Delivering Empirically-Supported Interventions to Sexual and Gender Minority Youth: Evaluating the Effectiveness of Affirm Facilitator Training

Background

Empirically-supported interventions (ESIs) designed to meet the needs of marginalized (e.g., racial, sexual, gender diverse) populations can increase the capacity of communities to provide equitable mental health services. The effectiveness of ESI’s is dependent on implementation fidelity, which hinges on facilitator skill and capacity to  deliver interventions as intended. Thus, facilitator training is a critical component of intervention effectiveness. Despite the extensive risks experienced by sexual and gender minority youth (SGMY), few ESI’s for this vulnerable population exist (Austin & Craig, 2015). AFFIRM is an evidence-supported manualized cognitive behavioral therapeutic (CBT) intervention, designed to improve coping and reduce depression among SGMY (Craig & Austin, 2016). To enhance facilitator competence in delivering the intervention and ensure fidelity, an AFFIRM CBT Facilitator Training was designed and evaluated. The AFFIRM training, informed by experiential learning theory, is a two-day (14-hour) intensive training that integrates didactic and experiential learning (e.g., role play, problem-based learning). The purpose of this study is to evaluate the effectiveness of the AFFIRM Facilitator Training using quantitative and qualitative analyses.

Methods

Training participants (n=58) represented diverse sexual (33% gay, 29% lesbian, 21% bisexual, 13% pansexual, 4% heterosexual); gender (52% female, 40% male, 8% transgender, 4% gender non-conforming); ethnoracial (42% Caucasian, 29% Asian, 19% Black, 5% Indigenous, 5% Latinx) and professional identities (e.g., community workers, case managers, social workers, psychologists).  A measure was developed through adaptation of items from the Lesbian, Gay, And Bisexual Affirmative Counseling Self-Efficacy Inventory - Short Form (Dillon, Alessi, Craig & Spadola, 2015) and the Train the Trainer Effectiveness Questionnaire (Tobias, Downes, Eddens & Ruiz, 2012). The resultant Affirmative CBT Facilitator Competence Scale (ACCS) (a = 0.922), is a 7-item scale designed to measure confidence to implement Affirmative CBT and included questions such as “I can help a client identify thinking patterns that may contribute to poor mental health” with responses on a five-point Likert scale. The ACCS was administered to facilitators immediately before and after the training. Total scores were calculated. Qualitative feedback was also collected and analyzed using thematic analysis.

Results

A paired sample t-test was conducted to compare the pre and post training ACCS scores. There was a significant difference between pre (M=14.92, SD = 4.84) and the post training scores (M=20.58, SD = 4.02); t(57) = -9.206, p < .001. Two major qualitative themes emerged: 1) Strengthened ability of facilitators to affirm LGBTQ+ identities utilizing CBT (“brought me to another level”; “put it all together”); 2) Increased competence to deliver AFFIRM to SGMY (“greater confidence”; “learned how to incorporate”).

Implications

The Affirmative CBT Facilitator Training increased the competence of a diverse group of practitioners to deliver AFFIRM to SGMY. Facilitator training is key to implementation fidelity and intervention effectiveness. As finding practitioners with the experience to facilitate ESIs can be challenging for many marginalized communities, the importance of providing effective training to ensure ESIs, such as AFFIRM, are being delivered to underserved populations is critical. The presentation will explore training considerations for intervention research and practice.