Pioneering LGBT social work: The formation of a new role through practice in institutional contexts

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This study examined how practice-driven processes shape professional role development when serving marginalized communities. Methods : Semi-structured interviews were conducted with 50 current or former LGBT social workers across 49 local authorities (78 % national coverage) between February and September 2024. Data were analyzed thematically. Results : Four themes emerged. (1) From ambiguity to practice-driven design - the absence of clear formal definitions enabled workers to become active architects of their own positions through locally responsive approaches. (2) Active outreach and visibility - institutional denial required continual outreach and visibility work, obliging workers to prove the population’s existence while delivering services. (3) Knowledge translation and brokering - the lack of professional LGBT knowledge transformed workers into institutional knowledge authorities and inter-system coordinators, fostering new professional discourse across municipal departments. (4) Structural factors - client quota systems, part-time allocations, and confidentiality requirements actively shaped role boundaries and functions. Conclusions : Professional roles for marginalized populations develop through practice-driven processes operating across three interconnected dimensions: Role Genesis, System Transformation, and Practice under existential role threat. These dimensions operate simultaneously, compelling workers to construct roles while educating systems and defending their existence. Structured ambiguity, combined with outreach, visibility work, and knowledge brokering, can enable comprehensive institutional innovation. Policy Implications : The Israeli model offers insights for developing responsive services for marginalized communities within mainstream welfare systems and provides policy guidance for creating specialized professional roles serving excluded populations in other national contexts. LGBT social work marginalized populations practice-driven processes professional role development social services Introduction The evolution of professional social work services for the LGBT population has been shaped by gradual shifts in societal understanding of sexual and gender diversity. Despite significant milestones, such as the removal of homosexuality from the DSM in 1973 (Blumenfeld & Raymond, 1988 ), official institutional recognition has not eliminated marginalization. Heteronormative values continue to perpetuate discrimination against LGBT individuals across various life domains (Herek, 2004 ). In Israel, despite the abolition of criminal prohibition on same-sex relations in 1988 (Harel, 2002 ), these patterns persist, affecting schools, workplaces, and family life (Author, 2023 ; Author et al., 2014 ; Author et al., 2008 ). This persistent marginalization creates a complex environment for social service provision, wherein official recognition coexists with ongoing structural and attitudinal barriers. The LGBT community spans all demographic and socioeconomic strata, rendering its members potential clients across the entire spectrum of social services (Cochran et al., 2003 ; Author & Author, 2014 ). Various subgroups within this community face unique challenges that require specialized and tailored responses. Research has revealed significant variations in health risk behaviors across various sexual orientation and gender identity groups, showing that populations traditionally grouped together actually exhibit markedly different risk profiles (Smalley et al., 2016 ). Specifically, transgender individuals frequently encounter institutionalized discrimination stemming from the pathologization of gender variance in medical and psychiatric systems (Bell & Figert, 2010 ; Lee, 2008 ; Hird, 2002 ). Bisexual individuals often experience erasure or invalidation even within ostensibly supportive settings (Author & Author, 2014 ). In Israel, LGBT individuals from religious or conservative backgrounds face particular complexities, especially those from ultra-Orthodox Jewish and Arab communities, who confront challenges of reconciling their LGBT identity with cultural and religious affiliations (Avishai, 2020 ; Goldin & Daas, 2022 ; Author, 2009). Despite this evident need for appropriate services, LGBT individuals often avoid accessing public services due to fears of discrimination (Clark et al., 2001 ; IOM, 2011; Zeeman et al., 2019 ). These fears are well-founded, as multiple studies have revealed significant manifestations of homophobia, heterosexism, and discriminatory professional assessments among social workers in municipal authorities across various countries, including Israel (Andrew et al., 2014 ; Ben-Ari, 2001 ; Breski & Lavie-Ajayi, 2023 ; Fish, 2006 ; Fredriksen-Goldsen et al., 2011 ; Kattari et al., 2017 ; Logie et al., 2007 ; Stotzer et al., 2013 ; Westwood, 2022 ). Such attitudes substantially impair professionals’ ability to provide equitable and appropriate services to sexual and gender minorities. The gap between the complex needs of LGBT populations and the capacity of mainstream services to address them effectively creates a compelling rationale for specialized professional roles. This gap is particularly pronounced in contexts where the welfare system operates in societies characterized by both progressive and traditional elements, as is the case in Israel. LGBT social services in Israel operated primarily through non-governmental organizations, notably the Agudá (the Israeli umbrella association for LGBTs) and the Israeli Gay Youth Organization (IGY), while the state maintained minimal involvement. A shift occurred in 2009 following a tragic shooting at the Tel Aviv LGBT Youth Center (Bar Noar) that claimed two lives and injured many others. This watershed event compelled state authorities to acknowledge their responsibility toward the LGBT community’s welfare needs (Author et al., 2019 ). This recognition culminated in the establishment of a specialized LGBT social worker position in Israeli social services departments in 2017, a globally pioneering initiative. This institutional novelty marked a transition from NGO-based service delivery to direct governmental responsibility through departments of social services (Author, 2020 ). Unlike other countries, where LGBT services remain primarily delivered by NGOs (Andrew et al., 2014 ), the Israeli model integrated LGBT roles directly into mainstream welfare systems. The new model diverged from previous collaborative arrangements between the Welfare and Social Affairs Ministry and LGBT organizations by providing direct treatment through departments of social services, emphasizing community integration and family-oriented approaches (Israeli Ministry of Welfare and Social Affairs, 2017, 2021). The LGBT social worker position was designed to enhance service accessibility and strengthen the professional competence of social workers working with LGBT populations. This role serves lesbian, gay, bisexual, and transgender individuals experiencing risk or distress, as well as their family members. The role was assigned four central responsibilities: identification and outreach, individual and family psycho-social treatment, group therapy, and establishing functional interfaces with relevant NGOs (Israeli Ministry of Welfare and Social Affairs, 2017). The implementation of this role initially focused on youth and young adults (ages 13–25) and was expanded after one year to encompass all age groups through retirement age. Between 2018–2020, the Agudá secured the Ministry’s tender to provide specialized training for newly appointed municipal LGBT social workers while continuing to offer services in municipalities where the position had not yet been established. This arrangement facilitated the transfer of the Agudá’s accumulated professional knowledge and experience to the new position holders in the public system. The Ministry further established professional development by providing specialized training through the Central School for Social Workers. To overcome implementation barriers and incentivize municipal cooperation, the Ministry fully subsidized these positions during the first 18 months of their operation (Israeli Ministry of Welfare and Social Affairs, 2017). In 2021, the Ministry began managing the LGBT social worker program independently. By this time, LGBT social workers were operating in 80 municipalities across Israel, despite the absence of any official requirement from local authorities to offer or fill such positions. The service expanded significantly, providing support to approximately 600 individuals concurrently (Israeli Ministry of Welfare and Social Affairs, 2021). Research has examined role development in related fields, such as implementation challenges of specialist nursing roles that were formally established in hospital settings (Jones, 2005 ). Studies have also explored how existing healthcare professionals navigate role boundaries and jurisdictions through daily practice in complex clinical environments (Caronia & Saglietti, 2018 ). However, these studies focus on roles that operate in established organizational frameworks and existing professional contexts. Research also shows limited empirical understanding of how social work professional characteristics form, particularly in roles focused on marginalized identities (Craig et al., 2017 ; Author & Author, 2024 ). A significant gap exists in understanding how entirely new professional roles develop through daily practice in social work, particularly when serving historically excluded populations that require novel approaches and institutional adaptations. The Israeli model of LGBT social workers, as the first governmental integration of such specialized roles within mainstream welfare systems, offers a distinctive opportunity to understand how practice-driven processes shape professional role development when serving marginalized populations. In light thereof, the current research sought to examine: How does practice shape the role of LGBT social workers, and what are the processes involved in developing and establishing a new role serving a marginalized population in the welfare system? Methods This qualitative study examined role development through semi-structured interviews. The study included 50 social workers who either currently hold or previously held the position of LGBT social worker in one of 49 local authorities (78% coverage). We approached all (80) local authorities with LGBT social worker positions. The main reasons for declining participation included work overload and time constraints, lack of approval from supervisors, concerns about exposure, and lack of interest in the research. Demographically, the sample provided broad geographic diversity, with 40% working in central Israel, 28% in the northern region, 17% in the southern region, and 15% in Jerusalem and environs. This diverse representation enabled a comprehensive exploration of how practice shapes role development across varied community contexts. We prioritized experienced practitioners (over 6 months in the role) when available, approaching former position holders primarily when positions were vacant or held by new workers with limited experience (Patton, 2002 ). Most participants (78%) did not identify as members of the LGBT community, with only 11 identifying as LGBT. Professional experience in the LGBT social worker role varied from a few months to 7 years, with an average tenure of 2.4 years (SD = 1.7). Position allocations varied considerably, ranging from 16–150% of a full-time position, with the majority (69%) holding half-time positions or less. Data collection Data were collected through semi-structured interviews conducted between February and September 2024 (Creswell & Poth, 2018 ; Harrell & Bradley, 2009 ). The interview protocol addressed how participants navigated institutional ambiguity, developed daily practices, established their position within organizations, and built collaborative relationships. Interview questions included: “How did you understand what your role should include?”, “What challenges did you face in establishing your position?” and “Describe your relationship with colleagues in the local authority”. Interviews lasted 60–90 minutes and were conducted in Hebrew via secure video conferencing. All interviews were audio-recorded with participants’ consent and transcribed verbatim for analysis. Data analysis Thematic analysis as per the principles proposed by Braun and Clarke ( 2006 , 2023 ) was applied to the data. This process included familiarization with the data through repeated reading of transcripts, line-by-line coding to identify relevant features, and the development of themes related to how practice shapes role development. Themes were systematically reviewed to ensure coherence and distinctiveness, focusing on how LGBT social workers navigate institutional constraints and contribute to role establishment. To enhance rigor, multiple researchers participated in coding and theme development through regular team meetings (Lincoln & Guba, 1985 ; Patton, 2014 ; Richards & Hemphill, 2018 ). Ethical considerations The study was approved by the Ethics Committee of [authors’ university] and by the Israeli Ministry of Welfare and Social Affairs. Informed consent was obtained before each interview. Given the limited number of LGBT social workers in Israel and the sensitive nature of their work, rigorous confidentiality measures were implemented (Orb et al., 2001 ). All identifying details in quotes were thoroughly anonymized (Vlad & Haaker, 2023 ). Findings Analysis of the interviews revealed four central themes that reflect how the LGBT social worker role was actively constructed through practice. The first three themes describe practice-driven development processes: how role ambiguity enabled workers to become architects of their own positions; how institutional denial led to the development of distinctive outreach and visibility practices as permanent role components; and how the absence of professional knowledge transformed workers into institutional knowledge brokers and discourse creators. The fourth theme shows how structural forces shaped these developments simultaneously, creating specific role configurations and boundaries that defined what the position became. From ambiguity to practice-driven design Most participants reported receiving minimal guidance beyond the role title. Despite the existence of formal Ministry guidelines, workers described being essentially left to interpret and construct their position’s meaning independently. As one participant described: “I think everyone takes it in different directions. There’s a lot of lack of clarity” [Tal]. This gap between official policy and practical implementation created a situation wherein workers became active architects of their own roles. In the absence of detailed operational guidance, role boundaries and content were defined through practice-driven processes that were shaped by various contextual factors. The position’s scope and meaning were constructed through interactions between field needs, institutional responses, local contexts, and individual worker orientations. This process resulted in significant variation across authorities in how the role was defined and structured, as shown below. The analysis found no clear mechanism dictating who is responsible for defining the role, leading to diverse approaches to role construction. In some authorities, social workers developed role definitions and work patterns themselves. This was not necessarily viewed as a shortcoming of the position: “The fact that I had to develop the position actually attracted me more to accept the role, like I’m making my mark and creating, and I have more room for freedom of action” [Lirón]. In some authorities, the role was shaped through collaboration between management and the social worker, as one participant describes: “We learned the subject together [...] so when I started initiating things and receiving clients, my managers already knew what it was about, and it was much easier for me to implement change within the department and propose projects” [Dekel]. Regardless of how role definitions initially emerged, once developed, they became the working framework within each authority. Even when workers could not identify the specific source of their practices, local definitions took hold over time. When authorities subsequently hired additional LGBT social workers, they inherited the established frameworks rather than having to construct their own. As one participant explained: “I think it was both explained to me and I learned it on the go with the previous social worker” [Amít]. This ambiguity in official guidelines created space for multiple factors to shape role definition. Field needs, individual professional orientations, and local contexts all became influential in determining what the position would encompass. Field needs emerged as a particularly influential variable: I realized there were so many confused parents, so I organized ‘How to deal with LGBT youth?’