Project Summary Background/Objective: Transgender adolescents experience significant mental health inequities identified as a critical health concern by the NIH, IOM, and CDC. These inequities are largely attributable to transgender adolescents’ exposure to discrimination in multiple places, including at school. Gender-affirming school practices, which supportively address the needs and experiences of transgender students (e.g., teachers using students’ affirmed name/pronouns), have been shown to mitigate mental health problems (e.g., depression, anxiety) for transgender adolescents. Despite calls from the US Department of Education to increase gender-affirming practice implementation in schools, few if any evidence-based resources exist to support practice adoption. To address this need, this study will refine and evaluate the effectiveness and implementation of a primary prevention intervention called “Gender-Affirming School Practices (GASP),” designed to promote healthy emotional and behavioral development in transgender adolescents. Aim 1: Refine the GASP online training to enhance its usability and acceptability using human-centered design methods, specifically usability testing, with target users (i.e., school staff). Aim 2: Develop a scalable implementation blueprint for GASP, defined as a comprehensive plan including implementation strategies (i.e., beyond the online training) and other key elements (e.g., goals, timeframe) needed for GASP adoption. Aim 3: Pilot the GASP intervention and GASP implementation blueprint in a randomized hybrid effectiveness-implementation type 2 trial in 6 large public high schools. School staff changes in knowledge, attitudes, and self-efficacy using GASP (hypothesized implementation mechanisms) and increased GASP adoption (implementation outcome) will be examined. Effectiveness of GASP will be assessed by examining whether GASP adoption by school staff (implementation outcome) is associated with improvements in transgender adolescents’ internalized transphobia, negative expectations for future events & non-affirmation experiences (effectiveness mechanisms) and mental health (effectiveness outcomes; e.g., depression, anxiety). School- and county-level factors (e.g., structural transphobia) will be explored as potential moderators of GASP implementation and effectiveness. Results will inform a fully-powered hybrid type 2 trial. Public Health Impact: GASP represents a feasible and scalable prevention program for improving the mental health of transgender adolescents. Identified implementation strategies and associated mechanisms may be generalizable to school-based interventions for other populations facing mental health inequities.

Project Narrative Transgender adolescents face a disproportionately high risk for serious mental health problems largely attributable to discrimination in multiple places, including at school. Gender-affirming school practices supportively address the needs and experiences of transgender students (e.g., teachers using students’ affirmed name/pronouns) and have been shown to mitigate mental health problems for transgender adolescents. This study will refine a scalable universal school-based prevention intervention to support transgender adolescents' mental health, develop a scalable implementation blueprint, and pilot the intervention and implementation blueprint in a cluster randomized hybrid type 2 effectiveness-implementation trial.