Evaluation of the Healthy Relationships Program for 2SLGBTQIA+ Youth
Condition: Adolescent Development
Study type: Interventional

Summary: 
      The Healthy Relationships Program (HRP) for two-spirit, lesbian, gay, bisexual, trans, queer,
      intersex, and asexual (2SLGBTQIA+) Youth is a flexible and adaptable 17-session mental health
      promotion and healthy relationship program for gender, sexual, and romantic minority youth.
      It helps build resiliency and promote well-being among 2SLGBTQIA+ youth. It affirms,
      validates, and celebrates sexual and gender diversity, cultivates a caring and supportive
      community, and helps 2SLGBTQIA+ youth develop skills and strategies that promote healthy
      relationships. Investigators will evaluate the HRP for 2SLGBTQIA+ youth in 10 intervention
      and 10 comparison Genders and Sexualities Alliance/Gay-Straight Alliances (GSAs) in schools
      across Canada. GSA advisors (educators) at intervention schools will receive training in the
      program prior to implementation. GSA members (students in grades 9 to 12) at both
      intervention and comparison sites will participate in a survey at three time points: (1)
      pre-GSA programming survey at the beginning of the school year, (2) a post-GSA programming
      survey at the end of the school year, and (3) a follow-up survey at the beginning of the next
      school year. The primary outcome is social-emotional functioning.
    

Detailed description: 
      Study Background and Design:

      Two-spirit, lesbian, gay, bisexual, trans, queer, intersex, and asexual (2SLGBTQIA+) youth
      experience disproportionately negative outcomes compared to their heterosexual and cisgender
      peers in a range of domains, including mental health, problematic substance use, and
      violence. The heightened risk experienced by these youth appears to be in large part a
      function of the discrimination and minority stress that they face. Antihomophobic and
      anti-transphobic school policies and programs can play a protective role in the lives of
      2SLGBTQIA+ youth. For example, 2SLGBTQIA+ youth who attend schools that have Genders and
      Sexualities Alliance/Gay-Straight Alliances (GSAs) are at a lower risk for negative health
      behaviours, including alcohol and substance use and report increased psychological well-being
      and psychosocial functioning. Research has found that school staff (e.g., GSA advisors)
      require more guidance, training, networking opportunities to build their capacity to support
      2SLGBTQIA+ youth. Some prominent program developers/academics in the field have suggested
      that GSAs should offer structured programming depending on the needs and desired of each
      group, to encourage 2SLGBTQIA+ youth to process and cope with victimization in healthy ways.

      The Healthy Relationships Program (HRP) for 2SLGBTQIA + Youth fills a gap in mental health
      promotion and healthy relationship programming for queer, trans, and gender diverse youth.
      The program has been piloted in Ontario schools and community agencies and was well received
      by both facilitators and participants. This study will scale up our previous work and
      undertake a quasi-experimental, mixed-method evaluation of the HRP for 2SLGBTQIA+ youth with
      school partners across Canada. The HRP for 2SLGBTQIA+ Youth will be delivered nationally
      within 10 high school GSAs, and 10 GSAs with standard programming will be utilized as a
      comparison group. GSA members (students in grades 9 to 12) will participate in pre, post and
      follow-up surveys. The use of three-time points allows the investigators to look at program
      impacts within a reasonable timeframe, and to identify potential mechanisms at
      post-intervention that could mediate changes at follow-up.

      By comparing the experiences of GSA members who participate in the HRP for 2SLGBTQIA+ Youth
      with those who participate in standard GSA programming, investigators will be able to
      evaluate the relative benefits of standard GSA programming versus formalized/structured
      programming. Specifically, investigators will be able to determine the extent to which the
      HRP for 2SLGBTQIA+ Youth promotes positive mental health and well-being among 2SLGBTQIA+
      youth and their allies. The study will identify changes in social-emotional assets and
      resilience, youth well-being, mental health, identity affirmation, dating violence and
      help-seeking.

