Research documents epidemic rates of behavioral (e.g., alcohol use), emotional (e.g.,
depression, suicidality), relational (e.g., dating violence victimization and
perpetration), and academic (e.g., academic commitment) problems among sexual and gender
minority youth (SGMY), including SGMY of color who experience disproportionate inequities
due to their multiply minoritized status.
The disproportionally high rates of behavioral, emotional, relational, and academic
problems among SGMY can be explained by experiences of minority stress related to
oppression and discrimination specific to occupying minoritized social identities,
including sexual orientation, gender identity, and race/ethnicity. Research shows that
racial discrimination, SOGIE (sexual orientation, gender identity, and expression)
discrimination and victimization interact to exacerbate their negative associations on
deleterious behavioral, emotional, relational, and academic outcomes.
Families, including caregivers, play a critical role in the lives of SGMY by buffering
against, exacerbating, and/or serving as a direct source of minority stress. A prevalent
form of minority stress experienced by SGMY is family rejection (attitudes and behaviors
that demonstrate disapproval of and/or efforts to change one's child's SOGIE) related to
their sexual/gender minority identity. Indeed, 71% to 82% of SGMY report family
rejection, and family rejection is more pronounced among SGMY of color (compared to
white, non-Latinx SGMY).
Family rejection predicts a host of deleterious emotional, behavioral, relational, and
academic outcomes. For example, youth who are told by their caregivers that something is
inherently wrong with them, that they will never have a good future, and engage in
damaging behaviors (e.g., expulsion from the home, harsh parenting/abuse), may
internalize those experiences. This internalization may result in depression and
suicidality. Caregiver rejection may also lead to risk behaviors in SGMY via the lack of
positive parent-child relationships, poor communication, absence of modeling of healthy
attitudes and behaviors, and poor monitoring/supervision. The absence of these parenting
behaviors and parent-child relationship variables may lead to substance use (via poor
coping mechanisms and/or lack of parental monitoring) as well as sexual risk taking
and/or dating violence (via lack of knowledge about healthy relationship behaviors, the
inability to seek guidance about mistreatment from others, and due to internalized
oppression which may render SGMY more vulnerable to victimization and less likely to
leave an abusive relationship).
The etiology of caregiver rejection of their SGMY is complex and multifaceted, Caregivers
may engage in rejecting behaviors due to care for their SGMY and desire to help their
child "fit in", "have a good life", and "be accepted by others" as well as a lack of
information on SOGIE and/or how to support their SGMY. Caregiver rejection of their SGMY
is often rooted in negative societal, cultural, and/or religious views about SGM people,
including strict notions about gender.
Beyond caregiver acceptance (a key component of reducing inequality among SGMY and
promoting positive youth development [PYD]), SGMY of color who report a strong sense of
connection to other SGM individuals have better outcomes than SGMY of color who do not
report these connections. Thus, programs that simultaneously seek to reduce caregiver
rejection of their SGMY and provide opportunities for SGMY to connect with other SGMY may
be especially powerful in reducing minority stressors and deleterious outcomes and
promoting overall PYD. What is more, programs that provide accurate information about
SOGIE, teach caregivers how to advocate for their SGMY, and reduce internalized
oppression among SGMY may also foster the development of critical consciousness (i.e.,
the process of understanding social conditions, health inequities, and systems of
oppression) in SGMY of color and their caregivers. Critical consciousness not only
fosters thriving in the face of adversity but also may lead to action (e.g., vocalizing
the need for policy change) to reduce inequality.
The Family Acceptance Project
The Family Acceptance Project (FAP) is a rigorously developed family-based intervention
for caregivers of SGMY as well as SGMY (within the context of their families) in the U.S.
FAP seeks to prevent myriad deleterious outcomes and promote PYD for SGMY in the context
of their families, cultures, and faith communities. FAP is designed to help families via
caregivers to decrease rejection and to support and affirm their SGMY (thereby reducing
SGMY behavioral, social, emotional, relational, and academic problems). Whereas to date
FAP has been almost exclusively delivered in in-person formats, a highly innovative
component of the current project is to create an online version of FAP.
FAP includes both caregiver and SGMY components as well as family and group sessions.
Work with caregivers focuses on 1) assessing caregivers' reactions to their SGMY; 2)
providing psychoeducation about family accepting and rejecting behaviors in the context
of their cultural and religious values; and 3) teaching skills to show love and
affirmation and acceptance to ones' SGMY as well as advocacy skills to stand up for their
SGMY in the face rejection. Youth components focus on 1) psychoeducation on family
rejecting and accepting behaviors, 2) reducing internalized oppression and increasing
positive identity development, and 3) instilling hope for the future. FAP also offers
opportunities to build connections with others (e.g., caregiver peer support, LGBTQ+
sense of community among SGMY) and promotes family bonding and communication, all of
which is hypothesized to reduce internalized oppression among SGMY and promote their PYD.
In FAP, education and guidance are presented to program participants in ways that
resonate with caregivers' cultural and religious values. This allows caregivers to
decrease rejecting behaviors that increase risk and increase supportive behaviors that
help to protect against risk and support well-being. FAP helps caregivers to develop a
different way of thinking about their SGMY that moves from issues of morality to those
focused on ensuring the health and well-being of their SGMY. FAP helps youth to
understand how their family's cultural and religious beliefs impact their sense of
self-worth, their risk behaviors, and hope for the future. Many SGMY see family rejecting
behaviors as the price of staying connected to their family, their culture, and their
faith. In addition to learning about chosen family, learning that caregivers can change
their behavior and learn to support and accept them is liberating and motivates youth to
deepen family connections and invest in these relationships.
Despite its national recognition and reach, there is little research evaluating the
efficacy of FAP. There is an urgent need for rigorous research on FAP to document its
efficacy in reducing behavioral, social, emotional, relational, and academic problems
especially among SGMY of color for whom FAP was largely developed. Moreover, FAP was
initially developed for in-person delivery. Yet, there is also a need for research that
examines innovative methods (e.g., online delivery) for implementation so that FAP can
reach SGMY of color across the U.S., including rural regions of the U.S. where access to
affirming, family-based interventions to support SGMY are rare if nonexistent.
The aim of the current study is to evaluate FAP-O via a randomized control trial (RCT) of
caregiver-SGMY of color (ages 14 to 20) dyads (45 dyads assigned to the FAP-O and 45
dyads assigned to the waitlist control condition), assess the acceptability and
feasibility of the FAP-O via program observations, post-session surveys (n = 90 dyads),
and exit interviews (n=20) with SGMY of color and their caregiver(s). Test the FAP-O's
efficacy in reducing behavioral, emotional, relational, and academic problems via a
baseline survey followed by an immediate post-test and 6-month follow-up survey. Identify
mediators (e.g., increases in family bonding, reductions in internalized oppression,
decreases in rejection and increases in acceptance of SGMY by caregivers, increases in
positive ethnic/racial identities) and examine intervention promise among demographic
subgroups (e.g., race and ethnicity, gender identity, sexual identity, religiosity) and
those experiencing low or high levels of racial or ethnic discrimination via surveys.