Affirmative Cognitive Behavioral Therapy (CBT) for Caregivers of Lesbian, Gay, Bisexual, Transgender, and Questioning (LGBTQ+) Populations
AFFIRM Caregiver is an evidence informed, seven session manualized intervention to enhance affirmative parenting practices that promote the safety and well-being of LGBTQ+ youth. The AFFIRM Caregiver model emerged from Youth AFFIRM, an evidence based affirmative Cognitive Behavior Therapy intervention which has been scientifically shown to reduce psychosocial distress and improve coping skills among LGBTQ+ youth (Austin, Craig, & D’Souza, 2017; Craig & Austin, 2016).
AFFIRM is rooted in an affirmative practice framework and utilizes best practice research on LGBTQ+ youth well- being and has growing empirical research base for its effectiveness (Austin et al. 2018, Craig et al., 2020; Craig et al., 2021). The developers adapted their model for use with parents by creating the AFFIRM Caregiver model.
Seminal literature on family acceptance (Ryan et al., 2010), and compassionate parenting (Kirby, 2019) were utilized to build the seven-session model. Preliminary data support the feasibility and effectiveness of AFFIRM Caregiver in US foster care settings (Austin et al., in Press).
Who is the program for?
AFFIRM Caregiver is designed to work with any caregiver of LGBTQ+ children and youth. This includes biological and adoptive parents, kinship/family members of origin, chosen family, foster/resource parents, and all other people who parent and support LGBTQ+ young people. The intervention is best implemented when cohorts are customized to specific types of caregivers, for example, biological and adoptive parents would attend their own group while foster parents might attend another.
Data from AFFIRM Caregiver studies shows effectiveness for improving affirmative caregiving attitudes and behaviors, as well as confidence in caregiver abilities to engage in affirmative caregiving skills with LGBTQ+ youth. Data show statistically significant improvements in affirmative attitudes and behaviors toward both LGB and transgender youth, as well as statistically significant improvements in affirmative caregiving competence for LGBTQ+ youth.
As a manualized intervention, AFFIRM Caregiver is typically delivered by trained and certified counselors, social workers and other mental health professionals in a group-based format. The seven modules are designed for flexible implementation with all populations, making them easy to integrate into existing service settings (e.g., into existing counseling groups or parenting programs).
For guidance on implementation, download this implementation guide created by Allegheny County Department of Human Services, a selected pilot site for AFFIRM Caregiver in child welfare settings.
“This program has changed the way I view the world.” - Caregiver Graduate
“This program was so much more than I thought it would be. I needed this.” - Caregiver Graduate
How do I get the Youth AFFIRM to my organization?
To implement AFFIRM Caregiver in your practice or within your organization, please email the National Quality Improvement Center on Tailored Services, Placement Stability, and Permanency for LGBTQ2S Children and Youth in Foster Care at SOGIECENTER@ssw.umaryland.edu or contact the AFFIRM co-creators directly at firstname.lastname@example.org.
*Craig, S.L., & Austin, A. (2016). The AFFIRM open pilot feasibility study: A brief affirmative cognitive behavioral coping skills group intervention for Sexual and Gender Minority Youth. Children and Youth Services Review, 64, 136-144
Craig, S.L., Austin, A. & Alessi, E. (2019). Cognitive behavioral therapy for LGBT youth mental health. In J. Pachankis & S. Safren (Eds.), Handbook of evidence-based mental health practice with LGBT clients (pp. 25-50). New York, NY: Springer.
Craig, S.L, Leung, V., Pascoe, R., Pang, N., Iacono, G., Austin, A. & Dillon, F. (2021). AFFIRM Online: Utilizing an affirmative cognitive-behavioural digital intervention to improve mental health, access and engagement among LGBTQA+ youth and young adults. International Journal of Environmental Research and Public Health 18, 1541, https://doi.org/10.3390/ijerph18041541
Craig, S. L., McInroy, L. B., Eaton, A. D., Iacono, G., Leung, V. W. Y., Austin, A., & Dobinson, C. (2019). Project Youth AFFIRM: Protocol for implementation of an affirmative coping skills intervention to improve the mental and sexual health of sexual and gender minority youth. JMIR Research Protocols. 8(6):e13462. http://dx.doi.org/10.2196/134626/13462