- what discourse to use, how to talk. It was for both professionals and parents. So, in my job I create events, I do events based on field needs. [Nitzán] Several authorities also conducted comprehensive needs assessments prior to role implementation: A good thing at the beginning of the work [...] we did field mapping, to refine our responses a bit, to understand how the community actually looks and what happens within the council. And this really refined the directions we’re going in. [Dorón] Beyond field needs, diverse conceptions of the target population led to the development of various work models. In authorities that defined the role as intended for the entire LGBT population, therapeutic work patterns developed, while in authorities that focused on at-risk LGBT populations, work patterns developed that also included accompaniment, advocacy, and rights uptake: Without money, without a home, you can’t do therapy. This seems basic to me. Most people who come to me are dealing with post-trauma and a large portion have gender dysphoria, so the first thing I do is help them get disability allowance and everything that comes with it. They receive a comprehensive rehabilitation package, housing assistance, and property tax reduction. [Ohád] The flexibility inherent in the role of LGBT social workers enabled them to initiate diverse approaches, including organizing departmental training sessions, supervising students, conducting community outreach with the local LGBT population, and recruiting volunteers. As one participant explained: “It became clear that I couldn’t handle the caseload alone and needed additional support. As I’d already completed a student supervision course... I’ve now been supervising five students for the past two years” [Ohad]. This case illustrates how comprehensive services can emerge organically from identified needs through creative resource utilization. Over approximately six years, what began as a single LGBT social worker position evolved into a full treatment and support center staffed by students and volunteers who provide both clinical services and rights advocacy, all without additional government funding. Notably, several study participants began their careers as students under this supervision program, and now hold LGBT social worker positions across the country. Workers’ own professional preferences were also found to have a central influence in shaping the role: It’s very personal, it’s like my affection for community work. After all, no one told me what to do, and how to establish presence. We even have some kind of division between me and the [other] worker (the second LGBT social worker). She really loves therapeutic work, and I really love both therapy and community work. [Yovál] Finally, LGBT social work carries inherent political implications that significantly shape role development. Local political contexts directly influenced how the position evolves. In municipalities seeking to enhance their progressive credentials, workers developed comprehensive and highly visible programs: “From the council head’s perspective, he wanted to be first place in the ranking [annual ranking of pro-LGBT authorities]” [Hadár]. Conversely, in communities where LGBT issues were contentious, workers adopted more constrained, separated, and discrete approaches: “The population and my role within the service was something we didn’t discuss or highlight [...] they knew my function existed, but I was kept completely separate” [Geffen]. These varying political climates produced markedly differing service models. Without standardized guidelines, the role evolves through localized adaptation processes, with individual social workers actively negotiating and defining their professional boundaries and scope of practice. Active outreach and visibility: Building a role in a contested space LGBT social workers’ role development encountered the need to react to institutional and social denial or minimization of the population’s existence in their local authorities, as described below. Participants were compelled to develop distinctive practices of ‘outreach and visibility’ that became integral to their role definitions. Institutional denial manifested in various ways. In some local authorities, questions were raised about the very need for the position: “When I accepted the role, there were voices asking, ‘Why is she even here? There are no LGBT people here.’” [Ron]. Others demanded concealment and discretion: “We don’t need to say that we have gay people here... and in schools you can talk about it, but no one’s supposed to hear” [Gal], while some expressed opposition through symbolic rejection: “The department head threw all five [pride] flags in the trash” [Zohar]. Such denial and exclusion led outreach, marketing, and visibility practices to become permanent and central components of the role. Outreach and marketing as ongoing practice. Through outreach and marketing, LGBT social workers aimed to accomplish multiple goals. First, they work to establish their role’s legitimacy within the social services. Second, they promote broader acceptance of the LGBT community within the local authority as a way to enhance their wellbeing in the community. Third, they aim to increase the community’s accessibility to social services. In the initial establishment phase, outreach practices involved intensive fieldwork, as one participant described: In the first year, I did extensive fieldwork. First with my department team, then with the municipality staff, health clinic teams, schools, educational staff. The idea was to create space for this... In the first year, I basically created a situation where people knew I was here, so now various calls started coming in. [Reút] Outreach and marketing efforts did not remain a temporary establishment phase. The ongoing need to reinforce the role’s presence in local consciousness manifested both in work with potential clients and in continuous engagement with various departmental and municipal stakeholders to recognize the role’s existence and utilize its services. What began as an initial phase of introduction and promotion evolved into a permanent practice that shapes role boundaries and content. Visibility and institutional navigation. Institutional denial and resistance compelled LGBT social workers to develop an entirely new set of professional capabilities that were not outlined in any official job description. These responses to immediate challenges evolved into permanent role components that fundamentally redefined their professional boundaries. Workers invested considerable effort in establishing institutional presence and displaying LGBT symbols in workplace spaces. They often encountered resistance specifically around visibility rather than around the work itself: People didn’t mind me doing this job, but they had difficulty with my making the role visible, that it needed to be everywhere, with everyone having flags on their desks and everyone needing to speak the language and discourse. [Yovál] Addressing visibility resistance became a significant ongoing role component requiring skills not included in official job descriptions. Workers had to carefully navigate between visibility needs and threats to the role’s very existence: “I won’t challenge them politically... because if I challenge them I might burn bridges, and they’ll simply close the position in a heartbeat” [Gal]. Workers developed sophisticated political instincts and strategic communication skills needed to maintain this delicate balance. Some workers adopted gradual, long-term approaches: “I brought flags and went between departments... initially many didn’t want to take them, but after some social work intervention, about three or four months later, I had distributed almost all the flags to different departments.” [Geffen]. Others developed direct and assertive approaches: “I said ‘listen, I’m a social worker, an LGBT social worker. You can’t tell me what to put in my office’” [Tom]. Strategy selection depended on local context, resistance characteristics, and available resources. Community initiatives evolved from being service delivery tools into strategic institutional positioning. These activities served multiple role-defining purposes simultaneously: demonstrating community existence to skeptical authorities, establishing the social workers’ expertise and relevance, and creating visible proof of demand for services. As one participant described: “A trans health workshop: It was amazing. Twenty-five people came. Trans people and their families... this is a place with fifty thousand residents” [Lirón]. Such events became essential to proving the role’s necessity and defining the LGBT social worker’s place in the institutional hierarchy. Thus, addressing institutional denial transformed from an initial obstacle into a defining feature of the role, requiring LGBT social workers to develop competencies in political navigation, strategic communication, and institutional advocacy. Knowledge translation and brokering: The LGBT social worker as a bridge between worlds The absence of established professional knowledge in welfare systems about LGBT populations positioned LGBT social workers as domain experts within their local authorities. What began as basic needs to explain concepts and bridge communication gaps evolved into comprehensive knowledge brokerage that now defines core aspects of the position. Through this process of becoming institutional knowledge authorities, LGBT social workers found themselves challenging fundamental assumptions about service delivery, professional terminology, and institutional practices. This process of continuous knowledge negotiation transformed them from service providers into institutional change agents, and primary architects of new professional discourse. Creating New Professional Discourse Within Departments. LGBT social workers׳ positioning as domain experts created ongoing demand for guidance from colleagues, gradually transforming knowledge dissemination into a central component of their role definition. What initially began as basic concept introduction evolved into systematic creation of professional discourse: “As part of the meetings I held at the beginning of the role, it was really about introducing myself and also providing some psychoeducation: asking about pronouns when we’re unsure, not defaulting to heterosexual assumptions” [Liron]. LGBT social workers became the professional address for questions and consultations on gender and sexual identity issues: “I see the role as not just accompanying clients, but really being a resource for professionals who can consult, clarify, and understand” [Niv]. This ongoing consultation process deepened their role as discourse shapers within their departments: “From my perspective, part of the LGBT social worker’s role is to instill this discourse within the teams. So teams speak the language, know the population, and know how to ask questions that enable dialogue” [Shira]. These consultations ranged from basic pronoun usage: “When someone came to the unit, staff were reluctant to answer the door because they weren’t sure which pronouns to use” [Hagít], to more complex issues of professional report writing: “A social worker called me and said, ‘I have a non-binary client. How do I write a social report in a gender-neutral way?’” [Mai]. To facilitate these knowledge transfers, the workers developed various approaches. Personal storytelling emerged as a particularly effective: “The approach that helped me most in connecting with them was through personal stories. When I brought stories from my clients, suddenly people could relate to it” [Hilá]. Additionally, some workers initiated structural changes in work processes and professional tools as another avenue for discourse transformation: “I changed the intake form to ‘Parent 1, Parent 2’ instead of ‘mother and father’” [Tomer]. These modifications embedded new professional language into departmental practices and adapted institutional procedures to LGBT realities. The integration of new discourse and tools further established the workers’ expertise and generated additional demand for their knowledge. Regular training and workshops became integral parts of their roles, with these activities continuing to expand over time: “Over the years, it kept developing and improving” [Shira]. For many workers, systemic intervention and discourse change became systematic role components: “I give lectures on LGBT issues in general. Providing training is part of my job” [Ohád]. This expanded recognition reinforced their position as institutional knowledge authorities, creating a self-reinforcing cycle of role development and professional boundary expansion. Municipal LGBT Expertise and Inter-System Navigation. The absence of LGBT expertise across municipal systems, combined with LGBT social workers’ unique positioning as domain authorities, created conditions for role expansion beyond traditional social work boundaries. What began as departmental consultation evolved into city-wide representation of LGBT expertise across all municipal and governmental interfaces. The complex, multi-system needs of LGBT clients revealed gaps in knowledge and appropriate services across municipal departments. LGBT social workers gradually discovered that effective LGBT support required them to function as municipal-wide coordinators rather than departmental specialists. This resulted in their simultaneously navigating across nearly all municipal and governmental systems, from schools, health clinics, military and national service, to social security, rehabilitation services, and residential facilities: “Today I went with my client who was just discharged from the army to a social worker at the health clinic, and we need to initiate the rehabilitation benefits process. And also, youth or adults who are transitioning: Transgender people need to start dealing with social security and everything that comes with it” [Michál]. This extensive inter-system work transformed the workers from departmental social workers into municipal LGBT brokers. As one participant reflected: It’s amazing to be able to mediate between these two places. It’s not exactly a natural connection, but there is... a connection was actually created through my role. I think this is the first position that really connects the municipality with the LGBT community in the city, and in my view, this is truly a mission [Hila] This brokering role required developing expertise in guiding municipal professionals across various systems to work with LGBT populations. Workers frequently found themselves educating healthcare providers and advocating for appropriate treatment: Doctors, psychiatrists, family physicians… take this boy, for example. He belongs to a health clinic. I explained to the mother that she needs to go to a family physician because you can’t go directly to a psychiatrist; you need a referral. And of course, she [the family physician] sent the mother to the regular clinics. Now, sorry, most psychiatrists there... they have one way of thinking: Trans equals mental imbalance. So I fight. I fight for him to be accepted now at [hospital], with Dr. P., who’s an expert in this, and he’ll also receive psychotherapy there. And we’re also advancing appointments at [another hospital] to start receiving hormone blockers. I want him to sit with a psychiatrist who won’t tell him ‘you’re crazy.’ She’ll understand [Ron]. When direct professional education proved insufficient, workers developed alternative pathways for service delivery. Some workers established alternative service channels when direct contact was problematic: “I built strong connections with the schools citywide, especially with guidance counselors. When a counselor had a transgender student, whose family didn’t want welfare involvement, I guided her throughout the year. It was beautiful intervention work.” [Zohar] This expanded systemic connectivity enabled the creation of a comprehensive municipal response tailored to LGBT population needs: “I take into account that those who encounter the community are first of all the settlement workers, or school counselors or teachers, and they all need to know the challenges, what’s appropriate to address, and what to emphasize” [Rotem]. Furthermore, some workers developed direct and regular contact with senior municipal administration levels, which does not ordinarily occur in other social work positions. These relationships enabled them to influence policy and service development at the municipal level: “Once a month we have a regular meeting: me, my team leader, and the deputy mayor who holds the LGBT portfolio. We bring cases from the field and she thinks about services she can develop” [Idó] Thus, the multi-system gap shaped the role, causing it to extend beyond traditional social work boundaries. LGBT social workers evolved into municipal LGBT experts, policy influencers, and inter-system coordinators. These role characteristics emerged from the intersection between traditional systems and representatives of a previously excluded population constructing their professional role. Structural Factors Shaping Role Boundaries and Functions The extensive role development described in the previous themes occurred within structural factors that actively shaped the specific configurations and characteristics that the role developed. The most significant of these shaping forces was the client quota system, a mechanism for budget allocation and activity measurement in the Ministry of Welfare and Social Affairs: “Honestly, they didn’t define how many cases I should have at the beginning. I know they now say 25 cases [for a full-time position]” [Yoval]. The quota system fundamentally shaped role definition by prioritizing measurable individual interventions over community work, as community workshops, training sessions, and institutional consultations did not generate countable client files. This structural mechanism directed the role away from community-oriented work toward more clinical, individual-focused practice that many participants describe today: “I basically only do therapy sessions” [Michal]. Part-time position allocations actively shaped role configurations by compelling workers to prioritize certain aspects while abandoning others. With positions allocated between 16% and 60% of full-time, the role evolved to be selectively focused rather than following the comprehensive approach described earlier. As one participant described: “It’s impossible to have both a large caseload and do community work. It’s simply not feasible given the hours” [Doron]. This constraint carved out roles that were necessarily partial and limited. Similarly, confidentiality requirements fundamentally shaped the role’s scope. Social services procedures require parental consent for treating minors, but for LGBT youth, this created a requirement to come out to parents as a condition for receiving services: “I can’t provide assistance while maintaining confidentiality for a minor. If I can’t maintain confidentiality, then they have no use for me” [Shai]. This constraint created roles that served only openly LGBT youth, excluding closeted and questioning youth who most needed confidential support. These structural factors also shaped roles that inherently required workers to provide services while simultaneously proving their necessity. Workers found themselves caught in a catch 22: They needed to demonstrate sufficient client numbers to justify funding, but the same factors that directed their practice reduced their ability to reach and serve the full population. This created positions where in documenting unmet needs and advocating for visibility became core job functions alongside direct service provision. As one participant experienced: I did extensive outreach, I did what I could with limited resources... I had great ideas for all kinds of programs, but a year later I received notice that I was no longer an LGBT social worker... My manager got word from the council head that she decided that there’s no LGBT population in the authority. No population, therefore no position. [Tom]. Together, these structural factors created a distinct type of professional role: one characterized not only by its therapeutic and community functions, but by the ongoing requirement to demonstrate its own necessity. LGBT social workers thus emerged as positions that combined direct service provision with institutional advocacy, where establishing legitimacy became as central to the role as delivering services to clients. Discussion This study examined how practice shapes the role of LGBT social workers and the processes involved in developing and institutionalizing a new role for a marginalized population within a public welfare system. Analysis of interviews with LGBT social workers from 49 local authorities revealed that role development occurred through active construction processes that were driven by practice. Four central themes emerged, revealing how professional roles for marginalized populations develop through a unique practice-driven process wherein practitioners themselves become active architects of their own professional boundaries and content. This process operates through three interconnected dimensions that emerge from the historical exclusion of LGBT populations and resulting institutional knowledge gaps: (1) Role Genesis – where the absence of frameworks created structured ambiguity that enabled self-construction; (2) System Transformation – where workers evolved from service providers to institutional knowledge authorities, expanding their influence to become inter-institutional brokers; and (3) Practice under existential role threat – where role construction occurs within ongoing struggles for legitimacy in contested institutional space. Role Genesis, the first dimension, demonstrates how the gap between official guidelines and operational reality created space for practice-driven role construction. This builds on the existing understanding of professional discretion (Dworkin, 2013 ; Author & Author, 2024 ; Lipsky, 2010 ) by revealing how practitioners navigate not merely policy adaptation but active role creation when formal frameworks prove insufficient for field realities. LGBT social workers encountered fundamental uncertainty about what their roles should encompass, from target populations and intervention methods to success metrics and professional relationships. This uncertainty created opportunities for workers to construct their professional identities through direct engagement with field needs, developing new practices through trial and response rather than implementing predetermined protocols. While this ambiguity created challenges and inconsistencies, it also enabled locally responsive approaches that required a much broader scope of role construction than traditional discretion, where workers typically adapt existing protocols rather than develop entirely new professional practices. The findings suggest that structured ambiguity, providing broad mission frameworks while leaving operational definition flexible, may be essential to roles serving populations whose needs have been historically excluded from mainstream service design. System Transformation reveals how individual practitioners can drive institutional change across multiple organizational domains simultaneously. This extends institutional work theory (Lawrence & Suddaby, 2006 ) in two key ways: firstly, by demonstrating multi-institutional change processes rather than change within single organizations, and secondly, by showing how workers create new professional discourse and knowledge that penetrate multiple systems concurrently. LGBT social workers’ positioning as “outsiders-within” enabled this transformation, as they functioned both as insiders in social services departments and as LGBT specialists recognized across the municipal authority. This enabled them to cross departmental boundaries and identify coordination gaps that established professionals in each system might not perceive. They became municipal-wide LGBT expertise hubs, educating healthcare providers, school counselors, and government officials while establishing new inter-system coordination mechanisms. They developed and disseminated new professional discourse, concepts, and practices that transformed how multiple departments approach LGBT populations in the local authority. This transformation was facilitated in part through the systematic development of visibility work as a core professional practice. Institutional denial and resistance required LGBT social workers to develop visibility work as a systematic professional practice rather than a temporary establishment phase. This extends institutional work theory by revealing how symbolic interventions become permanent tools for discourse transformation across organizational boundaries. LGBT social workers reported that making LGBT populations visible in municipal spaces served as one of their most immediate and effective tools for initiating dialogue and legitimizing their expertise across multiple departments. Visibility work thus emerged as a core competency for roles serving populations whose existence is contested or denied in institutional settings, thus requiring an ongoing symbolic presence to sustain the broader transformation process. Practice under existential role threat emerged as a defining characteristic of working with populations whose very existence generates public controversy. As the findings revealed, LGBT social workers operated within the constant reality of potential program closure, as their work served communities that are denied or contested in public discourse. This created a professional practice wherein workers had to develop careful navigation strategies and continuously establish the necessity of their roles. The position required living and operating within this tension: providing services while simultaneously proving population need, managing visibility while avoiding backlash, and building legitimacy while facing ongoing institutional resistance. The constant need to justify their existence transformed from an external threat into a core component of role definition, shaping how they approached every aspect of their work. The consistency of this process across 78% of all authorities with LGBT social worker positions suggests that this represents a systematic pattern of professional role development rather than isolated local adaptations. While each authority developed distinct local practices and strategies suited to their specific locale, the underlying dynamics of navigating structured ambiguity, transforming institutional systems, and managing existential role threats emerged consistently across diverse geographic, demographic, and political settings. Implications for Practice and Policy The findings of this study offer practical guidance for developing future professional roles serving marginalized populations in public systems. We believe that role design should embrace “structured ambiguity”, i.e., provide broad mission frameworks while maintaining operational flexibility for local adaptation (Author et al., 2025 ). These roles appear to benefit from clear guidance on core functions such as departmental training and visibility promotion, combined with the explicit expectation that the position will evolve through field learning. Success metrics should recognize systemic work alongside individual interventions, moving beyond traditional caseload measures to include institutional change indicators. Position allocations should anticipate the dual demands of direct service and system transformation, with time explicitly allocated for multi-departmental engagement and knowledge development activities. Workers in these roles require substantial investment in expertise development, as they transition from being service providers to institutional knowledge authorities. Entry-level training should provide both domain-specific knowledge and skills for educating colleagues across multiple systems. Organizations should either develop comprehensive training materials or provide workers with time and resources to create educational content suited to their local contexts. The role inherently demands ongoing learning and knowledge creation, requiring dedicated time for professional development and content preparation beyond traditional social work