AFFIRM Caregiver

Parents and Caregivers of LGBTQ+ (lesbian, gay, bisexual, transgender, queer and questioning, etc.) youth and young adults ages 0–24 

AFFIRM Caregiver is a seven-session group for adults who care for LGBTQ+ youth. It centers on creating safer, more affirming homes and family contexts while giving caregivers a supportive, closed-group space to learn, practice, and grow together. Caregivers are taught how to affirm their young people even before they know everything, and how to notice, challenge, and let go of beliefs or reactions that may be causing harm. Each session blends brief teaching, guided reflection, and hands-on skill practice, with simple take-home actions between meetings. Topics include identity affirmation, minority stress and coping, affirming communication, compassionate boundaries, hope-building, and strengthening supportive networks. Co-facilitated by trained leaders, cohorts run in person or virtually, weekly or in bundled formats. Caregivers aim to leave with practical language, routines, and confidence—and a peer community—to support lasting change at home. 

Ashley Austin, PhD, LCSW

• Agency/Affiliation: Affirmative Research
• Website: https://www.affirmativeresearch.net/
• Email: mail@affirmativeresearch.net
• Phone: 561-654-1549

Shelley Craig , PhD, RSW, LCSW

• Agency/Affiliation: Affirmative Research
• Website: https://www.affirmativeresearch.net/
• Email: mail@affirmativeresearch.net
• Phone: 561-654-1549

The goals of AFFIRM Caregiver are:

• Increase confidence to provide affirming, identity-supportive caregiving
• Strengthen affirming attitudes and intentions toward their LGBTQ+ youth
• Understand LGBTQ+ identities and minority stress to better recognize what their youth is navigating
• Foster empathy, self-reflection, and compassion in parenting and caregiving
• Notice, challenge, and let go of beliefs or reactions that may be harming their LGBTQ+ young person
• Engage in compassionate approaches to communication and connection with their LGBTQ+ young person
• Expand affirmative help seeking and resource use
• Increase capacity to advocate on behalf of their LGBTQ+ youth
• Cultivate safer, more inclusive and identity-affirming supports for LGBTQ+ youth

The essential components of AFFIRM Caregiver include:

• Foundational Pillars:
  • Affirmative Practice:
  • Practice-first affirmation:
    • Use the youth’s name/pronouns
    • Validate identity
    • Choose curiosity over correction even before you “know everything.”
  • Trauma-Informed Care (Lead with Love):
    • Recognizes that nonaffirmation is traumatizing
    • Focuses on prevention through four practices:
      • Let affection show
      • Express hurt feelings away from kids
      • Avoid rejecting behaviors
      • Do good before you feel good (act affirmingly while emotions catch up).
  • Compassion-Focused Parenting:
    • Lowers shame/defensiveness so caregivers can:
      • Notice harmful beliefs
      • Challenge harmful beliefs
      • Let go of harmful beliefs
      • Repair after missteps
• Safe, Affirming Group Environment (facilitator stance):
  • Facilitators balance meeting caregivers where they are with unconditional positive regard AND consistently modeling LGBTQ+ affirmation:
    • Language
    • Names/pronouns
    • Strengths focus
  • Facilitators support movement toward more affirming parenting through:
    • Structured reflection
    • Skill practice
    • Gentle accountability
• Understanding the impact of anti-LGBTQ+ attitudes and behaviors on stress:
  • Understanding of the role of early messaging on thoughts and feelings about LGBTQ+ identities
  • Recognize the harmful impact of minority stressors on LGBTQ+ youth well-being and mental health outcomes
  • Recognize the positive impact of family acceptance on LGBTQ+ youth outcomes
  • Development of new strategies for coping with and challenging behaviors rooted in homophobia, biphobia, and transphobia
  • Exploration of the intersectional dimensions of diversity:
    • Race
    • Religion
    • Culture
• Supporting LGBTQ+ Youth During the Coming Out Process:
  • Understand that coming out is iterative and context-dependent, occurring across settings and relationships over time rather than as a single event
  • Recognize acceptance as a protective factor—consistent everyday affirmation is associated with improved:
    •  Safety
    • Connection
    • Well-being
  • Recognize rejection as a risk factor that undermines trust and is linked to adverse outcomes. Rejection includes:
    • Shaming
    • Minimization
    • Misgendering
    • Pressure to conceal identity
  • Prioritize youth safety and avoiding retraumatization by demonstrating an unconditional loving stance
  • Regulate and process caregiver affect outside youth interactions so that these are addressed without burdening the youth:
    • Anxiety
    • Grief
    • Confusion
  • Avoiding explicit and implicit rejecting behaviors
  • Provide affirmation amid uncertainty—engaging in affirming practices while continuing to build one’s own LGBTQ+ understanding and acceptance
• Compassionate Caregiving: An Affirmative Approach:
  • Build self-care and self-compassion habits
  • Foster youth self-compassion by consistently modeling compassion and acceptance
  • Recognize compassionate caregiving as being trauma-informed
  • Embrace LGBTQ+-specific compassionate parenting strategies:
    • Know your child
    • Change your perspective & appreciate difference
    • Approach problems compassionately
    • Communicate acceptance
    • Know your triggers
    • Recognize subtle disapproval
    • Empathize
    • Accept yourself
• Developing Safe, Affirming Caregiver and Youth Networks of Support
  • Recognize the importance of identity-affirming activities on LGBTQ+ youth well-being
  • Learn and practice ways to engage in identity-affirming activities with the youth and on behalf of the youth
  • Explore and recognize the impact of affirming vs. nonaffirming people and systems on caregiving capacity and youth well-being
• Overcoming Barriers and Building Hope through Goal Setting
  • Recognize the relation among affirmation, hope, and well-being for LGBTQ Youth
  • Identify actions that empower youth in the face of discrimination
  • Practice advocating on behalf of their LGBTQ+ youth
  • Establish caregiving goals aimed at more explicitly affirming their LGBTQ+ youth’s needs and experiences
• Putting It All Together: An Affirming Transformation
  • Reflect on progress and growth by reviewing:
    • Key learnings
    • Shifts in attitudes
    • Shifts in behaviors
    • Shifts in family climate
  • Commit to continued affirmation: name the affirming practices to sustain and deepen at home and across settings
  • Connect to supports and resources by:
    • Identifying affirming people
    • Identifying affirming programs
    • Identifying services to access next
    • Clarifying how to reach the above when needed

