When we go to ask for help, they don't understand how to help us: Understanding how youth with childhood histories of conduct problems link sexuality and gender to school‐based service use

Gender and, to a lesser extent, sexual identity, are relevant factors in understanding variance in the prevalence, consequences, and treatment of conduct problems. The current study uses thematic analysis to explore how youth with early‐onset conduct problems and extensive histories of school‐based service use perceive gender and sexuality as impacting their service use experiences. Qualitative analysis of interviews with 41 youth (17–21 years old; 53.7% women) yielded themes pertaining to gender, sexual identity, and discrimination in service use contexts. Identified themes included homophobia in service use and adjacent school contexts, stereotypes around masculinity and femininity as conditioning peer and school staff's behavior, and salience of sexuality across developmental stages and historical timeframes. Results suggest that increased school staff training and school‐based interventions be implemented to support gender and sexual diversity, both within services for conduct problems and more broadly in school contexts. In particular, the current findings highlight homophobia as a factor limiting boys' access to mental health services. Practitioner Points Youth who had received school services for conduct problems discussed how they perceived gender and sexuality as impacting their service use experiences. Youth described homophobia directed against boys who received or sought services, regardless of sexuality, which may particularly limit access to services for boys with conduct problems. Findings support the implementation of preventative policies and practices to address homophobia in schools, and suggest that these may be particularly important in schools providing specialized services for conduct problems.