Adoption and Implementation of California State Transgender and Nonbinary Protections in Los Angeles Area High Schools

Background: California is a leader in adopting numerous transgender and nonbinary adolescent (TNBA)-protective education policies. However, the adoption and implementation of these policies remain largely unexamined. This study explored local school adoption and implementation of California state TNBA-protective policies. Methods: Nine Los Angeles area high schools enrolled in another study (R01MD016082) participated in this explorative qualitative case study. Case study methods included document collection, campus observations, member checks, and seven student focus group discussions (FGDs; n = 39) between August 2022 and April 2024. Data were analyzed by multiple coders following the Framework Method to compare the implementation of school, district, and state policies. Results: Implementation of name changes, gender-neutral restrooms, private accommodations, and sexual health education varied between schools and districts. While many schools did not meet state mandates to protect TNBA student access to education, others feasibly implemented these policies, and some adopted innovative approaches to protect TNBA. District oversight, publication of policies and facility access, staff training, funding, and infrastructure were key factors in successful implementation. Implications for School Health Policy, Practice, and Equity: Study findings highlight the feasibility of the implementation of TNBA protections in schools, with recommendations to adopt gender transition planning, publish policies for student access, and ensure the availability of gender-neutral restrooms and private accommodations. Conclusions: Implementation of these policies is feasible with sufficient support and oversight. TNBA-protective policies can be strengthened with accountability mechanisms and promotion of implementation strategies, such as technical assistance. Future research should examine the implementation of these policies statewide.