BELIEVING IT GETS BETTER:

The Impact of a

Randomized Controlled

Trial to Reduce Suicidality

among LGBTQ Youth

Catherine Griffith, Ph.DUniversity of Massachusetts Amherst

Introductions

• Name

• Where are you from?

• What do you do?

• What brought you to this workshop?

• What are you hoping to learn?

Agenda

• The Need for LGBTQ-Focused Groups

• Description of the Study

• Overview of Results

• Sample Activity

• Q&A

Rationale

Suicide is the third leading cause of death among adolescents

LGBTQ+ individuals are especially at risk due to higher rates of hopelessness, peer isolation, and a lack of positive coping skills

LGBTQ+ youth experience much more frequent instances of homophobic remarks, verbal and physical harassment, and assault than their non-LGBTQ+ peers

LGBTQ+ youth are 2-7 times more likely to commit suicide

Void in the research: unable to identify any evidence-based group interventions for LGBTQ+ youth

Relevance of the Study

• Knowledge as to the impact of a group counseling intervention on LGBTQ+ adolescents levels of hope, coping skills, and life attitudes

• Further understanding of the relationship between hope, coping skills, and suicidality

• Greater knowledge about the impact of group therapeutic factors on hope, coping, and life attitudes

• Curriculum will be disseminated to counseling practitioners and educators

A Call for Action

• Much is known about the correlation between hopelessness, lack of coping skills, and suicide among LGBTQ+ youth (Hass et al., 2010; Liu & Mustanski, 2012; Spirito Esposito-Smythers, 2006)

• There is a significant gap between knowledge and practice, and much more research is needed regarding interventions that reduce suicide risk for this population (Haas et al., 2010)

• Essentially, the problem has been identified, but mental health professionals are left with few evidence-based practices to turn to in order to help their clients.

Operational Definition of TermsLGBTQ+:

An umbrella term for the communities of individuals who identify as lesbian, gay, bisexual, transgender, queer, or otherwise as a minority in terms of affectional orientation or gender identity and expression (e.g., questioning, intersex, hijra third gender, etc).

Older Adolescent: Broadly defined, an adolescent is an individual who is in the process of developing

from a child into an adult; there is no one scientific definition for adolescence. For the purpose of this investigation, an older adolescent is operationally defined as any individual between the ages of 18-20.

Constructs of Interest

HOPE COPING

SUICIDALITYGROUP

THERAPEUTIC

FACTORS

Primary Research Question

What is the impact of an eight-week group counseling intervention on LGBTQ+ older adolescents’ levels of hopefulness, coping skills, and suicidality as compared to LGBTQ+ older adolescents who do not receive the intervention?

Exploratory Research Question 1

Are LGBTQ+ older adolescents self-reported levels of hopefulness and positive coping skills predictive of decreased suicidality?

Exploratory Research Question 2

What is the relationship between the presence of group therapeutic factors and levels of hopefulness, coping skills, and in a sample of LGBTQ+ older adolescents?

Exploratory Research Question 3

What is the relationship between LGBTQ+ older adolescents’ demographic information (i.e., age, ethnicity, biological sex, gender identity, affectional orientation, level of disclosure about one’s LGBTQ+ status, perception of peer support and perception of parental support) and their levels of hopefulness, coping skills, and suicidality?

Research Design

Randomized Controlled Trial

Waitlist Groups

Repeated Measures

Recruitment Procedures

RANDOM ASSIGNMENT TO THE INTERVENTION GROUP OR WAITLIST COMPARISON GROUP

Obtain IRB approval for the study

Posting Flyers

Visiting Organizations

Referrals

Conducting pre-screening interviews with potential participants

The Intervention

• The Basics:– 8 weeks– 45-60 minutes, once per week– 5-8 members per group

• Foundation:• Psychoeducational/Counseling Mix• Experiential• Strengths-based

• A note on use of the word “intervention”...

