"My resistance melts away": The role of mindfulness in supporting participatory researchers' efforts to share power with youth co-researchers.

Youth participatory action research (YPAR) is an approach widely utilized in various social science disciplines (e.g., community psychology, social work, public health), which requires researchers to share power with youth co-researchers and to collaborate across identities to work equitably. Understanding what approaches and practices support YPAR adult facilitators' ability to share power is a vital area of knowledge that can support greater freedom in how researchers approach YPAR. Mindfulness offers a powerful set of tools for adult researchers to track their reactions and equitably collaborate with youth co-researchers. Drawing on insights from our youth participatory research, the present study employed a collaborative autoethnography to integrate our unique experiences as YPAR facilitators. We reflected on a core research question: How does mindfulness inform and support our YPAR work? Two major themes emerged that relate to power-sharing in YPAR: (1) Mindfulness supports our ability to overcome barriers to being present in facilitating YPAR groups; (2) Facilitator presence fosters deeper connection with youth co-researchers and stronger collaboration. Mindfulness can provide researchers a holistic, strengths-based approach in youth collaboration, and may also provide skillful tools for researchers to counter the pressures of White supremacy culture in academia.

Assessing the Fidelity of an Affirmative Cognitive Behavioral Group Intervention.

Purpose: Support implementation fidelity in intervention research with lesbian, gay, bisexual, transgender, queer, and sexual and gender diverse (LGBTQ+) populations, this study explores the systematic development of a fidelity process for AFFIRM, an evidence-based, affirmative cognitive behavioral therapy group intervention for LGBTQ+ youth and adults. Method: As part of a clinical trial, the AFFIRM fidelity checklist was designed to assess clinician adherence. A total of 151 audio-recorded group sessions were coded by four trained raters. Results: Adherence was high with a mean fidelity score of 84.13 (SD = 12.50). Inter-rater reliability was 81%, suggesting substantial agreement. Qualitative thematic analysis of low-rated sessions identified deviations from the manual and difficulties in group facilitation, while high-rated sessions specified affirmative and effective clinical responses. Discussion: Findings were integrated into clinical training and coaching. The fidelity process provides insights into the challenges of implementing social work interventions effectively with LGBTQ+ populations in community settings.

Demonstrating LGBTQ+ Affirmative Practice in Groups:: Developing Competence through Simulation-Based Learning.

Lesbian, gay, bisexual, transgender, queer, and other sexual and/or gender minority (LGBTQ+) populations experience significant mental and behavioral health disparities. Social workers are uniquely positioned to address these vulnerabilities. However, clinical graduate education has not effectively promoted or taught competent practice with LGBTQ+ populations. This qualitative study details the foundational competencies required for affirmative practice in group therapy with LGBTQ+ populations and describes a simulation-based learning activity designed to develop these competencies in graduate students. The following themes were identified as critical to affirmative practice, as identified through student reflections on their simulation-based learning experiences: deeply engaging in a strengths-based stance, keeping the group in group therapy, avoiding the expert trap, and managing identity assumptions. Implications for clinical social work education and practice are discussed.

Efficacy of affirmative cognitive behavioural group therapy for sexual and gender minority adolescents and young adults in community settings in Ontario, Canada.

