Lakota Family Acceptance Project Pilot RCT

Indigenous LGBTQ2S+ youth experience disproportionately high rates of mental health problems including depression, anxiety, and suicidality as well as related issues such as alcohol and drug initiation/use and dating and sexual violence. Our preliminary research also shows that Lakota LGBTQ2S+ youth and their adult caretakers perceived the Family Acceptance Project (FAP)-a family support approach that seeks to reduce family rejecting behaviors and increase family accepting behaviors in the context of the family's cultural world-as highly acceptable and likely to be impactful in reducing mental health and related problems of Indigenous LGBTQ2S+ youth. To date, despite its promise for reducing mental health and related problems among LGBTQ2S+ youth, FAP has not been rigorously evaluated. The purpose of the proposed study is to pilot evaluate FAP for Lakota youth (ages 13 to 18) and their families. The researchers have assembled an interdisciplinary team of experts and Elders/Traditional Knowledge Keepers (TKKs), and the team will be comprised of \~10 Lakota LGBTQ2S+ youth on a Youth Advisory Board (YAB) and \~10 caregivers to Lakota LGBTQ2S+ youth on a Caregiver Advisory Board (CAB). The study will include \~40 families (Lakota LGBTQ2S+ youth and caregivers) in Rapid City, SD (20 families (10 FAP; 10 wait-list control) and on the nearby Pine Ridge Indian Reservation (10 FAP; 10 wait-list control). Following the baseline survey, families will be randomly assigned to the treatment or wait-list control. Participants will complete an immediate post-test and 6-month follow-up survey to test the hypotheses that FAP will lead to changes in targets, specifically increases in caregiver accepting behaviors, youth and caregiver connection to Lakota culture, family bonding, and youth future orientation and decreases in caregiver rejecting behaviors, caregiver harsh parenting, and youth internalized homo/bi/transphobia compared to the control condition. The researchers will also examine the hypotheses that there will be reductions in deleterious primary outcomes (depressive symptoms, anxiety symptoms, suicidality) and secondary outcomes (alcohol and drug use/initiation and dating and sexual violence victimization and perpetration) among youth in the treatment conditions compared to the control condition. Additionally, the researchers will assess the acceptability and feasibility of the FAP via program observations, post-session surveys, and exit interviews. The proposed project aligns Goal 3 of the NIMH to identify targets for intervention via a rigorous pilot RCT with a highly marginalized and underserved population and the Healthy People 2030 Goals to eliminate health disparities, which includes reductions in violence and injury among LGBTQ2S+ youth and youth of color.