An Online Family-based Program to Reduce Inequity Among Sexual and Gender Minority Youth of Color (Pilot RCT)
试验速览
- 阶段
- 2 期
- 状态
- 招募中
- 入组人数
- 180
- 试验地点
- 1
- 主要终点
- Depression (Youth and Caregivers)
研究概览
简要总结
Research shows that sexual and gender minority youth (SGMY) experience high rates of mental health problems and other challenges (e.g., social, academic). A major factor that leads to these challenges is family rejection (family behaviors and reactions that minimize, deny, ridicule and attempt to prevent or change a child's sexual orientation, gender identity and gender expression). Racial and ethnic minority youth experience the highest rates of family rejection and related health risks.
The Family Acceptance Project (FAP) is a research, education, and intervention initiative that was founded more than 20 years ago to help diverse families learn to support and affirm their SGMY. FAP's Family Support Model is grounded in the lived experiences of diverse SGMY and families and uses a culture-based family support framework that enables parents and caregivers to change rejecting behaviors that FAP's research has shown contribute to health risks and increase supportive and accepting behaviors that promote well-being for SGMY.
The overall goal of this research project is to evaluate a nine-week online version of FAP's Family Support Model (FAP-O). The investigators will specifically study how FAP-O:
- Promotes parent/caregiver acceptance and support of their sexual and gender minority youth.
- Increases family bonding and communication.
- Increases SGMYs' feelings of pride in being LGBTQ+ and more hopeful about the future.
- Leads to reductions in mental health problems reported by SGMY who experience family rejection.
Before receiving FAP-O's family support services, racial and ethnic minority SGMY (ages 14 to 25) and their caregivers will complete an initial pre-test survey. After completing this initial (baseline) survey, half of the families will participate in program sessions. Following the first round of sessions, all participants will complete an immediate follow-up survey, with an additional survey conducted six months after this. These surveys help us learn if FAP-O impacts the project's goals above. After the final survey, the other half of the families will attend program sessions. The investigators will also ask SGMY and caregivers to share what they liked about the program and their guidance for enhancing it.
详细描述
Research documents epidemic rates of behavioral (e.g., alcohol use), emotional (e.g., depression, suicidality), relational (e.g., dating violence victimization and perpetration), and academic (e.g., academic commitment) problems among sexual and gender minority youth (SGMY), including SGMY of color who experience disproportionate inequities due to their multiply minoritized status.
The disproportionally high rates of behavioral, emotional, relational, and academic problems among SGMY can be explained by experiences of minority stress related to oppression and discrimination specific to occupying minoritized social identities, including sexual orientation, gender identity, and race/ethnicity. Research shows that racial discrimination, SOGIE (sexual orientation, gender identity, and expression) discrimination and victimization interact to exacerbate their negative associations on deleterious behavioral, emotional, relational, and academic outcomes.
Families, including caregivers, play a critical role in the lives of SGMY by buffering against, exacerbating, and/or serving as a direct source of minority stress. A prevalent form of minority stress experienced by SGMY is family rejection (attitudes and behaviors that demonstrate disapproval of and/or efforts to change one's child's SOGIE) related to their sexual/gender minority identity. Indeed, 71% to 82% of SGMY report family rejection, and family rejection is more pronounced among SGMY of color (compared to white, non-Latinx SGMY).
Family rejection predicts a host of deleterious emotional, behavioral, relational, and academic outcomes. For example, youth who are told by their caregivers that something is inherently wrong with them, that they will never have a good future, and engage in damaging behaviors (e.g., expulsion from the home, harsh parenting/abuse), may internalize those experiences. This internalization may result in depression and suicidality. Caregiver rejection may also lead to risk behaviors in SGMY via the lack of positive parent-child relationships, poor communication, absence of modeling of healthy attitudes and behaviors, and poor monitoring/supervision. The absence of these parenting behaviors and parent-child relationship variables may lead to substance use (via poor coping mechanisms and/or lack of parental monitoring) as well as sexual risk taking and/or dating violence (via lack of knowledge about healthy relationship behaviors, the inability to seek guidance about mistreatment from others, and due to internalized oppression which may render SGMY more vulnerable to victimization and less likely to leave an abusive relationship).
The etiology of caregiver rejection of their SGMY is complex and multifaceted, Caregivers may engage in rejecting behaviors due to care for their SGMY and desire to help their child "fit in", "have a good life", and "be accepted by others" as well as a lack of information on SOGIE and/or how to support their SGMY. Caregiver rejection of their SGMY is often rooted in negative societal, cultural, and/or religious views about SGM people, including strict notions about gender.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 14 Years 至 —（Child, Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •Identify as a sexual/gender minority (including youth questioning their sexual orientation and/or gender identity AND their identity must be known to their participating caregiver).
- •Identify as a person of color/belonging to a minority racial and/or ethnic group.
- •Be between the ages of 14 and 25 years
- •Read and speak English
- •Live in the United States
- •Report consistent access to a phone, tablet, and/or computer with high-speed internet access
- •Report an ability to attend eight, two-hour online sessions at pre-determined times
- •Report moderate to high levels of caregiver/family rejection
- •Not be at high-risk for suicide
- •Not be actively psychotic
- •Inclusion Criteria (caregivers):
- •Be a caregiver (biological parent, stepparent, grandparent, aunt/uncle, or another adult who provides care) to an SGMY of color between the ages of 14 to 25
- •Be over the age of 18
- •Read and speak English
- •Live in the United States
- •Report consistent access to a phone, tablet, and/or computer with high-speed internet access.