training. Management at both organizational and ministry levels should recognize that these roles will encounter institutional resistance and backlash as inherent parts of their function. Leadership preparation should include an understanding that workers serving contested populations become focal points for broader societal tensions, requiring specialized support systems. This includes developing clear protocols for responding to complaints or challenges against the position, creating peer support networks that connect workers across different authorities, and ensuring that supervisory staff understand the unique pressures that these roles entail. Regular supervision should address both clinical work and the political navigation skills necessary for institutional survival and effectiveness. Organizations should also develop innovative approaches to confidentiality requirements that often prevent LGBT youth from accessing services without parental disclosure. Traditional social work protocols that require parental consent for treating minors create significant barriers for youth who cannot safely come out to their families. This may require developing alternative service pathways, collaborative arrangements with community organizations, or modified intake procedures that can provide appropriate support while respecting both ethical obligations and safety concerns. Finally, social work curricula should incorporate training on institutional navigation, visibility work, and multi-system coordination to prepare graduates for roles serving marginalized populations that require both direct service and systemic change competencies. Study Limitations and Future Research Directions This study has several limitations that should be considered when interpreting the findings. Firstly, the research relies solely on the perspectives of LGBT social workers themselves, without including the viewpoints of managers, colleagues, or service recipients. Secondly, the study was conducted within the specific context of Israel’s welfare system, which may limit the generalizability of the findings to other national contexts with differing organizational structures and cultural settings. Thirdly, the sample includes only authorities with active LGBT social worker positions, potentially creating selection bias by excluding cases where such roles were attempted but discontinued or failed. Finally, this qualitative study does not provide quantitative measures of role effectiveness or service outcomes. Future research should address these limitations through several directions. Studies examining the institutional effect of LGBT workers’ discourse interventions in welfare systems and municipal authorities would provide valuable insights into systemic change processes. Research focusing on the specific strategies that LGBT social workers employ to navigate the challenges identified in this study could offer practical guidance for role development. Comparative studies examining similar roles that serve marginalized populations in other countries or with other excluded groups would test whether similar patterns emerge. Finally, investigating cases where such positions were discontinued or failed could illuminate critical factors for role sustainability and institutional success. Declarations Funding - This work was supported by the Israel Science Foundation [Grant number: 1201/23]. Conflicts of interest/Competing Interests - The authors declare that they have no financial or non-financial interests that are directly or indirectly related to the work submitted for publication. Availability of data and material - anonymized data are available from the corresponding author upon reasonable request and subject to appropriate ethical approval. Code availability – Not applicable Authors’ Contributions – All authors made substantial, meaningful contributions to the study and manuscript. The first and last authors conceived and designed the study, secured funding, and provided overarching supervision of data collection, data analysis, and the writing process. The second, third, and fourth authors led the data collection and analysis and drafted major sections of the manuscript. Every author participated in the critical revision of the paper for important intellectual content and approved the final version submitted for publication. Ethics Approval - This study was approved by the Ethics Committee of [The authors’] University and by the Israeli Ministry of Welfare and Social Affairs. Consent to Participate - Informed consent was obtained from all individual participants included in the study. Participants were assured that their confidentiality and dignity would be maintained throughout the research process. Consent to Publish - The authors affirm that participants provided informed consent for the publication of anonymized quotes and findings from their interviews. Acknowledgments We gratefully acknowledge the LGBT social workers who enriched this study with their candid insights and unwavering commitment. We also thank the Israeli Ministry of Welfare and Social Affairs for authorising the research and facilitating access to local authorities, support that was indispensable to achieving comprehensive national coverage. References Andrew, B., Gary, G., Scott, B., & Daniel, F. (2014). Human Services for Low-Income and At-risk LGBT Populations: An Assessment of the Knowledge Base and Research Needs (Vol. 79). OPRE Report Number. Avishai, O. (2020). Religious queer people beyond identity conflict: Lessons from orthodox LGBT Jews in Israel. Journal for the Scientific Study of Religion , 59 (2), 360–378. Author, et al. (2008). Title omitted for blind review . Manuscript previously published. 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The LGBT health access project: A state-funded effort to improve access to care. American Journal of Public Health , 91 (6), 895–896. 10.2105/AJPH.91.6.895 Cochran, S. D., Sullivan, J. G., & Mays, V. M. (2003). Prevalence of mental disorders, distress, and mental health services use among lesbian, gay, and bisexual adults in the United States. Journal of Consulting and Clinical Psychology , 71 (1), 53–61. Craig, S. L., Iacono, G., Paceley, M. S., Dentato, M. P., & Boyle, K. E. (2017). Intersecting sexual, gender, and professional identities among social work students: The importance of identity integration. Journal of Social Work Education , 53 (3), 466–479. Creswell, J. W., & Poth, C. N. (2018). Qualitative inquiry and research design: Choosing among five approaches (4th ed.). Sage. Dworkin, R. (2013). Taking rights seriously . A&C Black. Fish, J. (2006). Heterosexism in health and social care . Palgrave. Fredriksen-Goldsen, K. I., Woodford, M. R., Luke, K. P., & Gutierrez, L. (2011). Support of sexual orientation content in social work education. Journal of social work education , 47 (1), 19–35. 10.5175/JSWE.2011.200900018 Goldin, M., & Daas, N. (2022). Action research towards initiating social change for LGBT and sexual and gender minorities. Arab society in Israel: Findings of a national study [in Hebrew]. Research report . The Aguda - Israel LGBTQ Association and The Israeli Institute for Gender and LGBT Research. Harel, A. (2002). The rise and fall of the homosexual legal revolution [in Hebrew]. HaMishpat, 7 , 195–216. Harrell, M. C., & Bradley, M. A. (2009). Data collection methods: Semi-structured interviews and focus groups (RAND Technical Report No. TR-718). RAND Corporation. https://doi.org/10.7249/TR718 Herek, G. M. (2004). Beyond homophobia: Thinking about sexual prejudice and stigma in the twenty-one century. Sexual Research and Social Policy , 1 (2), 6–24. Hird, M. J. (2002). Out/Performing Our Selves: Invitation for Dialogue. Sexualities , 5 (3), 337–356. Institute of Medicine (IOM) Committee on Lesbian, Gay, Bisexual, and Transgender Health Issues and Research Gaps and Opportunities (2011). The health of lesbian, gay, bisexual, and transgender people: Building a foundation for better understanding . National Academies Press https://www.ncbi.nlm.nih.gov/pubmed/22013611 Israeli Ministry of Welfare and Social Affairs (2017, September 10). Implementation of ‘LGBT circle’ - A model for treating the LGBT population in local authorities [In Hebrew]. Letter to directors of social services departments. Israeli Ministry of Welfare and Social Affairs (2021, February 16). Support programs for the LGBT community [In Hebrew]. https://www.gov.il/he/departments/guides/molsa-lgbt Jones, M. L. (2005). Role development and effective practice in specialist and advanced practice roles in acute hospital settings: systematic review and meta-synthesis. Journal of advanced nursing , 49 (2), 191–209. Kattari, S. K., Walls, N. E., Whitfield, D. L., & Langenderfer Magruder, L. (2017). Racial and ethnic differences in experiences of discrimination in accessing social services among transgender/gender-nonconforming people. Journal of Ethnic & Cultural Diversity in Social Work , 26 (3), 217–235. Lawrence, T. B., & Suddaby, R. (2006). 1.6 institutions and institutional work . The Sage handbook of organization studies. Lee, A. (2008). Trans Models in Prison: The Medicalization of Gender Identity and the Eighth Amendment Right to Sex Reassignment Therapy. Harvard Journal of Law & Gender (31), 447–471. Lincoln, Y. S., & Guba, E. G. (1985). Naturalistic inquiry . Sage. Lipsky, M. (2010). Street-level bureaucracy: Dilemmas of the individual in public service . Russell sage foundation. Logie, C., Bridge, T. J., & Bridge, P. D. (2007). Evaluating the phobias, attitudes, and cultural competence of Master of Social Work Students toward the LGBT populations. Journal of homosexuality , 53 (4), 201–222. 10.1080/00918360802103472 Orb, A., Eisenhauer, L., & Wynaden, D. (2001). Ethics in qualitative research. Journal of nursing scholarship , 33 (1), 93–96. Patton, M. Q. (2002). Qualitative research and evaluation methods (3rd ed.). Sage. Patton, M. Q. (2014). Qualitative research & evaluation methods: Integrating theory and practice . Sage. Richards, K. A. R., & Hemphill, M. A. (2018). A practical guide to collaborative qualitative data analysis. Journal of Teaching in Physical education , 37 (2), 225–231. Smalley, K. B., Warren, J. C., & Barefoot, K. N. (2016). Differences in health risk behaviors across understudied LGBT subgroups. Health Psychology , 35 (2), 103. Stotzer, R. L., Silverschanz, P., & Wilson, A. (2013). Gender identity and social services: Barriers to care. Journal of Social Service Research , 39 (1), 63–77. Vlad, A., & Haaker, M. (2023). How to Anonymise Qualitative and Quantitative Data . UKData Service. Retrieved from https://ukdataservice.ac.uk/app/uploads/howtoanonymisequalandquantdata2023-06 - 15.pdf​. Westwood, S. (2022). Religious-based negative attitudes towards LGBTQ people among healthcare, social care, and social work students and professionals: A review of the international literature. Health & Social Care in the Community , 30 (5), e1449–e1470. Zeeman, L., Sherriff, N., Browne, K., McGlynn, N., Mirandola, M., Gios, L., Davis, R., Sanchez-Lambert, J., Aujean, S., Pinto, N., Farinella, F., Donisi, V., Niedźwiedzka-Stadnik, M., Rosińska, M., Pierson, A., Amaddeo, F., Taibjee, R., Toskin, I., Jonas, K., & De Sutter, P. (2019). A review of lesbian, gay, bisexual, trans, and intersex (LGBTI) health and healthcare inequalities. European Journal of Public Health , 29 (5), 974–980. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7232441","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":492820579,"identity":"fd5847db-678e-4051-a473-c78b877078b6","order_by":0,"name":"Guy Shilo","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABBklEQVRIiWNgGAWjYDACCcbGAyCaH11cBo+WBrAWyTYoHybOg1sLAwNYi8ExVC0MOLXIz25uOPDh1+HEzfebn0l8bGOo45+RwPjhB4MFTi0Gdw42HJzZdzhx2zE2M8kZZxgkJG4kMEv24HGYgURiw2HeHpAWBjNpngqgw24kMEjj84v8DKiWzW3s36T/GDBIyANt+Y3X+zeAWnh+HE7cwMZjJs0AtMXgRgIbXlsMgFoOzmxIN55xLKfYsueMhOTGMw/bLHsM8Dks/eGDD3+sZfubj2+88bPNhl/uePLhGz8q6uRwOgwEGNsYHBsgTFC0MALZBng1AMEfBntCSkbBKBgFo2AEAwA3O1bTjDi3wgAAAABJRU5ErkJggg==","orcid":"","institution":"Tel Aviv University","correspondingAuthor":true,"prefix":"","firstName":"Guy","middleName":"","lastName":"Shilo","suffix":""},{"id":492820580,"identity":"a13659d3-bd51-4a09-a464-6f304619593f","order_by":1,"name":"Nataly Mor","email":"","orcid":"","institution":"Tel Aviv University","correspondingAuthor":false,"prefix":"","firstName":"Nataly","middleName":"","lastName":"Mor","suffix":""},{"id":492820581,"identity":"010efa47-ca09-4463-9b71-e3910d1d4aa1","order_by":2,"name":"Gal Hadad-Aviran","email":"","orcid":"","institution":"Tel Aviv University","correspondingAuthor":false,"prefix":"","firstName":"Gal","middleName":"","lastName":"Hadad-Aviran","suffix":""},{"id":492820582,"identity":"3c25571b-9ddb-49b8-92e0-e0b003039d8f","order_by":3,"name":"Noah Bar Goshen","email":"","orcid":"","institution":"Tel Aviv University","correspondingAuthor":false,"prefix":"","firstName":"Noah","middleName":"Bar","lastName":"Goshen","suffix":""},{"id":492820583,"identity":"bb340d14-4641-4e40-9138-2e5802b992c0","order_by":4,"name":"Lia Levin","email":"","orcid":"","institution":"Tel Aviv University","correspondingAuthor":false,"prefix":"","firstName":"Lia","middleName":"","lastName":"Levin","suffix":""}],"badges":[],"createdAt":"2025-07-28 09:53:30","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7232441/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7232441/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1080/00918369.2025.2610506","type":"published","date":"2026-02-03T00:00:00+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":102228749,"identity":"646d3c7c-36fb-4e89-a192-ece37fee1efc","added_by":"auto","created_at":"2026-02-09 15:10:41","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":775121,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7232441/v1/eae4901c-95c5-4375-aac2-3dc0f64757c7.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Pioneering LGBT social work: The formation of a new role through practice in institutional contexts","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe evolution of professional social work services for the LGBT population has been shaped by gradual shifts in societal understanding of sexual and gender diversity. Despite significant milestones, such as the removal of homosexuality from the DSM in 1973 (Blumenfeld \u0026amp; Raymond, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e1988\u003c/span\u003e), official institutional recognition has not eliminated marginalization. Heteronormative values continue to perpetuate discrimination against LGBT individuals across various life domains (Herek, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2004\u003c/span\u003e). In Israel, despite the abolition of criminal prohibition on same-sex relations in 1988 (Harel, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2002\u003c/span\u003e), these patterns persist, affecting schools, workplaces, and family life (Author, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Author et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; Author et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2008\u003c/span\u003e). This persistent marginalization creates a complex environment for social service provision, wherein official recognition coexists with ongoing structural and attitudinal barriers.