Conversion therapy is alive and well in almost every state.

That is, according to The Trevor Project’s newest report titled “It’s Still Happening” that was started in 2018 and found that there are over 1,300 active practitioners of conversion therapy across the U.S. today. Nearly half of the practitioners hold active professional licenses.

Conversion therapy refers to the controversial practice that seeks to change the sexual orientation or gender identity of LGBTQ people. From methods inspired by psychoanalyst Sigmund Freud’s research to aversion therapy, which utilizes electric shocks, conversion therapy has long been frowned upon within queer, trans and nonbinary communities.

However, The Trevor Project’s report uncovers that, contrary to medical organizations and mental health professionals’ long standing denouncement, conversion therapy is still widely happening throughout the country.

This report falls on the heels of the Supreme Court of the United States recently declining to hear a case that sought to challenge Washington’s ban on conversion therapy. The ruling upheld measures in Washington, including over 20 other states who legally stand against conversion therapy.

But “It’s Still Happening” reveals that regardless of state legality around conversion therapy, 48 states and the District of Columbia remain practicing anyway—on young LGBTQ people included.

“What’s happening [in states where conversion therapy is illegal] is you either have people who are breaking the law and providing conversion therapy to minors as licensed professionals, or you have conversion therapists providing this care to legal adults, or you have people who are doing it as unlicensed providers,” said Casey Pick, author of the study and the director of law and policy for the Trevor Project.

Pick found that while the South and the Midwest hold the highest numbers of identified practitioners, there are 5 states that take the cake. Here’s a rundown of what conversion therapy is like in these states.

There are a total of 251 identified practitioners in Pennsylvania, which is more than double that of the second highest state, according to the study. Half of the practitioners are purely operating religiously, or in a ministerial capacity, rather than having a license from the state medical or mental health board. The Trevor Project tracked that, in line with the national trend, most in Pennsylvania operate under an active unrestricted license.

In this year’s legislative session, Pennsylvania is one of the states with fewer anti-LGBTQ bills introduced on the floor. It only had three bills—none of which have moved forward. On Aug. 16 of last year, Pennsylvania Gov. Tom Wolf signed an executive order banning conversion therapy for minors.

Pick explains to Reckon that the loophole is that conversion therapy is still feasible for LGBTQ adults.

“They just can’t operate on minors,” she said, explaining that like discouraging young people from smoking cigarettes, the ban would hopefully send the same message to adults. “As we were pulling together the data for this report, it was encouraging to see just how many conversion therapists in those states now have to take pains to say ‘We do not work with minors. We do not work with anybody under 18.’ So that at least shows that the laws we’re passing are having an effect.”

This year, Texas faced more anti-LGBTQ bills on the floor than any other state in the country—at 69 bills. Three have since passed into law, some targeting LGBTQ youth.

The Trevor Project tracked down 104 identified practitioners in Texas—67 of which practice with active unrestricted licenses. Despite Texas not having any protections against conversion therapy, LGBTQ organizations in Texas have been speaking out on the ethical dangers of conversion therapy. Equality Texas, an LGBTQ political advocacy group claimed on their website that “risks of conversion therapy extend far beyond its ineffectiveness and the time and money wasted on “therapies” that do not work.”

Last June, the Texas GOP adopted a 40-page anti-LGBTQ platform at its biennial convention in Houston. In the document, there is a section titled “Homosexuality and Gender Issues,” which outlines support for counseling methods intended to “convert” members of the LGBTQ community.

The Trevor Project report found that Minnesota tracked 92 identified practitioners overall, with Missouri at 90. However, there are way less practitioners with active unrestricted licenses in Missouri, at 32%, than Minnesota’s 59%.

A major difference between the two is that Minnesota has a state-wide ban on conversion therapy, while Missouri does not. This April, Minnesota became the 21st state to ban conversion therapy on minors under Gov. Tim Walz’s signage. Meanwhile, Missouri continues to fight for a statewide ban after the state’s first county-wide ban in Jackson County this April that won with a unanimous vote.

In terms of this year’s legislative session, Missouri is number two behind Texas, at 43 anti-LGBTQ bills introduced. Minnesota had 11.

A little less than Minnesota and Missouri, Ohio is home to at least 72 conversion therapy practitioners that The Trevor Project tracked. Similar to Minnesota, 58% of Ohio practitioners are maintaining an active unrestricted license to engage in the mental health profession with minors. Ohio does not have a statewide ban on conversion therapy, and it faced nine anti-LGBTQ bills on the floor this year.

On the flip side, a bill was proposed this year to protect LGBTQ youth from conversion therapy. House Bill 220 is known as the “Anti-Conversion Therapy Act” was introduced in Ohio’s House of Representatives on June 21 to prohibit licensed healthcare providers from practicing conversion therapy with minors. It has not made any progress outside of the House Committee.

From The Trevor Project’s report, Pick wants people to recognize that not only is conversion therapy still a current problem, but that it is an urgent problem, too. She adds that the report should be a warning bell to keep an eye out on practices like conversion therapy, where lines are blurry, and practices can be subtle.

“[It is] important to talk about what kind of community we want to be,” she adds. “We don’t want our communities to be exploited by unethical conversion therapists, but in order to prevent that, we need to be vigilant. We need to know what’s happening so we can stop it.”