The Preliminary Effectiveness of a Community-Based Affirmative Coping Skills Intervention for Trans* and Gender Non-Conforming Youth: The Affirm Open Pilot Feasibility Study

Background: Trans* and gender non-conforming youth (TGNC) face multiple risks to their health and mental health. Yet, there is a lack of affirmative evidence-informed interventions attending to the specific needs and experiences of TGNC youth and grounded in the realities of contemporary service delivery. This study examined the preliminary effectiveness of a trans* affirmative cognitive-behavioral coping skills training (AFFIRM) to reduce depression and sexual risk behaviors and increase coping among TNGC youth.

 Methods: An open pilot study using a pre-post design was used to determine preliminary feasibility and acceptability. Following purposive and venue sampling and the development of an active community advisory board, a pilot implementation of the adapted 16 hour AFFIRM group intervention was delivered in August 2014. TGNC youth completed reliable measures of health and mental health risks (DSM-5 Self-Rated Level 1 Cross-Cutting Symptom Measure), depression (Becks Depression Inventory-2), sexual self-efficacy, and coping (A-COPES) at three time points (pre, post, and 6 week follow up). Program acceptability was measured using a series of questions rated on 1–5 scale post intervention. Repeated measures linear mixed modeling was used for analysis.

 Sample Characteristics: TGNC youth (n=8) between the ages of 16-18 participated in the study.  Participant gender identities (non-mutually exclusive) included: non-binary (75%), male (12.5%), female (25%), trans* (25%), two-spirit (12.5%), and other (12.5%). Sexual orientation among TGNC participants included: queer (62.5%), pansexual (25%), and other (e.g. asexual, questioning) (37.5%); and race/ethnicity was described as: Caucasian (62.5%), Asian (12.5%), Black (12.5%), Aboriginal (25%), Mixed (13%), and Indigenous (12.5%).  Self-reported risk factors included anxiety (100%), substance use (75%) and suicide attempts (50%).

 Results: TGNC AFFIRM participants experienced a significant reduction (M=8.86; SD = 4.38) in depression t(7) = 4.34 p<0.05.  Significant improvements in sexual self-efficacy (M=2.8; SD = 2.34); t(7) = 3.23 p<0.05 and coping (M=-3.62, SD = 9.67) t(7) = -.960, p<0.05 were found. There were no significant changes in in health risk behaviours. With regard to program acceptability, the majority of TGNC youth would recommend AFFIRM (M=3.58, SD =0.75), were satisfied with the program (M=3.0; SD=1.0) and indicated that it facilitated cognitive-emotion integration (M= 3.7, SD =0.75). Engagement and retention were high among TGNC participants: 100% of TGNC youth who completed the pre-assessment also completed the 16 hour AFFIRM intervention as well as the post-assessment, and 50% completed the 6 week follow-up.

 Conclusion: This study is the first to demonstrate the preliminary effectiveness of an affirmative intervention to address the mental health of a community sample of TNGC youth. The high rates of participation and retention, coupled with the positive responses to AFFIRM indicate the feasibility, acceptability and utility of a trans affirmative community-based CBT intervention for TGNC youth, suggesting this approach warrants further effectiveness research. Implications for trans* affirmative research and social work practice will be provided.