\u003c/p\u003e\u003cp\u003eThe LGBT community spans all demographic and socioeconomic strata, rendering its members potential clients across the entire spectrum of social services (Cochran et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2003\u003c/span\u003e; Author \u0026amp; Author, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). Various subgroups within this community face unique challenges that require specialized and tailored responses. Research has revealed significant variations in health risk behaviors across various sexual orientation and gender identity groups, showing that populations traditionally grouped together actually exhibit markedly different risk profiles (Smalley et al., \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). Specifically, transgender individuals frequently encounter institutionalized discrimination stemming from the pathologization of gender variance in medical and psychiatric systems (Bell \u0026amp; Figert, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2010\u003c/span\u003e; Lee, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2008\u003c/span\u003e; Hird, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2002\u003c/span\u003e). Bisexual individuals often experience erasure or invalidation even within ostensibly supportive settings (Author \u0026amp; Author, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). In Israel, LGBT individuals from religious or conservative backgrounds face particular complexities, especially those from ultra-Orthodox Jewish and Arab communities, who confront challenges of reconciling their LGBT identity with cultural and religious affiliations (Avishai, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Goldin \u0026amp; Daas, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Author, 2009).\u003c/p\u003e\u003cp\u003eDespite this evident need for appropriate services, LGBT individuals often avoid accessing public services due to fears of discrimination (Clark et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2001\u003c/span\u003e; IOM, 2011; Zeeman et al., \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). These fears are well-founded, as multiple studies have revealed significant manifestations of homophobia, heterosexism, and discriminatory professional assessments among social workers in municipal authorities across various countries, including Israel (Andrew et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; Ben-Ari, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2001\u003c/span\u003e; Breski \u0026amp; Lavie-Ajayi, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Fish, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2006\u003c/span\u003e; Fredriksen-Goldsen et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2011\u003c/span\u003e; Kattari et al., \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Logie et al., \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2007\u003c/span\u003e; Stotzer et al., \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Westwood, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Such attitudes substantially impair professionals\u0026rsquo; ability to provide equitable and appropriate services to sexual and gender minorities. The gap between the complex needs of LGBT populations and the capacity of mainstream services to address them effectively creates a compelling rationale for specialized professional roles. This gap is particularly pronounced in contexts where the welfare system operates in societies characterized by both progressive and traditional elements, as is the case in Israel.\u003c/p\u003e\u003cp\u003eLGBT social services in Israel operated primarily through non-governmental organizations, notably the Agud\u0026aacute; (the Israeli umbrella association for LGBTs) and the Israeli Gay Youth Organization (IGY), while the state maintained minimal involvement. A shift occurred in 2009 following a tragic shooting at the Tel Aviv LGBT Youth Center (Bar Noar) that claimed two lives and injured many others. This watershed event compelled state authorities to acknowledge their responsibility toward the LGBT community\u0026rsquo;s welfare needs (Author et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). This recognition culminated in the establishment of a specialized LGBT social worker position in Israeli social services departments in 2017, a globally pioneering initiative.\u003c/p\u003e\u003cp\u003eThis institutional novelty marked a transition from NGO-based service delivery to direct governmental responsibility through departments of social services (Author, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Unlike other countries, where LGBT services remain primarily delivered by NGOs (Andrew et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2014\u003c/span\u003e), the Israeli model integrated LGBT roles directly into mainstream welfare systems. The new model diverged from previous collaborative arrangements between the Welfare and Social Affairs Ministry and LGBT organizations by providing direct treatment through departments of social services, emphasizing community integration and family-oriented approaches (Israeli Ministry of Welfare and Social Affairs, 2017, 2021).\u003c/p\u003e\u003cp\u003eThe LGBT social worker position was designed to enhance service accessibility and strengthen the professional competence of social workers working with LGBT populations. This role serves lesbian, gay, bisexual, and transgender individuals experiencing risk or distress, as well as their family members. The role was assigned four central responsibilities: identification and outreach, individual and family psycho-social treatment, group therapy, and establishing functional interfaces with relevant NGOs (Israeli Ministry of Welfare and Social Affairs, 2017).\u003c/p\u003e\u003cp\u003eThe implementation of this role initially focused on youth and young adults (ages 13\u0026ndash;25) and was expanded after one year to encompass all age groups through retirement age. Between 2018\u0026ndash;2020, the Agud\u0026aacute; secured the Ministry\u0026rsquo;s tender to provide specialized training for newly appointed municipal LGBT social workers while continuing to offer services in municipalities where the position had not yet been established. This arrangement facilitated the transfer of the Agud\u0026aacute;\u0026rsquo;s accumulated professional knowledge and experience to the new position holders in the public system. The Ministry further established professional development by providing specialized training through the Central School for Social Workers. To overcome implementation barriers and incentivize municipal cooperation, the Ministry fully subsidized these positions during the first 18 months of their operation (Israeli Ministry of Welfare and Social Affairs, 2017).\u003c/p\u003e\u003cp\u003eIn 2021, the Ministry began managing the LGBT social worker program independently. By this time, LGBT social workers were operating in 80 municipalities across Israel, despite the absence of any official requirement from local authorities to offer or fill such positions. The service expanded significantly, providing support to approximately 600 individuals concurrently (Israeli Ministry of Welfare and Social Affairs, 2021).\u003c/p\u003e\u003cp\u003eResearch has examined role development in related fields, such as implementation challenges of specialist nursing roles that were formally established in hospital settings (Jones, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2005\u003c/span\u003e). Studies have also explored how existing healthcare professionals navigate role boundaries and jurisdictions through daily practice in complex clinical environments (Caronia \u0026amp; Saglietti, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). However, these studies focus on roles that operate in established organizational frameworks and existing professional contexts. Research also shows limited empirical understanding of how social work professional characteristics form, particularly in roles focused on marginalized identities (Craig et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Author \u0026amp; Author, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). A significant gap exists in understanding how entirely new professional roles develop through daily practice in social work, particularly when serving historically excluded populations that require novel approaches and institutional adaptations. The Israeli model of LGBT social workers, as the first governmental integration of such specialized roles within mainstream welfare systems, offers a distinctive opportunity to understand how practice-driven processes shape professional role development when serving marginalized populations.\u003c/p\u003e\u003cp\u003eIn light thereof, the current research sought to examine: How does practice shape the role of LGBT social workers, and what are the processes involved in developing and establishing a new role serving a marginalized population in the welfare system?\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis qualitative study examined role development through semi-structured interviews. The study included 50 social workers who either currently hold or previously held the position of LGBT social worker in one of 49 local authorities (78% coverage). We approached all (80) local authorities with LGBT social worker positions. The main reasons for declining participation included work overload and time constraints, lack of approval from supervisors, concerns about exposure, and lack of interest in the research.\u003c/p\u003e\u003cp\u003eDemographically, the sample provided broad geographic diversity, with 40% working in central Israel, 28% in the northern region, 17% in the southern region, and 15% in Jerusalem and environs. This diverse representation enabled a comprehensive exploration of how practice shapes role development across varied community contexts. We prioritized experienced practitioners (over 6 months in the role) when available, approaching former position holders primarily when positions were vacant or held by new workers with limited experience (Patton, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2002\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eMost participants (78%) did not identify as members of the LGBT community, with only 11 identifying as LGBT. Professional experience in the LGBT social worker role varied from a few months to 7 years, with an average tenure of 2.4 years (SD\u0026thinsp;=\u0026thinsp;1.7). Position allocations varied considerably, ranging from 16\u0026ndash;150% of a full-time position, with the majority (69%) holding half-time positions or less.\u003c/p\u003e\u003cp\u003e\u003cb\u003eData collection\u003c/b\u003e\u003c/p\u003e\u003cp\u003eData were collected through semi-structured interviews conducted between February and September 2024 (Creswell \u0026amp; Poth, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Harrell \u0026amp; Bradley, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2009\u003c/span\u003e). The interview protocol addressed how participants navigated institutional ambiguity, developed daily practices, established their position within organizations, and built collaborative relationships. Interview questions included: \u0026ldquo;How did you understand what your role should include?\u0026rdquo;, \u0026ldquo;What challenges did you face in establishing your position?\u0026rdquo; and \u0026ldquo;Describe your relationship with colleagues in the local authority\u0026rdquo;. Interviews lasted 60\u0026ndash;90 minutes and were conducted in Hebrew via secure video conferencing. All interviews were audio-recorded with participants\u0026rsquo; consent and transcribed verbatim for analysis.\u003c/p\u003e\u003cdiv id=\"Sec2\" class=\"Section2\"\u003e\u003ch2\u003eData analysis\u003c/h2\u003e\u003cp\u003eThematic analysis as per the principles proposed by Braun and Clarke (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2006\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) was applied to the data. This process included familiarization with the data through repeated reading of transcripts, line-by-line coding to identify relevant features, and the development of themes related to how practice shapes role development. Themes were systematically reviewed to ensure coherence and distinctiveness, focusing on how LGBT social workers navigate institutional constraints and contribute to role establishment. To enhance rigor, multiple researchers participated in coding and theme development through regular team meetings (Lincoln \u0026amp; Guba, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e1985\u003c/span\u003e; Patton, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; Richards \u0026amp; Hemphill, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cb\u003eEthical considerations\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe study was approved by the Ethics Committee of [authors\u0026rsquo; university] and by the Israeli Ministry of Welfare and Social Affairs. Informed consent was obtained before each interview. Given the limited number of LGBT social workers in Israel and the sensitive nature of their work, rigorous confidentiality measures were implemented (Orb et al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2001\u003c/span\u003e). All identifying details in quotes were thoroughly anonymized (Vlad \u0026amp; Haaker, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e"},{"header":"Findings","content":"\u003cp\u003eAnalysis of the interviews revealed four central themes that reflect how the LGBT social worker role was actively constructed through practice. The first three themes describe practice-driven development processes: how role ambiguity enabled workers to become architects of their own positions; how institutional denial led to the development of distinctive outreach and visibility practices as permanent role components; and how the absence of professional knowledge transformed workers into institutional knowledge brokers and discourse creators. The fourth theme shows how structural forces shaped these developments simultaneously, creating specific role configurations and boundaries that defined what the position became.\u003c/p\u003e\u003cp\u003e\u003cb\u003eFrom ambiguity to practice-driven design\u003c/b\u003e\u003c/p\u003e\u003cp\u003eMost participants reported receiving minimal guidance beyond the role title. Despite the existence of formal Ministry guidelines, workers described being essentially left to interpret and construct their position\u0026rsquo;s meaning independently. As one participant described: \u003cem\u003e\u0026ldquo;I think everyone takes it in different directions. There\u0026rsquo;s a lot of lack of clarity\u0026rdquo;\u003c/em\u003e [Tal]. This gap between official policy and practical implementation created a situation wherein workers became active architects of their own roles.