Collaboration Reduces Health Disparities Experienced by Guam’s LGBT Youth

Learn how by collaborating with schools and community partners, Guam’s Alternative Lifestyles Association (GALA) educates youth in healthy lifestyles—and promotes a spirit of inclusion.

About the Collaboration

GALA participants at an eventThe island of Guam is a U.S. territory located in the northwest Pacific Ocean. Far west of the International Date Line, the sun hits Guam’s shores long before it reaches the continental U.S.

Visitors are greeted by a warm Hafa Adai! from the Chamorro people, the island’s native residents. “Guam is a very open, loving community,” says Linda Flynn, Supervisor of Prevention and Training at the Guam Behavioral Health and Wellness Center, a SAMHSA Substance Abuse Prevention and Treatment Block Grant recipient. “That is the Chamorro nature—to welcome everybody, to make them feel comfortable, and to address any needs they might have.”

Despite the island’s welcoming culture, members of Guam’s lesbian, gay, bisexual, and transgender (LGBT) community often struggle for acceptance. “Historically, the LGBT community on Guam has been faced with issues of family rejection and discrimination,” says Tim de La Cruz, Executive Director of Guam’s Alternative Lifestyles Association (GALA), a community-based organization dedicated to strengthening the quality of life for LGBT individuals and their families, and a Partnerships for Success 2013 subrecipient.

People who identify as LGBT are particularly at risk for substance use and mental health issues.1 Data from a GALA health survey revealed that nearly half of LGBT respondents over age 18 have smoked cigarettes; more than half drank alcohol; 22 percent misused prescription drugs; 24 percent had used crystal meth; 37 percent had been bullied; and 25 percent told someone they were going to commit suicide.2 “These data tell a story of need—and of pain,” de La Cruz says. “And it shows how disproportionate the behavioral health needs of the LGBT community are on Guam.”

To address these disparities, the Guam Behavioral Health and Wellness Center partnered with GALA to provide a range of behavioral health services to the LGBTQI* community. With additional support from the island’s Department of Education Student Support Services, GALA brings health awareness, substance use prevention, and youth empowerment programs to schools and community centers. Their programming includes Storytelling for Empowerment, an evidence-based substance abuse and suicide prevention curriculum; a health and wellness program; and a Summer Power Camp that includes arts and crafts, physical fitness, and substance abuse and suicide prevention workshops for school-aged youth.

Offering services to all youth in need—not just LGBTQI youth—is at the heart of GALA’s approach. Their slogan—Navigating Life Together—informs all of the work they do. “We don't just work with the individual LGBT person but with their family, their friends, their neighborhood, and the villages that they live in,” de La Cruz says. Empowering youth is at the core of all programming, educating youth on making healthy choices and feeling confident to “live proud” and be themselves.

GALA relies on strong collaboration with a wide range of schools and community partners—including the University of Guam Cooperative Extension Service, the Guam Housing and Urban Renewal Authority, Big Brothers Big Sisters of Guam, victim advocacy services, village mayors, the military, and the Catholic Church—to identify youth who could benefit from their services. These partners also provide space and other supports for GALA to deliver their programming.

But GALA’s collaborative partners do more than host their youth prevention programs. They also provide inroads to the greater Guam community—opening the door to meaningful discussions about substance use, gender identity issues and sexual expression, and the unique risks LGBTQI youth face. “These discussions bring these issues out of the shadows,” says de La Cruz, “and lay the foundation for greater understanding and acceptance.”

Elements of Success

Kids getting onto a school bus

Provide Services to All Youth

GALA is careful not to single out LGBTQI youth in its programming. “We don’t want to add further stigma by having people think that being LGBT means you are associated with substance abuse. We don’t want to be ‘that’s the program for the gay kids,’” de La Cruz says. Instead, GALA offers its programming to any youth who is interested or recommended for services. This approach makes it possible for the organization to engage any students who might benefit from their substance use and suicide prevention programming, while opening a door for students struggling with gender or sexual identity issues. “We help all kids, and then those who identify as LGBT may open up to us,” says de La Cruz.

Opening the programming to all youth also helps GALA better tap the social networks that connect LGBT youth and their straight friends. “The culture in Guam means people like to work in teams and pairs. Having an LGBT person bring a non-LGBT friend to our workshops and activities creates an opportunity for friends to support one another.”

Find Local Champions

GALA relies on local supporters, or “champions,” to help lay the groundwork for their programming. For example, GALA relies on school counselors to help them gain entry into the schools. “Administrators hear that we’re an LGBT organization and assume that their students aren’t interested in what we wanted to teach,” says de la Cruz. “So the school counselors—who are very aware of the substance abuse issues in their schools—help convince their administrators of the relevance of our evidence-based programming to all their students.”

