Abstract Text Project Summary 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 culturally adapt and pilot evaluate FAP for Lakota youth (ages 13 to 18) and their families. We will specifically compare outcomes across three conditions: traditional FAP (T-FAP), Indigenized FAP (I-FAP), and a control condition. We 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). Aim 1 (Adaptation) includes using an Indigenized ADAPT-ITT Model to refine the FAP into the Indigenized FAP (I- FAP) via ongoing feedback from the YAB and CAB and Topical Experts/TKKs (Aim 1a), theatre testing I-FAP (Aim 1b), and an open pilot trial of the I-FAP with 14 families (7 on the Pine Ridge Indian Reservation and 7 in Rapid City) to further refine the I-FAP and evaluate the feasibility of research procedures and program implementation (Aim 1c). Aim 2 (Evaluation) will include via a pilot RCT of 60 families of Lakota LGBTQ2S+ youth and caregivers in Rapid City, SD (30 families [10 T-FAP; 10 I-FAP; 10 wait-list control]]) and on the nearby Pine Ridge Indian Reservation in SD 30 families [10 T-FAP; 10 I-FAP; 10 wait-list control]), assess the acceptability and feasibility of the I-FAP (Aim 2a) via program observations, post-session surveys (n=40 families in the treatment condition), and exit interviews (n=12 participants in the treatment condition [6 youth; 6 caregivers] or until data are saturated) with Lakota LGBTQ2S+ youth and their caregivers. We will test the hypotheses that I-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 (Aim 2b). We will also examine the hypotheses that there will be reductions in deleterious primary outcomes (depressive symptoms, anxiety symptoms, suicidality; Aim 2c) and secondary outcomes (alcohol and drug use/initiation and dating and sexual violence victimization and perpetration; Aim 2d) among youth in the treatment conditions compared to the control condition.

Project Narrative Although research documents the concerning rates of mental and behavioral health problems (e.g., substance use/initiation) among Indigenous LGBTQ2S+ youth, there is very little known about how to prevent these deleterious issues that devastate Indigenous communities. The proposed project aims to adapt and evaluate the first ever culturally grounded, family-based program to prevent mental health and related problems among Lakota LGBTQ2S+ youth. 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.