OBJECTIVE: This study tested the efficacy of AFFIRM, a brief affirmative cognitive-behavioural group intervention tailored to reduce psychosocial distress and improve coping among sexual and gender minority adolescents and young adults (SGMY). METHOD: SGMY (n = 138; M age = 22.44) were allocated to immediate 8-week AFFIRM intervention delivered at 12 community-based organisations or an 8-week waitlisted control. At baseline, post-intervention or post-waitlist, participants completed self-reported assessments of depression, hope, coping, and stress appraisal. Implementation outcomes of feasibility and acceptability were also assessed. RESULTS: Compared to waitlist, SGMY in the intervention condition significantly reduced their depressive symptoms (b = - 5.79, p = .001) as well as increased reports of hope (agency: b = 0.84, p = .001; pathway: b = 0.79, p = .001), and coping by emotional support (b = 0.59, p < .001), instrumental support (b = 0.67, p < .001), positive framing (b = 0.59, p < .001), humour (b = 0.36, p = .014), planning (b = 0.49, p < .001) as well as reflective coping (b = 0.27, p = .009). Intervention participants were also less likely to perceive stress as a threat (b = - 0.43, p = .001), and more likely to perceive stress as challenge (b = 0.67, p < .001) and have the resources to deal with that stress (b = 0.38, p = .016) in comparison to waitlisted control participants. All outcomes had medium to large effect sizes. AFFIRM participants reported low attrition (8.5%) and high levels of engagement and acceptability (e.g. 99% agreed intervention was relevant to their lives). Over 63% of the community organizations that participated in the training hosted AFFIRM at least once during the study. CONCLUSIONS: Results demonstrate efficacy for the community-based implementation of an affirmative clinical intervention designed for SGMY to address depression and foster coping with universal and minority stressors.

Critical reflections and reflexivity on responding to the needs of LGBTQ+ youth in a global pandemic.

The global community has been significantly impacted by the COVID-19 global pandemic. LGBTQ+ (i.e., lesbian, gay, bisexual, transgender, queer, etc.) youth may face increased stressors amidst the pandemic given their significant mental and sexual health disparities, pervasive rejection - including quarantining in homes with heightened risk of abuse and victimization, and a lack of access to essential resources. Responsive supports are needed at this time for vulnerable LGBTQ+ youth, particularly tailored mental health supports. This critical reflexive paper will highlight, as qualitative social work researchers and practitioners, the swift response to the needs of vulnerable LGBTQ+ youth across Canada during this pandemic. We provide a transparent account of how we have utilized critical reflexivity, cultivated through qualitative research, to support LGBTQ+ youth. This article will elucidate the importance of critical reflexivity in effectively transitioning essential offline mental health services for LGBTQ+ youth to a technology-mediated mental health affirmative intervention. The aim of this paper is to provide qualitative researchers and practitioners practical direction through important insights gleaned by supporting marginalized LGBTQ+ youth during particularly trying times such as a global pandemic.

Adapting Clinical Skills to Telehealth: Applications of Affirmative Cognitive-Behavioral Therapy with LGBTQ+ Youth.

Online social work services (e.g., telemental health; telebehavioral health; virtual care; telehealth) present significant opportunities for clinical social workers to provide effective care to marginalized populations, such as LGBTQ+ youth. The COVID-19 pandemic has led to an increased focus on telehealth, and while there are excellent resources to guide ethics, standards, and legal decisions (NASW, n.d.), there is less guidance in the literature to specifically inform the adaptation of offline clinical skills to telehealth, particularly for LGBTQ+ youth. To address this gap, we present examples from our experience offering AFFIRM, an affirmative cognitive behavioral therapy (CBT) group intervention now being delivered through telehealth. Specifically, this paper will: (a) describe the key considerations for the delivery of CBT via telehealth to youth; (b) detail specific clinical skills and strategies to enable successful online implementation; (c) describe the adaptation approach through a case study of cognitive restructuring with a transgender youth; (d) and offer specific guidance to support clinicians to adapt their clinical skills to the virtual environment.

AFFIRM Online: Utilising an Affirmative Cognitive-Behavioural Digital Intervention to Improve Mental Health, Access, and Engagement among LGBTQA+ Youth and Young Adults.

