Feasibility of a Multi-Level School Intervention for LGBTQ Youth

Study Overview
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Brief Summary
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The goal of this R21 grant is to test the feasibility of a theoretically informed, LGBTQ-affirming intervention (Proud & Empowered; P&E). Although LGBTQ adolescents experience disparities in behavioral health outcomes compared to their heterosexual peers, interventions are scarce. For example, LGBTQ adolescents are 3 to 4 times more likely to meet criteria for an internalizing disorder and 2 to 5 times more likely to meet criteria for externalizing disorders than their heterosexual peers. Our intervention seeks to address disparate behavioral health problems such as depression, anxiety and trauma symptomology. Our goal will be achieved by completing two specific aims: 1) Assess the feasibility, including recruitment, enrollment, fidelity of service delivery, satisfaction, safety, and retention, of the intervention in a randomized control trial with four schools, 2) Obtain preliminary estimates of intervention effects on key behavioral health symptoms for LGBTQ youth and school climate (norms, attitudes, beliefs, behaviors) at the school level in preparation for a larger efficacy trial. This innovative R21 application brings together a team of nationally recognized minority stress and prevention science experts and responds to a nationally established public health need for research from the Institute of Medicine, the National Institutes of Health, and the National Gay and Lesbian Task Force.

Official Title
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Feasibility of a Multi-Level School Intervention for LGBTQ Youth

Conditions
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Sexual Minority Stress Experiences Among LGBTQ Youth

Intervention / Treatment
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* Other: Proud & Empowered!


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: LGBTQ student in one of four high schools Exclusion Criteria: Not meeting inclusion criteria

Ages Eligible for Study
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Minimum Age: 12 Years
Maximum Age: 20 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Intervention schools<br>Schools will be assigned to either intervention or control schools. Students in intervention schools will receive the intervention in semester 1. | Other: Proud & Empowered!<br>* Proud & Empowered! is a school-based intervention to decrease sexual minority stress and improve coping among LGBTQ students. It is administered by school counselors and trained social workers.<br>|
| Active Comparator: Control schools<br>Students in control schools will receive no intervention | Other: Proud & Empowered!<br>* Proud & Empowered! is a school-based intervention to decrease sexual minority stress and improve coping among LGBTQ students. It is administered by school counselors and trained social workers.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Sexual Minority Adolescent Stress Inventory (SMASI) | 54-item survey across 10 domains of minority stress. Assesses experiences of minority stress among adolescents. Each statement reflects past-30-day thoughts, feelings, and situations a person may have experienced, with response options of 1 = yes and 0 = no. A total score was calculated by summing the 54 items. The total score ranged from 0-54. Higher values correspond to a worse outcome, meaning the individual in question has had more stressful experiences. | Change between baseline and post-intervention/follow-up (12 weeks). | 
| Beck Anxiety Inventory (BAI) | 21-item self-report assessment of anxiety symptoms. The total score is calculated by taking the sum of the 21 items. There are five responses an individual can choose from for each item, these being Not at all which is scored as a 1, Mildly, but it didn't bother me much which is scored as a 2, Moderately -- It wasn't pleasant at times which is scored as a 3, Severely -- It bothered me a lot which is scored as a 4, and Decline to answer which is scored as a 5. The total score ranges from 0-63. Higher values indicate higher self-reported anxiety: Score of 0-21 indicates low anxiety, Score of 22-35 indicates moderate anxiety, Scores of 36+ indicates potentially concerning levels of anxiety. Subscales are calculated through summation. | Change between baseline and post-intervention/follow-up (12 weeks). | 
| PTSD Checklist for DSM-5 (PCL-5) | 20-item self-report assessment of post-traumatic stress disorder (PTSD) symptoms which addresses all 20 DSM-5 symptoms of PTSD. A total symptom severity score can be calculated by summing the scores for each of the 20 items. Each item has five possible responses including Not at all which is scored as a 0, A little bit which is scored as a 1, Moderately which is scored as 2, Quite a bit which is scored as a 3, and Extremely which is scored as a 4. The potential range of scores is 0-80. Higher scores indicate a worse outcome where the individual has higher severity of PTSD symptoms. | Change between baseline and post-intervention/follow-up (12 weeks). | 
| Beck Depression Inventory | 21-item self-report assessment of depression symptoms and severity of depression. The items are rated on a 4-point scale ranging from 0-3 based on the severity of each item (e.g., 0=I do not feel sad, 1=I feel sad much of the time, 2=I am sad all the time, and 3=I am so sad or unhappy that I can't stand it). The total range of scores is from 0-63. Higher values indicate a worse outcome and indicates a greater severity of depression. Scores of 0-13 indicates minimal depression, scores of 14-19 indicates mild depression, scores of 20-28 indicates moderate depression, scores of 29-63 indicates severe depression. Subscale values are achieved through summation. | Change between baseline and post-intervention/follow-up (12 weeks). | 
| Coping Strategies Inventory | 16-item assessment measuring specific coping strategies people use in response to stressful events. Individuals respond to 16 items, with each item assessing components of Problem Solving, Cognitive Restructuring, Social Support, Express Emotions, Problem Avoidance, Wishful Thinking, and Social Withdrawal. Individuals can respond in 5 different ways, these being Never, Seldom, Sometimes, Often, or Almost Always. These responses are scored from 1-5 with Never being a 1 and Almost Always being a 5. The total score is a summation of item scores with a range from 16-80. Higher scores in a particular primary scale indicates that the individual implements that form of coping strategy more often. | Change between baseline and post-intervention/follow-up (12 weeks). | 
| Adapted CSSRS Suicide Questions (Columbia Suicide Severity Rating Scale) | Six items assessing current suicidality that were adapted from the longer, treatment-based Columbia Suicide Severity Rating Scale. The first two items ask about passive ideation and active ideation, and affirmative responses link to follow-up questions about methods, intent, plans, and attempts. The scale is scored as follows: 0 = no to passive ideation and no to active ideation = yes to passive ideation (but no to active ideation) = yes to active ideation (but no method, intent, plan) = yes to method (but no intent or plan) = yes to intent (but no plan) = yes to plan Attempts can be scored on its own or added to the overall scale for a risk score of 6 if participant has a recent suicide attempt. | Change between baseline and post-intervention/follow-up (12 weeks). | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Youth Risk Behavior Survey Substance Use Questions | Measures individual's usage of various substances in their lifetime and within the past 30 days as well as the ways in which individuals have used marijuana, tobacco, or nicotine in the past 30 days. Each substance is individually analyzed for both lifetime usage and past 30 day usage. Individuals can answer Yes or No for both lifetime usage and past 30 day usage. Each substance can range from 0 to the maximum number of survey responses. In addition, for marijuana, students can specify the way in which they used it with response options of smoking, vaping, edible or beverage form, or other. For nicotine and tobacco, students can specify the way in which they used it with the response options of smoking, vaping, or other. Yes responses indicate a worse outcome indicating that individuals have used or are currently using the substance in question. | Change between baseline and post-intervention/follow-up (12 weeks). |