Using Multiphase Qualitative Research to Develop an Affirmative Intervention for Transgender and Gender Non-Conforming Youth

Background:Transgender and gender non-conforming (TGNC) youth experience pervasive discrimination, microaggressions, and victimization in their homes, schools, and communities, contributing to disparate rates of suicide, anxiety and depression.  Clinical interventions targeting these youth must be empirically supported and affirming, competently and sensitively attending to the impact of transphobic discrimination while engaging youths’ strengths.  The unique bias-based challenges faced by TGNC youth require the integration of transgender affirmative practices into research informed interventions.  Transgender affirmative clinical practice acknowledges and counters the oppressive contexts in which transgender clients often experience health and mental healthcare.  This study will describe a multiphase, qualitative research process used to inform the development and ongoing adaptation of a transgender affirmative cognitive behavioral intervention for TGNC youth.

Methods: Phase 1 of the intervention development process included the collection of qualitative data from 3 focus groups (N=28) conducted with culturally diverse LGBQ and TGNC youth, as well as, l interviews with service providers working with TGNC youth (N=5). Data collection focused on understanding needs and experiences of youth with attention to intersecting developmental, cultural, gender, and sexual identities.  Following the integration of phase 1 findings into a transgender affirmative cognitive behavioral intervention, phase 2 involved the collection of post-treatment implementation data through open ended qualitative survey questions from TGNC youth participants (n=8), and intervention facilitators (n=6).  All data was analyzed using grounded theory strategies (Charmaz, 2015).  Grounding analyses in the data led to identification of codes, generation of categories and the emergence of themes used to inform the development and subsequent iterations of the intervention protocol, training, and manual. 

Findings: The first phase of qualitative data analysis yielded the following four themes: (1) interplay between an emerging understanding of gender identity and intersecting cultural, religious, and sexual identities, (2) the impact of transphobia across multiple dimensions of the youths’ lives (3) the simultaneous importance of and disconnection from trans affirmative support and community, and (4) the importance of nurturing resilience among TGNC youth.  Findings associated with phase 2 post-intervention implementation data suggest that the intervention had high levels of acceptability among TGNC youth.  However, findings from both participant and facilitator data found that facilitator level of experience, comfort, and competence working with TGNC notably impacted the delivery of the affirmative intervention.  Finally findings revealed the importance of tuning in to evolving identities and the role of technology and virtual community in the lives of TGNC youth.  Findings from phase 2 were use to guide the 3^rd and current phase of the intervention development.

Conclusions and Implications: Several elements of affirmative practice with TGNC youth emerge from this study and are key to developing interventions and programs that address the current service gaps.  Moreover, in keeping with ever evolving experiences of young people in society, it is imperative that programs targeting TGNC youth, as well as the practitioners delivering the interventions have the competence and flexibility to affirmatively engage emerging trans identities and youth culture into practice.