Digital mental health interventions may enable access to care for LGBTQA+ youth and young adults that face significant threats to their wellbeing. This study describes the preliminary efficacy of AFFIRM Online, an eight-session manualised affirmative cognitive behavioural group intervention delivered synchronously. Participants (Mage = 21.17; SD = 4.52) had a range of sexual (e.g., queer, lesbian, pansexual) and gender (e.g., non-binary, transgender, cisgender woman) identities. Compared to a waitlist control (n = 50), AFFIRM Online participants (n = 46) experienced significantly reduced depression (b = -5.30, p = 0.005, d = 0.60) and improved appraisal of stress as a challenge (b = 0.51, p = 0.005, d = 0.60) and having the resources to meet those challenges (b = 0.27, p = 0.059, d = 0.39) as well active coping (b = 0.36, p = 0.012, d = 0.54), emotional support (b = 0.38, p = 0.017, d = 0.51), instrumental support (b = 0.58, p < 0.001, d = 0.77), positive framing (b = 0.34, p = 0.046, d = 0.42), and planning (b = 0.41, p = 0.024, d = 0.49). Participants reported high acceptability. This study highlights the potential of digital interventions to impact LGBTQA+ youth mental health and explores the feasibility of digital mental health to support access and engagement of youth with a range of identities and needs (e.g., pandemic, lack of transportation, rural locations). Findings have implications for the design and delivery of digital interventions for marginalised youth and young adults.

An Affirmative Coping Skills Intervention to Improve the Mental and Sexual Health of Sexual and Gender Minority Youth (Project Youth AFFIRM): Protocol for an Implementation Study.

BACKGROUND: Sexual and gender minority youth (SGMY, aged 14-29 years) face increased risks to their well-being, including rejection by family, exclusion from society, depression, substance use, elevated suicidality, and harassment, when compared with their cisgender, heterosexual peers. These perils and a lack of targeted programs for SGMY exacerbate their risk for HIV and other sexually transmitted infections. Cognitive behavioral therapy (CBT) interventions support clients by generating alternative ways of interpreting their problems and beliefs about themselves. CBT, tailored to the experiences of SGMY, may help SGMY improve their mood and coping skills by teaching them how to identify, challenge, and change maladaptive thoughts, beliefs, and behaviors. Based on the promising results of a pilot study, a CBT-informed group intervention, AFFIRM, is being tested in a pragmatic trial to assess its implementation potential. OBJECTIVE: The aim of this study is to scale-up implementation and delivery of AFFIRM, an 8-session manualized group coping skills intervention focused on reducing sexual risk behaviors and psychosocial distress among SGMY. Our secondary aim is to decrease sexual risk taking, poor mental health, and internalized homophobia and to increase levels of sexual self-efficacy and proactive coping among SGMY. METHODS: SGMY are recruited via flyers at community agencies and organizations, as well as through Web-based advertising. Potential participants are assessed for suitability for the group intervention via Web-based screening and are allocated in a 2:1 fashion to the AFFIRM intervention or a wait-listed control in a stepped wedge wait-list crossover design. The intervention groups are hosted by collaborating community agency sites (CCASs; eg, community health centers and family health teams) across Ontario, Canada. Participants are assessed at prewait (if applicable), preintervention, postintervention, 6-month follow-up, and 12-month follow-up for sexual health self-efficacy and capacity, mental health indicators, internalized homophobia, stress appraisal, proactive and active coping, and hope. Web-based data collection occurs either independently or at CCASs using tablets. Participants in crisis are assessed using an established distress protocol. RESULTS: Data collection is ongoing; the target sample is 300 participants. It is anticipated that data analyses will use effect size estimates, paired sample t tests, and repeated measures linear mixed modeling in SPSS to test for differences pre- and postintervention. Descriptive analyses will summarize data and profile all variables, including internal consistency estimates. Distributional assumptions and univariate and multivariate normality of variables will be assessed. CONCLUSIONS: AFFIRM is a potentially scalable intervention. Many existing community programs provide safe spaces for SGMY but do not provide skills-based training to deal with the increasingly complex lives of youth. This pragmatic trial could make a significant contribution to the field of intervention research by simultaneously moving AFFIRM into practice and evaluating its impact. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/13462.