The Intervention (cont.)• Session One: Intros & Icebreaker

• Sessions Two-Five: Positive Coping Skills– Wellness Wheel– Free Writing– Breathing– Positive Reframing

• Sessions Five-Seven: Hope Building– Hope as a Coping Skill– Hopes in a Hat– Letter From a Future You– Always My Son Documentary

• Session Eight: Reviewing Progress & Goodbyes

Data Collection Procedures

• Intervention and waitlist comparison groups complete pre, mid, and post assessments

• Provided in hard copy packets

• 10-15 minutes to complete

• Alpha-numerical codes rather than identifying information

• Data is stored in a locked desk in the researchers office, and data analysis software is password protected

InstrumentationDemographic Questionnaire (created by researcher)

Age, ethnicity, biological sex, gender identity, affectional orientation, level of disclosure about one’s LGBTQ+ status, rating of perceived peer and parental support.

Herth Hope Index (HHI; Herth, 1992)

12 items on a four-point Likert agreement scale; 3 factors; Cronbach’s alpha = .97, indicating internal consistency, with a .91 test/re-test reliability at two weeks indicating stability over time

Brief COPE (Carver, 1997)

28 items on a four-point Likert frequency scale; 9 factors; Cronbach’s alpha for factor varies from .52- .90; Test re-test reliability over the course of three administrations ranged from .50 to .90

Life Attitudes Schedule –Short Form (LAF-SF; Rohde et al., 1996)

24 true/false items; 4 factors; Cronbach = .84; no test-retest

Therapeutic Factors Inventory Short Form (TFI-S; Joyce et al, 2011)

19 items on a seven point Likert scale; 4 factors; Cronbach’s alpha for factor varies from .71 - .91; test re-test ranges from .28 - .93

Exit Survey (created by researcher)

Data Analysis

Data Analysis• Independent Variable (1): intervention or comparison group; demographic data

• Dependent Variables (5): hope, coping skills (2 subscales), life attitudes, and group therapeutic factors

• Primary Research Question (differences between groups): – Multiple Analysis of Variance (MANOVA)– Repeated Measures

• Exploratory Research Question 1 (relationship between hope, coping, and life attitudes):– Multiple Linear Regression (MLR)– Pearson Product Moment Correlation (one-tailed)

• Exploratory Research Question 2 (effect of group therapeutic factors on hope, coping, and life attitudes):– Pearson Product Moment Correlation (two-tailed)

Results• 34 Participants

• No differences at pre-test• Waitlist group no pos. difference through pre, mid, and post• Intervention group pos. differences at mid and post

– Strong significance, power, and effect sizes

• Four Outcome Variables: Strong Correlations– e.g., Hope & Suicidality .886; others .303 - .707

• TFI: Only correlated w/ Adaptive Coping (.528)• Intervention group more likely to seek additional resources

– IG: 52% ( n= 11), WG: <1% (n = 1)

Potential Implications

• Availability of an evidenced-based intervention specifically tailored for LGBTQ+ youth to:– Increase hopefulness– Increase positive coping strategies– Increase life attitudes/decrease suicidal ideation and proneness

• Provide support for group counseling as a preferred treatment modality for this population– Based on the influence of group therapeutic factors on participants’ adaptive coping skills

• Important information for counselor educators in educating students on “what works” in addressing LGBTQ+ issues

• Further evaluation of the psychometrics of the instruments

Potential Implications

• Availability of an evidenced-based intervention specifically tailored for LGBTQ+ youth

• Important information for counselor educators in educating students on “what works” in addressing LGBTQ+ issues

• Provide support for group counseling as a preferred treatment modality for this population

• Further evaluation of the psychometrics of the instruments

• General contribution of intervention research to the counseling field

Potential Limitations• Treatment fidelity

– Ensuring the group curriculum is adhered to– Each group had their own unique characteristics

• Novelty effect may present a threat to internal validity– Participants alter their behavior because the intervention produces

excitement and enthusiasm

• Data collection measures are all self-report– Not always the most accurate method

• Population and ecological validity• Attrition

– High number of waitlist group dropouts

Future Research

• Mixed methods research– Sequential explanatory design in particular, would be helpful in

determining the qualitative, lived experiences of the participants– Given that this is a newer intervention, it would also help identify

which elements of the intervention are the most and least helpful.

• Replication of the study – Younger age groups (13-19 years old)– Different geographical groups– Groups of any population that was underrepresented by the

current study (e.g., bisexual clients, transgender clients, etc.)

QUESTIONS?

Thanks!