the DCNF.

Another form later asks caregivers how strongly they would support behaviors associated with different gender identities.

“I would take my child to a medical facility for hormone treatment that would help them look like a different gender if that’s what they wanted,” one statement reads.

Parents are also asked if they “display pro-LGBTQ+ symbols” in their home or would allow their child to bring a “same-gender significant other to family events and celebrations.”

‘Promising Model For Replication’

As the HHS developed its rule, grant-funded researchers who established the QIC-LGBTQ2S center helped connect federal officials with the team operating in Cuyahoga County. Angela Weeks, project director for the center, made the introduction in May 2023.

Weeks told the county team that HHS senior advisor Julie Kruse had closely followed the work and was “really impressed with all that you did at Cuyahoga County,” according to an email obtained by the DCNF.

“She would like to bring in ACF leadership to hear from you, including Assistant Secretary January Contreras,” Weeks said.

Kruse quickly followed up on Weeks’ introduction by heaping praise on the Cuyahoga County group, calling them “trailblazers” and letting them know their work was “very appreciated at ACF.”

The email exchange led to a June 9 call with Kruse and an invitation to present to Contreras in July.

Emails indicate the Cuyahoga County team understood their conversation with HHS leadership to be part of fulfilling a direct charge to the agency from Biden, who announced in a 2023 pride month statement that the HHS would advance rulemaking designed to “protect LGBTQI+ youth in foster care” by requiring state agencies to provide affirming placements.

In preparation for the July call, the Cuyahoga County team put together a presentation agenda to explain why their program was “a promising model for replication.” One staff member shared “real life experiences” from implementing the interventions, according to an agenda obtained by the DCNF.

The team was thrilled to speak to the administration.

“You’re obviously a group of rock stars!” Karen Anderson, deputy director of resources and placement at the DCFS, wrote in a July 7 email to Kruse. “This is life saving work and we are grateful that this administration is so thoughtfully considering how to imbed it inpolicy [sic]”

Kinnect included the meeting in its August 2023 newsletter, sharing that the organization was invited to participate in a meeting about affirming LGBTQ youth with federal officials at the HHS.

The feeling was mutual. Catherine Heath at the ACF’s Children’s Bureau emailed the county group who participated in the July call to thank them for a “great virtual site visit.” She also noted a previous visit she made to Cuyahoga County had been important.

“We put many aspects of your work into the latest Program Instructions issued to states,” Heath said.

The July meeting wasn’t the last time the Cuyahoga County team interfaced with federal officials.

Members of the team also agreed to participate in an interview with Mathematica, a research and data analytics consultancy firm contracted by the ACF to visit child welfare agencies to learn about data practices “that could potentially help develop nationwide requirements for SOGIE data collection,” per an email obtained by the DCNF.

In September 2023, Kruse emailed multiple individuals from DCFS and Kinnect to invite their comments on the proposed rule and help them “identify LGBTQI+ foster and adoptive parents” who could talk to top officials.

Family Builders, which developed YAP, submitted public comments on the proposed foster care regulation in November 2023, telling the agency that offering religious exemptions would provide a “license to discriminate and to do harm.”

“Any provider that is unwilling to provide safe and proper care for youth who are LGBTQI+ are unable to provide safe and proper care to any youth,” they advised. “We recommend all placement providers and child welfare agencies be held to a standard of care where they are prohibited from discrimination based on all protected classes, including sexual orientation, sex, and gender.”

Kinnect also submitted a public comment in support of the proposed rule.

The HHS modified the final rule’s wording in response to some concerns raised by faith-based groups, calling providers for children who identify as LGBTQ “designated placements” rather than “safe and appropriate.” It also noted the rule does not require religious foster parents to become designated placements.

The final rule must be implemented by October 2026, according to the federal register.

ACF spokesperson Pat Fisher told the DCNF the administration considered each of the nearly 14,000 comments it received while developing its final rule. He said the ACF “believes that all children deserve to grow up in a safe home.”

“For most children, that is with their parents, which is why ACF has invested substantially in funding supports and services to parents in order to maintain family unity and prevent entry into foster care,” he said. “For all youth that do enter the foster care system, including those who are LGBTQI+, federal law requires they receive safe and proper care.”

A Cuyahoga County spokesperson told the DCNF that the DCFS “has not confirmed what influence its program had on the federal rule.”

Intertwined Work

To become a “designated placement” for LGBTQ children, the HHS’ final rule also requires foster parents to “be trained with the appropriate knowledge and skills to provide for the needs of the child related to the child’s self-identified sexual orientation, gender identity, and gender expression.”

While the rule does not identify specific training, many of the resources developed through the QIC-LGBTQ2S center can now be found directly on the ACF Children’s Bureau website.

For instance, the website lists the YAP and CAFF interventions developed in Cuyahoga County. It also lists the National Center for Youth with Diverse Sexual Orientation, Gender Identity & Expression (SOGIE), which is run by many of the same individuals who previously lead the QIC-LGBTQ2S center, including principal investigator Marlene Matarese and project director Angela Weeks.

The SOGIE Center is an effort led by the Innovations Institute at the University of Connecticut School of Social Work. Its website houses materials developed through QIC-LGBTQ2S, including the Cuyahoga County interventions.