\u003c/p\u003e\u003cp\u003eIn the absence of detailed operational guidance, role boundaries and content were defined through practice-driven processes that were shaped by various contextual factors. The position\u0026rsquo;s scope and meaning were constructed through interactions between field needs, institutional responses, local contexts, and individual worker orientations. This process resulted in significant variation across authorities in how the role was defined and structured, as shown below.\u003c/p\u003e\u003cp\u003eThe analysis found no clear mechanism dictating who is responsible for defining the role, leading to diverse approaches to role construction. In some authorities, social workers developed role definitions and work patterns themselves. This was not necessarily viewed as a shortcoming of the position: \u003cem\u003e\u0026ldquo;The fact that I had to develop the position actually attracted me more to accept the role, like I\u0026rsquo;m making my mark and creating, and I have more room for freedom of action\u0026rdquo;\u003c/em\u003e [Lir\u0026oacute;n]. In some authorities, the role was shaped through collaboration between management and the social worker, as one participant describes: \u003cem\u003e\u0026ldquo;We learned the subject together [...] so when I started initiating things and receiving clients, my managers already knew what it was about, and it was much easier for me to implement change within the department and propose projects\u0026rdquo;\u003c/em\u003e [Dekel].\u003c/p\u003e\u003cp\u003eRegardless of how role definitions initially emerged, once developed, they became the working framework within each authority. Even when workers could not identify the specific source of their practices, local definitions took hold over time. When authorities subsequently hired additional LGBT social workers, they inherited the established frameworks rather than having to construct their own. As one participant explained: \u003cem\u003e\u0026ldquo;I think it was both explained to me and I learned it on the go with the previous social worker\u0026rdquo;\u003c/em\u003e [Am\u0026iacute;t].\u003c/p\u003e\u003cp\u003eThis ambiguity in official guidelines created space for multiple factors to shape role definition. Field needs, individual professional orientations, and local contexts all became influential in determining what the position would encompass. Field needs emerged as a particularly influential variable:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eI realized there were so many confused parents, so I organized \u0026lsquo;How to deal with LGBT youth?\u0026rsquo;- what discourse to use, how to talk. It was for both professionals and parents. So, in my job I create events, I do events based on field needs. [Nitz\u0026aacute;n]\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eSeveral authorities also conducted comprehensive needs assessments prior to role implementation:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eA good thing at the beginning of the work [...] we did field mapping, to refine our responses a bit, to understand how the community actually looks and what happens within the council. And this really refined the directions we\u0026rsquo;re going in. [Dor\u0026oacute;n]\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eBeyond field needs, diverse conceptions of the target population led to the development of various work models. In authorities that defined the role as intended for the entire LGBT population, therapeutic work patterns developed, while in authorities that focused on at-risk LGBT populations, work patterns developed that also included accompaniment, advocacy, and rights uptake:\u003c/p\u003e\u003cp\u003eWithout money, without a home, you can\u0026rsquo;t do therapy. This seems basic to me. Most people who come to me are dealing with post-trauma and a large portion have gender dysphoria, so the first thing I do is help them get disability allowance and everything that comes with it. They receive a comprehensive rehabilitation package, housing assistance, and property tax reduction. [Oh\u0026aacute;d]\u003c/p\u003e\u003cp\u003eThe flexibility inherent in the role of LGBT social workers enabled them to initiate diverse approaches, including organizing departmental training sessions, supervising students, conducting community outreach with the local LGBT population, and recruiting volunteers. As one participant explained: \u003cem\u003e\u0026ldquo;It became clear that I couldn\u0026rsquo;t handle the caseload alone and needed additional support. As I\u0026rsquo;d already completed a student supervision course... I\u0026rsquo;ve now been supervising five students for the past two years\u0026rdquo;\u003c/em\u003e [Ohad].\u003c/p\u003e\u003cp\u003eThis case illustrates how comprehensive services can emerge organically from identified needs through creative resource utilization. Over approximately six years, what began as a single LGBT social worker position evolved into a full treatment and support center staffed by students and volunteers who provide both clinical services and rights advocacy, all without additional government funding. Notably, several study participants began their careers as students under this supervision program, and now hold LGBT social worker positions across the country.\u003c/p\u003e\u003cp\u003eWorkers\u0026rsquo; own professional preferences were also found to have a central influence in shaping the role:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eIt\u0026rsquo;s very personal, it\u0026rsquo;s like my affection for community work. After all, no one told me what to do, and how to establish presence. We even have some kind of division between me and the [other] worker (the second LGBT social worker). She really loves therapeutic work, and I really love both therapy and community work. [Yov\u0026aacute;l]\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eFinally, LGBT social work carries inherent political implications that significantly shape role development. Local political contexts directly influenced how the position evolves. In municipalities seeking to enhance their progressive credentials, workers developed comprehensive and highly visible programs: \u003cem\u003e\u0026ldquo;From the council head\u0026rsquo;s perspective, he wanted to be first place in the ranking [annual ranking of pro-LGBT authorities]\u0026rdquo;\u003c/em\u003e [Had\u0026aacute;r]. Conversely, in communities where LGBT issues were contentious, workers adopted more constrained, separated, and discrete approaches: \u003cem\u003e\u0026ldquo;The population and my role within the service was something we didn\u0026rsquo;t discuss or highlight [...] they knew my function existed, but I was kept completely separate\u0026rdquo;\u003c/em\u003e [Geffen]. These varying political climates produced markedly differing service models. Without standardized guidelines, the role evolves through localized adaptation processes, with individual social workers actively negotiating and defining their professional boundaries and scope of practice.\u003c/p\u003e\u003cp\u003e\u003cb\u003eActive outreach and visibility: Building a role in a contested space\u003c/b\u003e\u003c/p\u003e\u003cp\u003eLGBT social workers\u0026rsquo; role development encountered the need to react to institutional and social denial or minimization of the population\u0026rsquo;s existence in their local authorities, as described below. Participants were compelled to develop distinctive practices of \u0026lsquo;outreach and visibility\u0026rsquo; that became integral to their role definitions.\u003c/p\u003e\u003cp\u003eInstitutional denial manifested in various ways. In some local authorities, questions were raised about the very need for the position: \u003cem\u003e\u0026ldquo;When I accepted the role, there were voices asking, \u0026lsquo;Why is she even here? There are no LGBT people here.\u0026rsquo;\u0026rdquo;\u003c/em\u003e [Ron]. Others demanded concealment and discretion: \u003cem\u003e\u0026ldquo;We don\u0026rsquo;t need to say that we have gay people here... and in schools you can talk about it, but no one\u0026rsquo;s supposed to hear\u0026rdquo;\u003c/em\u003e [Gal], while some expressed opposition through symbolic rejection: \u003cem\u003e\u0026ldquo;The department head threw all five [pride] flags in the trash\u0026rdquo;\u003c/em\u003e [Zohar]. Such denial and exclusion led outreach, marketing, and visibility practices to become permanent and central components of the role.\u003c/p\u003e\u003cp\u003e\u003cb\u003eOutreach and marketing as ongoing practice.\u003c/b\u003e Through outreach and marketing, LGBT social workers aimed to accomplish multiple goals. First, they work to establish their role\u0026rsquo;s legitimacy within the social services. Second, they promote broader acceptance of the LGBT community within the local authority as a way to enhance their wellbeing in the community. Third, they aim to increase the community\u0026rsquo;s accessibility to social services. In the initial establishment phase, outreach practices involved intensive fieldwork, as one participant described:\u003c/p\u003e\u003cp\u003eIn the first year, I did extensive fieldwork. First with my department team, then with the municipality staff, health clinic teams, schools, educational staff. The idea was to create space for this... In the first year, I basically created a situation where people knew I was here, so now various calls started coming in. [Re\u0026uacute;t]\u003c/p\u003e\u003cp\u003eOutreach and marketing efforts did not remain a temporary establishment phase. The ongoing need to reinforce the role\u0026rsquo;s presence in local consciousness manifested both in work with potential clients and in continuous engagement with various departmental and municipal stakeholders to recognize the role\u0026rsquo;s existence and utilize its services. What began as an initial phase of introduction and promotion evolved into a permanent practice that shapes role boundaries and content.\u003c/p\u003e\u003cp\u003e\u003cb\u003eVisibility and institutional navigation.\u003c/b\u003e Institutional denial and resistance compelled LGBT social workers to develop an entirely new set of professional capabilities that were not outlined in any official job description. These responses to immediate challenges evolved into permanent role components that fundamentally redefined their professional boundaries. Workers invested considerable effort in establishing institutional presence and displaying LGBT symbols in workplace spaces. They often encountered resistance specifically around visibility rather than around the work itself:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003ePeople didn\u0026rsquo;t mind me doing this job, but they had difficulty with my making the role visible, that it needed to be everywhere, with everyone having flags on their desks and everyone needing to speak the language and discourse. [Yov\u0026aacute;l]\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAddressing visibility resistance became a significant ongoing role component requiring skills not included in official job descriptions. Workers had to carefully navigate between visibility needs and threats to the role\u0026rsquo;s very existence: \u003cem\u003e\u0026ldquo;I won\u0026rsquo;t challenge them politically... because if I challenge them I might burn bridges, and they\u0026rsquo;ll simply close the position in a heartbeat\u0026rdquo;\u003c/em\u003e [Gal]. Workers developed sophisticated political instincts and strategic communication skills needed to maintain this delicate balance. Some workers adopted gradual, long-term approaches: \u003cem\u003e\u0026ldquo;I brought flags and went between departments... initially many didn\u0026rsquo;t want to take them, but after some social work intervention, about three or four months later, I had distributed almost all the flags to different departments.\u0026rdquo;\u003c/em\u003e [Geffen]. Others developed direct and assertive approaches: \u003cem\u003e\u0026ldquo;I said \u0026lsquo;listen, I\u0026rsquo;m a social worker, an LGBT social worker. You can\u0026rsquo;t tell me what to put in my office\u0026rsquo;\u0026rdquo;\u003c/em\u003e [Tom]. Strategy selection depended on local context, resistance characteristics, and available resources.\u003c/p\u003e\u003cp\u003eCommunity initiatives evolved from being service delivery tools into strategic institutional positioning. These activities served multiple role-defining purposes simultaneously: demonstrating community existence to skeptical authorities, establishing the social workers\u0026rsquo; expertise and relevance, and creating visible proof of demand for services. As one participant described: \u003cem\u003e\u0026ldquo;A trans health workshop: It was amazing. Twenty-five people came. Trans people and their families... this is a place with fifty thousand residents\u0026rdquo;\u003c/em\u003e [Lir\u0026oacute;n]. Such events became essential to proving the role\u0026rsquo;s necessity and defining the LGBT social worker\u0026rsquo;s place in the institutional hierarchy.\u003c/p\u003e\u003cp\u003eThus, addressing institutional denial transformed from an initial obstacle into a defining feature of the role, requiring LGBT social workers to develop competencies in political navigation, strategic communication, and institutional advocacy.\u003c/p\u003e\u003cp\u003e\u003cb\u003eKnowledge translation and brokering: The LGBT social worker as a bridge between worlds\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe absence of established professional knowledge in welfare systems about LGBT populations positioned LGBT social workers as domain experts within their local authorities. What began as basic needs to explain concepts and bridge communication gaps evolved into comprehensive knowledge brokerage that now defines core aspects of the position. Through this process of becoming institutional knowledge authorities, LGBT social workers found themselves challenging fundamental assumptions about service delivery, professional terminology, and institutional practices. This process of continuous knowledge negotiation transformed them from service providers into institutional change agents, and primary architects of new professional discourse.\u003c/p\u003e\u003cp\u003e\u003cb\u003eCreating New Professional Discourse Within Departments.\u003c/b\u003e LGBT social workers׳ positioning as domain experts created ongoing demand for guidance from colleagues, gradually transforming knowledge dissemination into a central component of their role definition. What initially began as basic concept introduction evolved into systematic creation of professional discourse: \u003cem\u003e\u0026ldquo;As part of the meetings I held at the beginning of the role, it was really about introducing myself and also providing some psychoeducation: asking about pronouns when we\u0026rsquo;re unsure, not defaulting to heterosexual assumptions\u0026rdquo;\u003c/em\u003e [Liron]. LGBT social workers became the professional address for questions and consultations on gender and sexual identity issues: \u003cem\u003e\u0026ldquo;I see the role as not just accompanying clients, but really being a resource for professionals who can consult, clarify, and understand\u0026rdquo;\u003c/em\u003e [Niv].