The AFFIRM open pilot feasibility study: A brief affirmative cognitive behavioral coping skills group intervention for sexual and gender minority youth Shelley L. Craig a, ⁎, Ashley Austin b a Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, Ontario M5S 1A1, Canada b School of Social Work, Barry University, 11300 NE 2nd Avenue, Miami Shores, FL 33161-6695, United States abstract article info Article history: Received 26 October 2015 Received in revised form 21 February 2016 Accepted 22 February 2016 Available online 23 February 2016 This pilot study sought to evaluate the feasibility and effectiveness of a brief, eight module affirmative cognitive behavioral coping skills group intervention (AFFIRM) with sexual and gender minority youth (SGMY) developed through community partnerships. A diverse sample of SGMY (n = 30) participated in the AFFIRM pilot and com- pleted reliable measures of depression, reflective coping, and stress appraisal at three time points. Over the study duration, significant reductions were found in depression and appraising stress as a threat. Significant increases were found in reflective coping and perceiving stress as a challenge. Participants found the intervention to be valuable and reported high levels of acceptability and skills acquisition. These promising findings suggest that AFFIRM has potential effectiveness as a community-based intervention for SGMY. Implications for practice and research are provided. © 2016 Elsevier Ltd. All rights reserved. Keywords: Cognitive-behavioral therapy Gay Lesbian Bisexual Transgender youth Depression Stress appraisal Feasibility Pilot intervention Community 1. Sexual and gender minority youth Sexual and gender minority youth (SGMY) as a population experi- ence notable stress, exemplified by their increased risk for familial rejec- tion (D'Augelli, Grossman, & Starks, 2008), social exclusion (Ueno, 2005), and substance use (Mustanski, Andrews, Herrick, Stall, & Schnarrs, 2014). SGMY are understudied and underserved (Dysart- Gale, 2010) and are more likely to endure emotional stressors (e.g., isolation, harassment, victimization) than their non-SGMY peers (Birkett, Espelage, & Koenig, 2009; Berlan, Corliss, Field, Goodman, & Austin, 2010). These experiences exacerbate the risk of psychological distress, including depression (Martin-Storey & Crosnoe, 2012; King et al., 2008) and increased suicidality (Marshal et al., 2011; Marshal et al., 2013). SGMY often lack the support and coping skills to navigate between their stigmatized identities and psychosocial risk factors (Berghe, Dewaele, Cox, & Vincke, 2010; Doty, Willoughby, Lindahl, & Malik, 2010). The health disparities of SGMY are well documented — yet community-based, developmentally relevant empirical interven- tions that address mental health risks and promote resilience and well-being are scarce (Horn, Kosciw, & Russell, 2009; Saewyc, 2011). Given significant gaps in the extant intervention literature, this study utilized an open trial format (Ward-Ciesielski, 2013) to implement and evaluate the feasibility and preliminary effectiveness of a brief, affir- mative cognitive behavioral coping skills group intervention for SGMY in a community-based setting. 1.1. Minority stress theory The disparate mental health risks experienced by SGMY can be ex- plained in part by minority stress theory (MST) (Meyer, 2003), which was initially applied to sexual minority (e.g., lesbian, gay, bisexual) pop- ulations and has more recently been expanded to include gender minor- ity (e.g., transgender) populations (Austin & Craig, 2015a). SGMY encounter disproportionate chronic stress, discrimination, and victimi- zation associated with their SGM identities (Almeida, Johnson, Corliss, Molnar, & Azrael, 2009; Diamond et al., 2011), which subsequently in- creases their likelihood of experiencing psychological distress and men- tal health problems, including depression, anxiety, and increased suicidality (Marshal et al., 2013; Martin-Storey & Crosnoe, 2012). An elaboration of stress and coping theory (Lazarus & Folkman, 1984), MST proposes that individuals from marginalized populations experi- ence a unique form of stress due to conflict between their internal sense of self and their experiences of majority social norms and Children and Youth Services Review 64 (2016) 136–144 ⁎ Corresponding author. E-mail addresses: shelley.craig@utoronto.ca (S.L. Craig), AAustin@barry.edu (A. Austin). http://dx.doi.org/10.1016/j.childyouth.2016.02.022 0190-7409/© 2016 Elsevier Ltd. All rights reserved. Contents lists available at ScienceDirect Children and Youth Services Review journal homepage: www.elsevier.com/locate/childyouth