The SOGIE Center’s work is likewise heavily intertwined with the ACF. Weeks is featured in a training session on sexual orientation and gender for agency staff.

The SOGIE Center also influenced the foster care rule.

In a comment on the proposed foster care regulation, the Innovations Institute recommended the agency require affirming placements for all children, not just those who identify as LGBTQ. It suggested having placements and staff undergo LGBTQ trainings, advising the ACF to look at trainings offered by its own SOGIE Center.

The Innovations Institute wrote in its comment that it is best practice to ask children as young as six about their gender identity, noting “this identity component forms as early as two-years-old.”

The final rule released in April cites the federally-funded research conducted by activists tied to the SOGIE center.

A study on Cuyahoga County authored by Weeks, along with Matarese, Elizabeth Greeno and Paige Hammond, is cited multiple times. The study was funded through the QIC-LGBTQ2S and cites “intersectionality, queer theory, and minority stress theory” as its guiding frameworks. It surveyed 252 youth in the foster care system, finding 32% of those surveyed had a “diverse SOGIE.”

The regulation also cites a literature review co-authored by Matarese, titled “Youth with Diverse Sexual Orientation, Gender Identity and Expression in Child Welfare: A Review of Best Practices,” which was also produced through the federally funded QIC-LGBTQ2S, according to the document.

The ties between these activists also predate the Biden administration.

In 2019, the Biden Foundation also partnered with the University of Maryland, Baltimore School of Social Work, where the QIC-LGBTQ2S center was based, to make a video on affirming youth.

This is a clip teaching a dad to ‘affirm’ his sons choice to be a girl from a 2019 video that was part of the Biden Foundation ‘As You Are’ campaign.

No one should be surprised how hard this administration is pushing transgender ideology onto children and families. pic.twitter.com/1vVYqtPvvn

— Meg Brock (@MegEBrock) December 8, 2023

The Affirm Me program should raise “further alarm” about the foster care rule, American Principles Project President Terry Schilling told the DCNF.

“The purpose of such programs is clearly to ensure that gender-confused foster kids are funneled into environments where their confusion is only further reinforced, while also excluding potential foster parents who wish to help their children become comfortable in their own bodies,” he said.

While the rule only applies to foster care, Schilling said “families of all stripes should be very concerned about what a Harris presidency might have in store next.”

Non-Affirmation As Abuse 

Lifeline Children’s Services, a Chrisitan nonprofit that supports foster youth and families, opposed the rule when it was announced, in part due to a concern that biological families’ opinions about where their child is placed would be ignored. The organization told the DCNF it was alarmed to see government entities at both the federal and state level labeling people of faith as “unsafe.”

“Foster homes are not public squares; they are private homes that deserve the basic religious freedoms guaranteed by the Constitution, as every other American home,” the group told the DCNF.

In recent years, there have been multiple reported instances of parents losing their children to the foster system because they did not affirm a transgender identity.

Maryland parents lost custody of their autistic son after staff at the Children’s National Hospital in Washington, D.C. informed them he was transgender, according to a lawsuit filed in March. Officials told them to “remove passages from their Bibles that affirm traditional sexual values” and refused to return their son until “they renounced their lifetime faith,” the complaint alleges.

The child’s parents reside in one of the four locations — Prince George’s County, Maryland — that was an implementation site for the QIC-LGBTQ2S center grant.

In Montana, another family allegedly lost their teenage daughter to child protective services when they did not allow her to live as a boy, Reduxx reported in January.

In California, the Los Angeles County Department of Children and Family Services took a 14-year-old girl from her mother’s home because she would not affirm her daughter’s desire to transition to a boy, according to the Daily Signal. Officials accused the mother of emotional abuse and put her daugher in a foster home.

An Ohio judge granted custody to a transgender-identifying teen’s grandparents in 2018 after the parents opposed her wishes to begin hormone therapy and denied her identity as a male. The judge wrote their daughter had “a legitimate right to pursue life with a different gender identity than the one assigned at birth.”

Broyles’ organization, the Child and Parental Rights Campaign, is currently handling one case involving a California family whose child was taken by child protective services (CPS). She is familiar with several similar cases in other states.

“Because juvenile courts or dependency proceedings are shrouded in secrecy, we have no real idea how much this is happening,” Broyles told the DCNF. “But given this Ohio program and given what the Biden administration and HHS has been putting out there as guidance for states, there’s no question in my mind that this is happening in a substantial way.”

The Biden administration’s rule creates an assumption that parents who have a scientific or religious belief that there are two genders are emotionally abusive — or worse, failing to provide for their child’s needs, she said.

As schools increasingly embrace gender ideology, parents may face greater threats than policies against disclosing when a child identifies as transgender. Teachers are mandated reporters who are obligated to call CPS if they believe a parent is inflicting harm, Broyles noted.

“The only reason why we’re not seeing it on a mass scale is that somewhere inside they know that’s not true,” she said. “Some common sense inside them is questioning the truth of that assertion, however, you can imagine that there’s going to be some number of school officials that don’t question it.”

“I totally see parents being at a much higher risk right now for school systems becoming their adversary and being the conduit through which child protective services now begins to interfere with their families,” she said.

Kinnect’s executive director did not respond to multiple requests for comment. Kruse, Weeks and Matarese also did not respond to requests for comment.

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