AFFIRM Youth is an evidence-based, eight module, manualized coping skills training intervention focused on reducing mental health and behavioral risks created for LGBTQ+ populations. Systematically developed specifically for LGBTQ+ youth, AFFIRM has been found to be efficacious with this vulnerable population across a range of organizations and communities (e.g. schools, health care centers, mental health clinics, online). As a manualized intervention, AFFIRM Youth is typically delivered by trained and certified counselors, social workers and other mental health professionals in a group-based format. AFFIRM Youth is successfully tailored to the needs of transgender and nonbinary youth as well as LGBTQ+ with intersecting minoritized identities and been translated into Chinese, Dutch, Spanish and Urdu. The eight modules are designed for flexible implementation with all LGBTQ+ youth populations, making them easy to integrate into existing school and other settings (e.g., into existing counseling groups).

Based on the extensive research base demonstrating that Cognitive Behavior Therapy (CBT) is among the most effective interventions for child, adolescent and adult depression, anxiety and suicidality, AFFIRM is based on the tenets of CBT while simultaneously attending to the unique needs, experiences and challenges of LGBTQ+ young people through a trauma-informed and affirmative approach.

AFFIRM has significant empirical evidence indicating that it reduces depression and promotes increases in healthy decision making and coping for LGBTQ+ youth (e.g. Austin, Craig, & D’Souza, 2018; Austin & Craig, 2015; Craig et. al, 2021, Craig, Austin & Alessi, 2019; Craig et. al, 2019; Craig & Austin, 2016*). Articulated in 12+ research articles, dozens of invited and adjudicated presentations, AFFIRM Youth addresses the stressors that LGBTQ+ youth encounter in school and community settings (eg. bullying, discrimination) and helps them develop effective coping skills which support healthy behaviors and foster wellbeing.

The AFFIRM Youth curriculum provides opportunities to develop:

• youth cognition (self-awareness, identifying risk),

• mood (the link between thoughts and feelings)

• behavior (strengths and ways of coping) through teaching and practicing skills

• helps them to identify safe and supportive adults in their schools and communities.

AFFIRM is currently in a clinical trial in Ontario with Research Ethics Board (REB) approval, with interim results indicating statistically significant reduction in depression and significant increases in hope, coping and stress appraisal.

AFFIRM Caregiver is an evidence-informed, seven-session, manualized intervention aimed at enhancing affirmative parenting practices in order to promote LGBTQ+ youth safety and well-being. The AFFIRM Caregiver model emerged from AFFIRM Youth, an evidence-based affirmative Cognitive Behavioral Therapy intervention, which reduces psychosocial distress and improves coping skills among LGBTQ+ youth (Austin et al., 2015; Craig et al., 2013; Craig & Austin, 2016).  Because AFFIRM is rooted in both an affirmative practice framework and best practice research for LGBTQ+ youth well-being and has a mounting base of empirical support for its effectiveness (Austin et al. 2018, Craig et al., 2020; Craig et al., 2021), it was used as the foundation for creating the AFFIRM Caregiver model. In addition, seminal literature on family acceptance (Ryan et al., 2010), and emergent practice for promoting 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).

The purpose of AFFIRM Caregiver is threefold—to help caregivers Learn, Reflect, and Grow. Through the intervention participants Learn more about what it means to be an affirmative caregiver to a young LGBTQ+ person; Reflect on how current societal attitudes, beliefs, and behaviors, as well as past experiences might impact the lives of LGBTQ+ youth; and Grow in the ways necessary to make LGBTQ+ youth feel wholly valued, loved, and affirmed. AFFIRM Caregiver focuses on building caregiver skills and the necessary commitment to: (a) Adopt an affirming stance toward sexual and gender diversity, (b) recognize LGBTQ+-specific sources of stress (e.g., identity-based rejection, bullying, stigma, etc.), (c) acknowledge the critical role of caregiver support for youths’ LGBTQ+ identities and experiences, and (d) engage LGBTQ+ youth from an affirming and trauma-informed perspective. A variety of therapeutic strategies are employed to move participants away from both passive and active forms of identity-based rejection and towards explicitly affirming attitudes and behaviors. AFFIRM Caregiver’s seven sequential and developmental sessions aim to initially foster knowledge acquisition, then move toward promoting attitude and behavioral change. 

Primary outcomes associated with the AFFIRM Caregiver approach:

1. Increase caregivers’ knowledge and understanding about the impact of homophobia/ transphobia/ biphobic stigma (including parental rejection) on the lives of LGBTQ+ youth.

2. Enhance caregivers’ recognition of the importance of affirmative reactions to LGBTQ+ youth identities and experiences.

3. Decrease caregivers’ unhelpful thoughts, attitudes, and behaviors rooted in homophobia/transphobia and stigma.

4. Improve caregivers’ awareness of the potential role and impact of trauma on the lives of LGBTQ+ youth.

5. Enhance caregiver self-efficacy to offer identity affirming support to LGBTQ+ youth.

6. Improve caregivers’ ability to access resources that support affirmative caregiving strategies.

7. Increase caregivers’ engagement in self-care, self-compassion, and compassionate caregiving behaviors.

AFFIRM Adult is an evidence-informed eight-module, the manualized intervention focused on increasing health coping skills and reducing depression and created specifically for LGBTQ+ individuals. Based on the extensive research base demonstrating that Cognitive Behavior Therapy (CBT) is among the most effective interventions for reducing depression, anxiety and suicidality AFFIRM is based on the tenets of CBT while simultaneously attending to the unique needs, experiences, and challenges of LGBTQ+ populations. In response to community need and organizational demand, we adapted our successful evidence-based AFFIRM Youth intervention to meet the needs of LGBTQ+ adults across a range of settings and circumstances. Consistent with AFFIRM Youth, the AFFIRM Adult curriculum provides opportunities to develop cognition (self-awareness, identifying risk), enhance mood (recognizing the link between thoughts and feelings), and modify behavior (identifying strengths and ways of coping) through a variety of CBT skills. Moreover, AFFIRM Adult tunes in to the impact of minority stressors on well-being and helps participants reconstitute safe and affirming sources of support across multiple domains of functioning (e.g., social, occupational, community, and cultural). Indeed, emerging evidence supports the feasibility and effectiveness of AFFIRM Adult for addressing mental health concerns and improving the well-being of diverse LGBTQ+ Adults.