Coming to terms with one's sexual identity is a particularly complex process for Christian LGBT+ youth, many of whom are at high risk for negative outcomes such as depression, substance abuse and suicide. Many Christian families are just beginning to actively wrestle with how to view and treat their LGBT+ children. This survey of 310 Seventh-day Adventist adult Millennials explored perceived levels of their families' acceptance or rejection of their sexual orientation or gender identity during their teen years. Other variables included recent levels of self-esteem, social support, depression, substance abuse, high-risk sexual activity, and suicidal thinking or attempts. Findings showed generally low levels of family acceptance and support, as well as elevated rates of depression and at-risk thoughts and behaviors. A high proportion of respondents have retained strong spiritual commitment and moderate church involvement. We include recommendations for social workers who work with Christian families who have LGBT+ children. [ABSTRACT FROM AUTHOR]