      Participants:

      GSA members (students in grades 9 to 12) participating in high school GSAs where the HRP for
      2SLGBTQIA+ Youth is delivered, and GSA members participating in high school GSAs delivering
      standard programming. Although GSAs vary in size, investigators conservatively estimate that
      approximately 100 GSA members will participate in this study (i.e., 5 youth from each of the
      20 schools - 10 intervention and 10 non-intervention). However, the total number of youth
      participants may vary considerably since GSAs vary in size (2 to 30+ students).

      Procedures:

      The school boards partnering on this study will assist in identifying intervention and
      comparison school sites within their district. All intervention GSA advisors will receive a
      two-day training on the HRP for 2SLGBTQIA+ youth. GSA members (students in grades 9 to 12)
      from intervention and comparison sites will be invited to participate in any of the following
      research activities:

        1. A pre-GSA programming survey at the beginning of the school year (October/November
           2021).

        2. A post-GSA programming survey at the end of the school year (May/June 2022).

        3. A follow-up survey at the beginning of the next school year (October 2022). They will
           also be invited to participate in an interview at the end of the school year.

      Investigators will recruit a second cohort the following year if needed to reach the sample
      size (i.e., number of schools). If a second cohort is included, the timing would be:

      A pre-GSA programming survey at the beginning of the school year (October/November 2022).

      2. A post-GSA programming survey at the end of the school year (May/June 2023). 3. A
      follow-up survey at the beginning of the next school year (October 2023). They will also be
      invited to participate in an interview at the end of the school year.

      GSA members will consent to their own participation to protect them for requiring to disclose
      their sexual orientation and/or gender identity to their parents as a condition for research
      participation. Guardian consent will only be obtained if absolutely required by a partnering
      school board.

      Planned analyses:

      Investigators will explore the pre-test data through bivariate analyses to investigate
      baseline equivalency between intervention and comparison groups using chi-square or t-test as
      appropriate; any unbalanced covariates will be controlled for in multivariate models. (If two
      cohorts, cohort differences on baseline characteristics will also be investigated). Youth
      will be clustered within GSAs, and so associations with outcomes variables at follow-up will
      be explored using multilevel models. This will allow us to control for both individual and
      site-level covariates. Intent-to-test analyses will be used, and missing data will be
      addressed using full information maximum likelihood. The main predictor for all models will
      be group status (intervention vs. comparison).
    

Intervention name(s): Healthy Relationships Program (HRP) for 2SLGBTQIA+ Youth; Standard GSA Programming
Intervention type(s): Behavioral; Behavioral
Intervention description(s): The Healthy Relationships Program (HRP) for Two-Spirit, Lesbian, Gay, Bisexual, Trans, Queer, Intersex, and Asexual + (2SLGBTQIA+) Youth is a small group positive mental health promotion program for gender, sexual, and romantic minority youth. It helps build resiliency and promote well-being among 2SLGBTQIA+ youth. It affirms, validates, and celebrates sexual and gender diversity, cultivates a caring and supportive community, and helps 2SLGBTQIA+ youth develop skills and strategies that promote healthy relationships. This trauma-informed, strengths-focused program explores stressors unique to 2SLGBTQIA+ youth, including identity and expression invalidation, stigma, prejudice and discrimination, internalized oppression, coming out, safety, and microaggressions. This program includes 17 sessions, each lasting approximately 45 minutes. It may be delivered in school-based Genders and Sexualities Alliances/Gay-Straight Alliances (GSA) or 2SLGBTQIA+ youth group settings.; Students at comparison sites will participate in standard GSA programming, a safe space for 2SLGBTQIA+ youth and their allies to meet, develop relationships, support each other, socialize, and learn about sexuality and gender-related topics, and lobby for social change.
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Intervention model description: GSA members (students in grades 9 to 12) will be assessed in one of two arms. The intervention arm includes GSAs that will implement the Healthy Relationships Program (HRP) for two-spirit, lesbian, gay, bisexual, trans, queer, intersex, and asexual (2SLGBTQIA+) youth. The comparison arm will be GSAs where standard GSA programming is delivered.
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: Mental health; Social emotional functioning; Gender identity; Sexual identity