The study's purpose was to explore the relationships between parents and LGBTQ+ youth who left their homes and went to residential out-of-home care. This study sheds light on different patterns of family relationships, offering insights into the changes that may occur at three points in time: before, during, and after leaving out-of-home care. Employing constructivist grounded theory methodology, 31 in-depth semi-structured interviews were conducted with LGBTQ+ youth aged 16 to 32 (average 21.6) who had aged out of out-of-home care services for homeless LGBTQ+ youth in Israel. The analysis indicated four patterns of relationships: (a) improvement pattern, reflecting a gradual increase in parental acceptance levels over time; (b) partial acceptance pattern, showing a middle situation between conditional acceptance and rejection; (c) from rejection to acceptance pattern, demonstrating rejection before and during out-of-home care, which rapidly progressed to acceptance after leaving out-of-home care; and (d) persistent disconnection pattern, indicating permanent rejection. The discussion highlights the need to train family therapists to recognize distinct relational patterns between LGBTQ+ youth and their families and to tailor interventions accordingly. Policy efforts should include funding for family support centers and the assignment of dedicated LGBTQ+ caseworkers within local social service departments to promote parental acceptance and reduce the risk of youth homelessness.