In another community, it was a local mayor who helped GALA get a foothold. “We have a wonderful mayor in my village,” says the Guam Behavioral Health and Wellness Center’s Linda Flynn. “He’s always looking for ways to provide services to people in need and he saw the value of GALA’s programming for at-risk kids in his community.” The mayor helped GALA connect with the Catholic Church, who invited the organization to use their center for an afterschool program. Soon after, the principal of the town’s middle school invited GALA to run a lunchtime program at the school.

Be Willing to Adapt

Establishing a presence in the schools also requires flexibility, both in terms of how and when programming is delivered. GALA is willing to adapt—so long as the changes don’t compromise the programs’ core elements. “GALA staff will deliver programming during homeroom break, at lunch time, or during class time—whatever works for schools’ individual needs,” says de La Cruz. One school wanted to incorporate Storytelling for Empowerment into its freshman English Academy, and another incorporated GALA’s health and wellness program into its health education classes. Two schools embedded workshops on substance use into their discipline program, for students who have been suspended from school. “We were concerned that our programming would be seen as punitive,” de La Cruz says. “So we’ve reframed what we do for them as restorative justice.”

Get Families Involved

GALA is committed to involving families in their prevention work and addressing substance use within families, which can get passed down through the generations. “Family plays a strong role in Guam’s cultural identity, particularly among the native Chamorro, so we tap into the importance of kinship and family ties,” de La Cruz says. “You may be an LGBT youth, but you are also part of a family.” Family members are also often recruited to administer and facilitate workshops in the community. “Some are parents of LGBT children, and some are not,” de La Cruz says. “Involving parents helps us promote acceptance within families and also extends our reach into the community.”

Their involvement also helps GALA gain additional expertise. For example, one parent volunteer is a certified HIV risk reduction specialist at a local recovery center, and another works for the Sexual Assault Response Team at one of the island’s U.S. military bases. “Involving parents helps us leverage additional resources and create a wider network of allies.”

Enlist the Help of New Partners

Guam’s substance misuse prevention leaders have learned to think outside the box when it comes to reducing barriers to GALA program participation. “A lot of our higher-risk youth are in the Micronesian population, living in low-cost housing,” notes Flynn. “In the summer, they are responsible for caring for their younger siblings. And even if they could get away, they needed transportation.” To reduce these barriers, GALA found community centers willing to host the summer camps within the neighborhoods where children lived, so many could just walk to camp. They also brought in adults who perform volunteer work as part of their public housing residency to provide onsite childcare. “There was a big desire for these kids to participate in the workshops,” Flynn says. “GALA does not think, ‘We can’t do this because the kids have barriers.’ Their approach is, ‘How can we overcome those barriers?’”


Guam's Alternative Lifestyle Association LogoSince its partnership with the Guam Behavioral Health and Wellness Center began in 2013, GALA has implemented its programs in one high school and three middle schools, serving northern and central villages. Approximately 350 youth have participated in their community-based Storytelling for Empowerment workshops, and in the 2017–2018 school year alone, 260 youth participated in their school and summer camp programs. Evaluation data from freshmen students at Simon Sanchez High School and Summer Power Camp participants showed increases in knowledge related to substance misuse and other behavioral health issues. “They’ve also gained decision-making and communication skills that help them handle peer pressure,” de La Cruz says.

By establishing a presence in schools and communities, GALA has also educated parents, teachers, school administrators, and other adults on the behavioral health needs of LGBTQI youth, including the increased risk of substance misuse and suicide. And they are bringing LGBTQI issues out into the open, fostering an environment of support and greater acceptance.

“What connects our LGBT communities around the world is we have a shared story of discrimination and oppression,” de La Cruz says. “Empowerment is at the heart of healing that. And it is empowerment that is embodied in what we do and reflected in the ways that we engage LGBT youth, their families, their friends, and their communities.”

For more information, please visit the Guam Behavioral Health and Wellness Center and the Guam Alternative Lifestyles Association (GALA) websites.
*LGBTQI stands for Lesbian, Gay, Bisexual, Transgender, Queer or Questioning, and Intersex.


Behavioral Health Equity: SAMHSA Resources for Lesbian, Gay, Bisexual, and Transgender (LGBT)

Cultural Competency for Understanding and Addressing the Prevention Needs of Lesbian, Gay, Bisexual, Transgender, and Queer/Questioning (LGBTQ) Populations (Archived SAMHSA Webinar)


1. David, A.M., Lapid Rosadino, M.G., and Tydingco, T. (on behalf of the Guam SEOW). (2016). Guam State Epidemiological Profile 2015 Update. Hagatna, Guam: Prevention and Training Branch, Guam Behavioral Health and Wellness Center.

2. de La Cruz, Tim. (2015). GALA, Inc. Needs Assessment Report: A Profile of Substance Abuse Among the LGBT Community on Guam & Tobacco, Alcohol, Other Drug and Suicide Perceived Risk and Protective Factors.

Last Updated: 10/29/2018