- •Report an ability to attend nine, two-hour online sessions at pre-determined times.
- •Be aware of the SGM youth's minority identity
- •NOT identify as SGM
- •Report spending time with participating youth at least 5 waking hours per week
- •Not be at high-risk for suicide
- •Not be actively psychotic
排除标准
- 未提供
研究组 & 干预措施
Immediate Treatment
Participants in this arm receive the intervention (9, 2-hour weekly sessions) immediately after enrollment
干预措施: Family Acceptance Project - Online (Behavioral)
Waitlist Control
Provide check-ins, provide resources, and offer participants in this arm the same intervention program as the experimental immediate treatment group after 6-month follow-ups and measurements have been completed.
结局指标
主要结局
Depression (Youth and Caregivers)
时间窗: Past 2-weeks at pre-test (enrollment), past 2-weeks at post-test (within one week of intervention end), past 2-weeks at 6-month follow-up
Patient Health Questionnaire (PHQ-9) modified- 9 Item measure for detecting major depression. Measured on a 4 point scale with 0= Not at all to 3= Nearly every day. Higher scores indicate more depressive symptomology.
Suicidality (Youth)
时间窗: Past month at pre-test (enrollment), past month at post-test (within one week of intervention end), past month at 6-month follow-up
The Suicidal Ideation Attributes Scale (SIDAS): Community-based validation study of a new scale for the measurement of suicidal ideation. Suicide and Life-Threatening Behavior. A 5 item measure. Scale is 0-10 with higher scores indicating severity of suicidal ideation.
Generalized Anxiety (Youth and Caregivers)
时间窗: Past 2-weeks at pre-test (enrollment), past 2-weeks at post-test (within one week of intervention end), past 2-weeks at 6-month follow-up
Generalized Anxiety Disorder Screener (GAD-7) is a self-report anxiety questionnaire of 7 items. The 4 point scale is 0= Not at all to 3= Nearly every day. Higher scores signify greater anxiety severity.
Alcohol Use (Youth)
时间窗: Past month at pre-test (enrollment), past month at post-test (within one week of intervention end), past month at 6-month follow-up
Youth Risk Behavior Survey 2023 - Alcohol items is a 3 item measure that assesses alcohol use over the past 30 days. item 1 is a 7 point scale 0=0 days to 6= all 30 days, item 2 is a 7 point scale 0=0 days to 6= 20 or more days, and item 3 is an 8 point scale 0=I did not drink alcohol in the past 30 days to 7=10 or more drinks. Higher scores represent more alcohol use.
Drug Use (Youth)
时间窗: Past month at pre-test (enrollment), past month at post-test (within one week of intervention end), past month at 6-month follow-up
Youth Risk Behavior Survey 2023 - Drug use items is an 8 item measure of drug use over the past 30 days. The 6 point scale 0=0 times to 5=40 or more times. Higher scores represent more drug use.
Teen Dating Violence - Victimization (Youth)
时间窗: Past month at pre-test (enrollment), past month at post-test (within one week of intervention end), past month at 6-month follow-up
Measure of Adolescent Relationship Harassment and Abuse (MARSHA) - Victimization a 21 item measure with 3 subscales (privacy, social, intimidation) a 4 point scale with 0= 0 times to 3= more than 10 times. Higher scores indicate presence of unhealthy relationship behavior victimization.
Teen Dating Violence - Perpetration (Youth)
时间窗: Past month at pre-test (enrollment), past month at post-test (within one week of intervention end), past month at 6-month follow-up
Measure of Adolescent Relationship Harassment and Abuse (MARSHA) - Perpetration 24 item measure with 4 subscales (social, intimidation, cyber control, isolation). 4 point scale with 0= 0 times to 3= more than 10 times. Higher scores indicate unhealthy relationship behavior perpetration.
School Engagement (Youth)
时间窗: No time frame at pre-test (enrollment), post-test (within one week of intervention end), or 6-month follow-up.
Items from Hulsey et al. (2018) is a 5 item measure with a 4 point scale 1=Not at all true of me -- 4= Extremely true of me. Higher scores indicate increased school engagement.
Sexual Risk Taking (Youth)
时间窗: Past month at pre-test (enrollment), past month at post-test (within one week of intervention end), past month at 6-month follow-up
Youth Risk Behavior Survey 2023 - Sexual risk taking items over the past 30 days is a 4 item measure with item 1 having an 11 point scale 0= I have never had sex/I have had sex, but not in the past month to 10= 10 or more people and the remaining 3 items have a 5 point scale 0= 0 times to 4= 6 or more times. Higher scores indicate higher risky sexual behavior.
Caregiver perspective of youth mental health (Caregivers)
时间窗: No time frame at pre-test (enrollment), post-test (withing one week of intervention end), or 6-month follow-up.
Pediatric Symptom Checklist-17 (PSC-17) is a 17 item measure with a 3 point scale 0=Never to 2=Often. Higher scores can indicate mental health disorder characteristics.
次要结局
未报告次要终点
研究者
Katie M Edwards
Professor, School of Social Work
University of Michigan