Case Study
Patient Demographic: Client Age: 13 Sex Assigned at Birth: Male Gender: Transgender; Gender Nonconforming (TGNC) Ethnicity: Caucasian Counseling Setting: Child and Family Agency, School-Based Services Type of Counseling: Individual and Family Presenting Problem: Truancy; Gender Dysphoria Diagnosis: Gender Dysphoria, Provisional (F64.1); Social Exclusion or Rejection V62.4 (Z60.4)
Mental Status Exam: Mental Status Exam: The client is dressed in age-appropriate clothing. They wear eye makeup and chipped black fingernail polish, and they have bitten most fingernails down to the quick. The client’s mood is irritable, and they are quick to show anger toward their mother when misgendered. Their thoughts are coherent, and they deny audio/visual hallucinations. The client acknowledges feeling sad and hopeless but denies suicidal ideation. They attribute increased levels of anxiety at school to bullying, particularly with select peers. They explain that a select group of students threaten the client and call them offensive and derogatory names. Family History and History of th
Presenting Problem: You are a school-based mental health counselor in a public middle school. Your client is a 13-year-old Caucasian 7th grader who presents for the initial intake with their mother. The mother says that the client has had several unexcused absences from school because “he is confused about his gender.” The client adamantly denies being confused and explains that they self-identify as transgender. The client’s preferred pronouns are “they/them.” The client further states that they have had a strong desire to be a different gender since early childhood, and this desire and their distress have recently intensified. The mother reports that the client is chronically irritable, spends a lot of time alone, and has “basically shut everyone out.”The client reports experiencingbullying—both verbal and physical—in school “nearly every day.” In addition to the bullying, the client says that certain teachers refuse to allow them to use the bathroom aligned with their identified gender. To prevent this conflict, the client does not eat breakfast or lunch at school.
Other Contexts:    e  The client’s mother and father are both realtors. The mother states that she used to see a therapist for anxiety, which she now manages with medication. The father works long hours, and the mother returns home early to attend to the client’s needs. The mother states that she realized that the client wished to be another gender when they were younger, but she believed it was just a phase. She explains that the father is not supportive and refuses to discuss the issue. The mother is concerned about the client’s truancy and desires to be supportive but has mixed feelings about it. She says that she is fearful every day and believes that if she accepts the client’s truth, it will set the child up for “a lifetime of prejudice and discrimination

Question: Preventing the client from using a gender-neutral restroom or a restroom that corresponds to their gender identity violates which one of the following?
(A): The First Amendment of the United States Constitution
(B): Title II of the Americans with Disabilities Act (ADA)
(C): The Family Educational Rights and Privacy Act of 1974 (FERPA)
(D): Title IX of the Education Amendments of 1972

Correct Answer: Title IX of the Education Amendments of 1972
Explanation: Title IX of the Education Amendments of 1972 prohibits discrimination based on sex in any federally funded educational program (ie, public schools or state universities). Title IX further defines “sex” to include sexual orientation and gender identity. In 2021, the US Department of Education Office for Civil Rights issued a Title IX Notice of Interpretation, stating that the Department of Education “will enforce Title IX’s prohibition on discrimination based on sex to include: (1) discrimination based on sexual orientation and (2) discrimination based on gender identity” Title IX helps ensure that all students experience equity in education. This protection includes allowing students to use gender-neutral restrooms or a restroom that corresponds to their gender identity. FERPA, also known as the Buckley Amendment, protects the privacy of educational records by giving parents the right to access and, if necessary, amend their child’s academic records. This same right is given to students 18 and older or students of any age entering postsecondary institutions. Students who wish to change their educational records to reflect their gender identity or name change may be entitled to FERPA protections. Counselors must stay up to date on legislation affecting transgender rights and protections because the scope of these protections varies according to state and federal laws. The First Amendment of the United States Constitution protects freedom of speech. Title II of the ADA protects students with disabilities from discrimination or exclusion from events, services, and programs. Students experiencing gender dysphoria may be protected under ADA or Section 504 if they have a qualifying disability; gender dysphoria itself is not a qualifying disability. Therefore, the correct answer is (B)
Competency: professional practice and ethics