\u003c/p\u003e\u003cp\u003eThis ongoing consultation process deepened their role as discourse shapers within their departments: \u003cem\u003e\u0026ldquo;From my perspective, part of the LGBT social worker\u0026rsquo;s role is to instill this discourse within the teams. So teams speak the language, know the population, and know how to ask questions that enable dialogue\u0026rdquo;\u003c/em\u003e [Shira]. These consultations ranged from basic pronoun usage: \u003cem\u003e\u0026ldquo;When someone came to the unit, staff were reluctant to answer the door because they weren\u0026rsquo;t sure which pronouns to use\u0026rdquo;\u003c/em\u003e [Hag\u0026iacute;t], to more complex issues of professional report writing: \u003cem\u003e\u0026ldquo;A social worker called me and said, \u0026lsquo;I have a non-binary client. How do I write a social report in a gender-neutral way?\u0026rsquo;\u0026rdquo;\u003c/em\u003e [Mai].\u003c/p\u003e\u003cp\u003eTo facilitate these knowledge transfers, the workers developed various approaches. Personal storytelling emerged as a particularly effective: \u003cem\u003e\u0026ldquo;The approach that helped me most in connecting with them was through personal stories. When I brought stories from my clients, suddenly people could relate to it\u0026rdquo;\u003c/em\u003e [Hil\u0026aacute;]. Additionally, some workers initiated structural changes in work processes and professional tools as another avenue for discourse transformation: \u003cem\u003e\u0026ldquo;I changed the intake form to \u0026lsquo;Parent 1, Parent 2\u0026rsquo; instead of \u0026lsquo;mother and father\u0026rsquo;\u0026rdquo;\u003c/em\u003e [Tomer]. These modifications embedded new professional language into departmental practices and adapted institutional procedures to LGBT realities.\u003c/p\u003e\u003cp\u003eThe integration of new discourse and tools further established the workers\u0026rsquo; expertise and generated additional demand for their knowledge. Regular training and workshops became integral parts of their roles, with these activities continuing to expand over time: \u003cem\u003e\u0026ldquo;Over the years, it kept developing and improving\u0026rdquo;\u003c/em\u003e [Shira]. For many workers, systemic intervention and discourse change became systematic role components: \u003cem\u003e\u0026ldquo;I give lectures on LGBT issues in general. Providing training is part of my job\u0026rdquo;\u003c/em\u003e [Oh\u0026aacute;d]. This expanded recognition reinforced their position as institutional knowledge authorities, creating a self-reinforcing cycle of role development and professional boundary expansion.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMunicipal LGBT Expertise and Inter-System Navigation.\u003c/b\u003e The absence of LGBT expertise across municipal systems, combined with LGBT social workers\u0026rsquo; unique positioning as domain authorities, created conditions for role expansion beyond traditional social work boundaries. What began as departmental consultation evolved into city-wide representation of LGBT expertise across all municipal and governmental interfaces.\u003c/p\u003e\u003cp\u003eThe complex, multi-system needs of LGBT clients revealed gaps in knowledge and appropriate services across municipal departments. LGBT social workers gradually discovered that effective LGBT support required them to function as municipal-wide coordinators rather than departmental specialists. This resulted in their simultaneously navigating across nearly all municipal and governmental systems, from schools, health clinics, military and national service, to social security, rehabilitation services, and residential facilities: \u003cem\u003e\u0026ldquo;Today I went with my client who was just discharged from the army to a social worker at the health clinic, and we need to initiate the rehabilitation benefits process. And also, youth or adults who are transitioning: Transgender people need to start dealing with social security and everything that comes with it\u0026rdquo;\u003c/em\u003e [Mich\u0026aacute;l].\u003c/p\u003e\u003cp\u003eThis extensive inter-system work transformed the workers from departmental social workers into municipal LGBT brokers. As one participant reflected:\u003c/p\u003e\u003cp\u003eIt\u0026rsquo;s amazing to be able to mediate between these two places. It\u0026rsquo;s not exactly a natural connection, but there is... a connection was actually created through my role. I think this is the first position that really connects the municipality with the LGBT community in the city, and in my view, this is truly a mission [Hila]\u003c/p\u003e\u003cp\u003eThis brokering role required developing expertise in guiding municipal professionals across various systems to work with LGBT populations. Workers frequently found themselves educating healthcare providers and advocating for appropriate treatment:\u003c/p\u003e\u003cp\u003eDoctors, psychiatrists, family physicians\u0026hellip; take this boy, for example. He belongs to a health clinic. I explained to the mother that she needs to go to a family physician because you can\u0026rsquo;t go directly to a psychiatrist; you need a referral. And of course, she [the family physician] sent the mother to the regular clinics. Now, sorry, most psychiatrists there... they have one way of thinking: Trans equals mental imbalance. So I fight. I fight for him to be accepted now at [hospital], with Dr. P., who\u0026rsquo;s an expert in this, and he\u0026rsquo;ll also receive psychotherapy there. And we\u0026rsquo;re also advancing appointments at [another hospital] to start receiving hormone blockers. I want him to sit with a psychiatrist who won\u0026rsquo;t tell him \u0026lsquo;you\u0026rsquo;re crazy.\u0026rsquo; She\u0026rsquo;ll understand [Ron].\u003c/p\u003e\u003cp\u003eWhen direct professional education proved insufficient, workers developed alternative pathways for service delivery. Some workers established alternative service channels when direct contact was problematic:\u003cem\u003e\u0026ldquo;I built strong connections with the schools citywide, especially with guidance counselors. When a counselor had a transgender student, whose family didn\u0026rsquo;t want welfare involvement, I guided her throughout the year. It was beautiful intervention work.\u0026rdquo;\u003c/em\u003e [Zohar]\u003c/p\u003e\u003cp\u003eThis expanded systemic connectivity enabled the creation of a comprehensive municipal response tailored to LGBT population needs:\u003cem\u003e\u0026ldquo;I take into account that those who encounter the community are first of all the settlement workers, or school counselors or teachers, and they all need to know the challenges, what\u0026rsquo;s appropriate to address, and what to emphasize\u0026rdquo;\u003c/em\u003e [Rotem].\u003c/p\u003e\u003cp\u003eFurthermore, some workers developed direct and regular contact with senior municipal administration levels, which does not ordinarily occur in other social work positions. These relationships enabled them to influence policy and service development at the municipal level: \u003cem\u003e\u0026ldquo;Once a month we have a regular meeting: me, my team leader, and the deputy mayor who holds the LGBT portfolio. We bring cases from the field and she thinks about services she can develop\u0026rdquo;\u003c/em\u003e [Id\u0026oacute;]\u003c/p\u003e\u003cp\u003eThus, the multi-system gap shaped the role, causing it to extend beyond traditional social work boundaries. LGBT social workers evolved into municipal LGBT experts, policy influencers, and inter-system coordinators. These role characteristics emerged from the intersection between traditional systems and representatives of a previously excluded population constructing their professional role.\u003c/p\u003e\u003cp\u003e\u003cb\u003eStructural Factors Shaping Role Boundaries and Functions\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe extensive role development described in the previous themes occurred within structural factors that actively shaped the specific configurations and characteristics that the role developed. The most significant of these shaping forces was the client quota system, a mechanism for budget allocation and activity measurement in the Ministry of Welfare and Social Affairs: \u003cem\u003e\u0026ldquo;Honestly, they didn\u0026rsquo;t define how many cases I should have at the beginning. I know they now say 25 cases [for a full-time position]\u0026rdquo;\u003c/em\u003e [Yoval].\u003c/p\u003e\u003cp\u003eThe quota system fundamentally shaped role definition by prioritizing measurable individual interventions over community work, as community workshops, training sessions, and institutional consultations did not generate countable client files. This structural mechanism directed the role away from community-oriented work toward more clinical, individual-focused practice that many participants describe today: \u003cem\u003e\u0026ldquo;I basically only do therapy sessions\u0026rdquo;\u003c/em\u003e [Michal].\u003c/p\u003e\u003cp\u003ePart-time position allocations actively shaped role configurations by compelling workers to prioritize certain aspects while abandoning others. With positions allocated between 16% and 60% of full-time, the role evolved to be selectively focused rather than following the comprehensive approach described earlier. As one participant described: \u003cem\u003e\u0026ldquo;It\u0026rsquo;s impossible to have both a large caseload and do community work. It\u0026rsquo;s simply not feasible given the hours\u0026rdquo;\u003c/em\u003e [Doron]. This constraint carved out roles that were necessarily partial and limited.\u003c/p\u003e\u003cp\u003eSimilarly, confidentiality requirements fundamentally shaped the role\u0026rsquo;s scope. Social services procedures require parental consent for treating minors, but for LGBT youth, this created a requirement to come out to parents as a condition for receiving services: \u003cem\u003e\u0026ldquo;I can\u0026rsquo;t provide assistance while maintaining confidentiality for a minor. If I can\u0026rsquo;t maintain confidentiality, then they have no use for me\u0026rdquo;\u003c/em\u003e [Shai]. This constraint created roles that served only openly LGBT youth, excluding closeted and questioning youth who most needed confidential support.\u003c/p\u003e\u003cp\u003eThese structural factors also shaped roles that inherently required workers to provide services while simultaneously proving their necessity. Workers found themselves caught in a catch 22: They needed to demonstrate sufficient client numbers to justify funding, but the same factors that directed their practice reduced their ability to reach and serve the full population. This created positions where in documenting unmet needs and advocating for visibility became core job functions alongside direct service provision. As one participant experienced:\u003c/p\u003e\u003cp\u003eI did extensive outreach, I did what I could with limited resources... I had great ideas for all kinds of programs, but a year later I received notice that I was no longer an LGBT social worker... My manager got word from the council head that she decided that there\u0026rsquo;s no LGBT population in the authority. No population, therefore no position. [Tom].\u003c/p\u003e\u003cp\u003eTogether, these structural factors created a distinct type of professional role: one characterized not only by its therapeutic and community functions, but by the ongoing requirement to demonstrate its own necessity. LGBT social workers thus emerged as positions that combined direct service provision with institutional advocacy, where establishing legitimacy became as central to the role as delivering services to clients.\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study examined how practice shapes the role of LGBT social workers and the processes involved in developing and institutionalizing a new role for a marginalized population within a public welfare system. Analysis of interviews with LGBT social workers from 49 local authorities revealed that role development occurred through active construction processes that were driven by practice. Four central themes emerged, revealing how professional roles for marginalized populations develop through a unique practice-driven process wherein practitioners themselves become active architects of their own professional boundaries and content.\u003c/p\u003e\u003cp\u003eThis process operates through three interconnected dimensions that emerge from the historical exclusion of LGBT populations and resulting institutional knowledge gaps: (1) Role Genesis \u0026ndash; where the absence of frameworks created structured ambiguity that enabled self-construction; (2) System Transformation \u0026ndash; where workers evolved from service providers to institutional knowledge authorities, expanding their influence to become inter-institutional brokers; and (3) Practice under existential role threat \u0026ndash; where role construction occurs within ongoing struggles for legitimacy in contested institutional space.\u003c/p\u003e\u003cp\u003eRole Genesis, the first dimension, demonstrates how the gap between official guidelines and operational reality created space for practice-driven role construction. This builds on the existing understanding of professional discretion (Dworkin, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Author \u0026amp; Author, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Lipsky, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2010\u003c/span\u003e) by revealing how practitioners navigate not merely policy adaptation but active role creation when formal frameworks prove insufficient for field realities. LGBT social workers encountered fundamental uncertainty about what their roles should encompass, from target populations and intervention methods to success metrics and professional relationships. This uncertainty created opportunities for workers to construct their professional identities through direct engagement with field needs, developing new practices through trial and response rather than implementing predetermined protocols. While this ambiguity created challenges and inconsistencies, it also enabled locally responsive approaches that required a much broader scope of role construction than traditional discretion, where workers typically adapt existing protocols rather than develop entirely new professional practices. The findings suggest that structured ambiguity, providing broad mission frameworks while leaving operational definition flexible, may be essential to roles serving populations whose needs have been historically excluded from mainstream service design.\u003c/p\u003e\u003cp\u003eSystem Transformation reveals how individual practitioners can drive institutional change across multiple organizational domains simultaneously. This extends institutional work theory (Lawrence \u0026amp; Suddaby, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2006\u003c/span\u003e) in two key ways: firstly, by demonstrating multi-institutional change processes rather than change within single organizations, and secondly, by showing how workers create new professional discourse and knowledge that penetrate multiple systems concurrently. LGBT social workers\u0026rsquo; positioning as \u0026ldquo;outsiders-within\u0026rdquo; enabled this transformation, as they functioned both as insiders in social services departments and as LGBT specialists recognized across the municipal authority. This enabled them to cross departmental boundaries and identify coordination gaps that established professionals in each system might not perceive. They became municipal-wide LGBT expertise hubs, educating healthcare providers, school counselors, and government officials while establishing new inter-system coordination mechanisms. They developed and disseminated new professional discourse, concepts, and practices that transformed how multiple departments approach LGBT populations in the local authority.\u003c/p\u003e\u003cp\u003eThis transformation was facilitated in part through the systematic development of visibility work as a core professional practice. Institutional denial and resistance required LGBT social workers to develop visibility work as a systematic professional practice rather than a temporary establishment phase. This extends institutional work theory by revealing how symbolic interventions become permanent tools for discourse transformation across organizational boundaries. LGBT social workers reported that making LGBT populations visible in municipal spaces served as one of their most immediate and effective tools for initiating dialogue and legitimizing their expertise across multiple departments. Visibility work thus emerged as a core competency for roles serving populations whose existence is contested or denied in institutional settings, thus requiring an ongoing symbolic presence to sustain the broader transformation process.\u003c/p\u003e\u003cp\u003ePractice under existential role threat emerged as a defining characteristic of working with populations whose very existence generates public controversy. As the findings revealed, LGBT social workers operated within the constant reality of potential program closure, as their work served communities that are denied or contested in public discourse. This created a professional practice wherein workers had to develop careful navigation strategies and continuously establish the necessity of their roles. The position required living and operating within this tension: providing services while simultaneously proving population need, managing visibility while avoiding backlash, and building legitimacy while facing ongoing institutional resistance. The constant need to justify their existence transformed from an external threat into a core component of role definition, shaping how they approached every aspect of their work.\u003c/p\u003e\u003cp\u003eThe consistency of this process across 78% of all authorities with LGBT social worker positions suggests that this represents a systematic pattern of professional role development rather than isolated local adaptations. While each authority developed distinct local practices and strategies suited to their specific locale, the underlying dynamics of navigating structured ambiguity, transforming institutional systems, and managing existential role threats emerged consistently across diverse geographic, demographic, and political settings.\u003c/p\u003e\u003cp\u003e\u003cb\u003eImplications for Practice and Policy\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe findings of this study offer practical guidance for developing future professional roles serving marginalized populations in public systems. We believe that role design should embrace \u0026ldquo;structured ambiguity\u0026rdquo;, i.e., provide broad mission frameworks while maintaining operational flexibility for local adaptation (Author et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). These roles appear to benefit from clear guidance on core functions such as departmental training and visibility promotion, combined with the explicit expectation that the position will evolve through field learning. Success metrics should recognize systemic work alongside individual interventions, moving beyond traditional caseload measures to include institutional change indicators. Position allocations should anticipate the dual demands of direct service and system transformation, with time explicitly allocated for multi-departmental engagement and knowledge development activities.\u003c/p\u003e\u003cp\u003eWorkers in these roles require substantial investment in expertise development, as they transition from being service providers to institutional knowledge authorities. Entry-level training should provide both domain-specific knowledge and skills for educating colleagues across multiple systems. Organizations should either develop comprehensive training materials or provide workers with time and resources to create educational content suited to their local contexts. The role inherently demands ongoing learning and knowledge creation, requiring dedicated time for professional development and content preparation beyond traditional social work training.\u003c/p\u003e\u003cp\u003eManagement at both organizational and ministry levels should recognize that these roles will encounter institutional resistance and backlash as inherent parts of their function. Leadership preparation should include an understanding that workers serving contested populations become focal points for broader societal tensions, requiring specialized support systems. This includes developing clear protocols for responding to complaints or challenges against the position, creating peer support networks that connect workers across different authorities, and ensuring that supervisory staff understand the unique pressures that these roles entail. Regular supervision should address both clinical work and the political navigation skills necessary for institutional survival and effectiveness.\u003c/p\u003e\u003cp\u003eOrganizations should also develop innovative approaches to confidentiality requirements that often prevent LGBT youth from accessing services without parental disclosure. Traditional social work protocols that require parental consent for treating minors create significant barriers for youth who cannot safely come out to their families. This may require developing alternative service pathways, collaborative arrangements with community organizations, or modified intake procedures that can provide appropriate support while respecting both ethical obligations and safety concerns.\u003c/p\u003e\u003cp\u003eFinally, social work curricula should incorporate training on institutional navigation, visibility work, and multi-system coordination to prepare graduates for roles serving marginalized populations that require both direct service and systemic change competencies.\u003c/p\u003e\u003cp\u003e\u003cb\u003eStudy Limitations and Future Research Directions\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis study has several limitations that should be considered when interpreting the findings. Firstly, the research relies solely on the perspectives of LGBT social workers themselves, without including the viewpoints of managers, colleagues, or service recipients. Secondly, the study was conducted within the specific context of Israel\u0026rsquo;s welfare system, which may limit the generalizability of the findings to other national contexts with differing organizational structures and cultural settings. Thirdly, the sample includes only authorities with active LGBT social worker positions, potentially creating selection bias by excluding cases where such roles were attempted but discontinued or failed. Finally, this qualitative study does not provide quantitative measures of role effectiveness or service outcomes.\u003c/p\u003e\u003cp\u003eFuture research should address these limitations through several directions. Studies examining the institutional effect of LGBT workers\u0026rsquo; discourse interventions in welfare systems and municipal authorities would provide valuable insights into systemic change processes. Research focusing on the specific strategies that LGBT social workers employ to navigate the challenges identified in this study could offer practical guidance for role development. Comparative studies examining similar roles that serve marginalized populations in other countries or with other excluded groups would test whether similar patterns emerge. Finally, investigating cases where such positions were discontinued or failed could illuminate critical factors for role sustainability and institutional success.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding -\u0026nbsp;\u003c/strong\u003eThis work was supported by the Israel Science Foundation [Grant number: 1201/23].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of interest/Competing Interests -\u0026nbsp;\u003c/strong\u003eThe authors declare that they have no financial or non-financial interests that are directly or indirectly related to the work submitted for publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material\u003c/strong\u003e - anonymized data are available from the corresponding author upon reasonable request and subject to appropriate ethical approval.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCode availability\u003c/strong\u003e – Not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ Contributions –\u0026nbsp;\u003c/strong\u003eAll authors made substantial, meaningful contributions to the study and manuscript. The first and last authors conceived and designed the study, secured funding, and provided overarching supervision of data collection, data analysis, and the writing process. The second, third, and fourth authors led the data collection and analysis and drafted major sections of the manuscript. Every author participated in the critical revision of the paper for important intellectual content and approved the final version submitted for publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Approval -\u0026nbsp;\u003c/strong\u003eThis study was approved by the Ethics Committee of [The authors’] University and by the Israeli Ministry of Welfare and Social Affairs.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Participate -\u0026nbsp;\u003c/strong\u003eInformed consent was obtained from all individual participants included in the study. Participants were assured that their confidentiality and dignity would be maintained throughout the research process.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Publish -\u0026nbsp;\u003c/strong\u003eThe authors affirm that participants provided informed consent for the publication of anonymized quotes and findings from their interviews.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe gratefully acknowledge the LGBT social workers who enriched this study with their candid insights and unwavering commitment. We also thank the Israeli Ministry of Welfare and Social Affairs for authorising the research and facilitating access to local authorities, support that was indispensable to achieving comprehensive national coverage.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAndrew, B., Gary, G., Scott, B., \u0026amp; Daniel, F. 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A review of lesbian, gay, bisexual, trans, and intersex (LGBTI) health and healthcare inequalities. \u003cem\u003eEuropean Journal of Public Health\u003c/em\u003e, \u003cem\u003e29\u003c/em\u003e(5), 974\u0026ndash;980.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"LGBT social work, marginalized populations, practice-driven processes, professional role development, social services","lastPublishedDoi":"10.21203/rs.3.rs-7232441/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7232441/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction\u003c/strong\u003e: In 2017 Israel pioneered a globally novel position: LGBT social workers within the welfare system, shifting service provision from NGOs to direct governmental responsibility and creating new professional roles for a historically marginalized population. This study examined how practice-driven processes shape professional role development when serving marginalized communities.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: Semi-structured interviews were conducted with 50 current or former LGBT social workers across 49 local authorities (78 % national coverage) between February and September 2024. Data were analyzed thematically.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: Four themes emerged. (1) \u003cem\u003eFrom ambiguity to practice-driven design\u003c/em\u003e - the absence of clear formal definitions enabled workers to become active architects of their own positions through locally responsive approaches. (2) \u003cem\u003eActive outreach and visibility\u003c/em\u003e - institutional denial required continual outreach and visibility work, obliging workers to prove the population’s existence while delivering services. (3) \u003cem\u003eKnowledge translation and brokering\u003c/em\u003e - the lack of professional LGBT knowledge transformed workers into institutional knowledge authorities and inter-system coordinators, fostering new professional discourse across municipal departments. (4) \u003cem\u003eStructural factors\u003c/em\u003e - client quota systems, part-time allocations, and confidentiality requirements actively shaped role boundaries and functions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e: Professional roles for marginalized populations develop through practice-driven processes operating across three interconnected dimensions: Role Genesis, System Transformation, and Practice under existential role threat. These dimensions operate simultaneously, compelling workers to construct roles while educating systems and defending their existence. Structured ambiguity, combined with outreach, visibility work, and knowledge brokering, can enable comprehensive institutional innovation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePolicy Implications\u003c/strong\u003e: The Israeli model offers insights for developing responsive services for marginalized communities within mainstream welfare systems and provides policy guidance for creating specialized professional roles serving excluded populations in other national contexts.\u003c/p\u003e","manuscriptTitle":"Pioneering LGBT social work: The formation of a new role through practice in institutional contexts","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-31 16:53:30","doi":"10.21203/rs.3.rs-7232441/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9dad74b2-e41b-48cc-8d0b-1cd139e4fcbd","owner":[],"postedDate":"July 31st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-02-09T15:08:39+00:00","versionOfRecord":{"articleIdentity":"rs-7232441","link":"https://doi.org/10.1080/00918369.2025.2610506","journal":{"identity":"journal-of-homosexuality","isVorOnly":true,"title":"Journal of Homosexuality"},"publishedOn":"2026-02-03 00:00:00","publishedOnDateReadable":"February 3rd, 2026"},"versionCreatedAt":"2025-07-31 16:53:30","video":"","vorDoi":"10.1080/00918369.2025.2610506","vorDoiUrl":"https://doi.org/10.1080/00918369.2025.2610506","workflowStages":[]},"version":"v1","identity":"rs-7232441","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7232441","identity":"rs-7232441","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}