Parent/Caregiver Services

AFFIRM Caregiver directly provides services to parents/caregivers and addresses the following:

• Rejecting behaviors toward LGBTQ+ youth, interpersonal/relational abuse rooted in anti-LGBTQ+ attitudes and behaviors, parental stress, reactivity, and dysregulation rooted in misinformation about LGBTQ+ identities, parent-child conflict and disconnection

Recommended Intensity

Typically one weekly 90-minute session

Recommended Duration

7 weeks/sessions 

Delivery Settings

This program is typically conducted in a(n):

• Adoptive Home
• Birth Family Home
• Community Daily Living Setting
• Community-based Agency / Organization / Provider
• Foster / Kinship Care
• Group or Residential Care
• Hospital
• Outpatient Clinic
• Public Child Welfare Agency (Dept. of Social Services, etc.)
• School Setting (Including: Day Care, Day Treatment Programs, etc.)
• Virtual (Online, Smartphone, Zoom, Telephone, Video, etc.)

Homework

This program does include a homework component.

Very brief, between session activities (5-15 minutes) in which participants try out new skills (e.g., self-reflection, new affirmative parenting practice)

Resources Needed to Run Program

The typical resources for implementing the program are:

In-Person groups should have: 

• Art supplies
• Colored pencils
• Markers
• Craft paper
• Paper for note taking
• Large easel pad or whiteboard
• A room large enough to accommodate a group
• Snacks
• Printed workbooks
• A computer and projector to play the online videos that are part of this curriculum

Virtual groups should have access to a user-friendly, group-based telehealth platform (e.g., Zoom) with: 

• Printed participant workbooks delivered to participant homes before the program begins
• Effective Wi-Fi for delivering group-based virtual interventions

Prerequisite/Minimum Provider Qualifications

A mental health degree such as Master of Social Work (MSW), Professional Counselor (PC), Marriage and Family Therapist (MFT), Psychologist 

Manual Information

There is a manual that describes how to deliver this program.

Program Manual(s)

Manual details:  

• Austin, A., & Craig, S. L. (2017). Affirmative caregiving for lesbian, gay, bisexual, transgender, questioning and queer+ (LGBTQ+) populations: Intervention manual. University of Toronto. 

Virtual pdf versions of the manual and workbook are provided to all AFFIRM Caregiver trained facilitators. 

Training Information

There is training available for this program.

Training Contact

Training Type/Location:

Affirmative Research holds virtual AFFIRM Caregiver trainings for individuals seeking training throughout the year that can be purchased through the Affirmative Research Website. Affirmative Research also offers virtual organizational trainings which can also be scheduled at the organization’s convenience. In-person organizational training can be available on request. 

Implementation resources are available from the Training Contact above.

Number of days/hours:

The virtual trainings are held over 3 days for 5.5 hours per day for providers. There is no separate supervisor training. 

What is included in the Relevant Published, Peer-Reviewed Research section? 

• Note: The following study was not included in rating AFFIRM Caregiver on the Scientific Rating Scale.

  Austin, A., Craig, S. L., Matarese, M., Greeno, E. J., Weeks, A., & Betsinger, S. A. (2021). Preliminary effectiveness of an LGBTQ+ affirmative parenting intervention with foster parents. Children and Youth Services Review, 127, Article 106107. https://doi.org/10.1016/j.childyouth.2021.106107

  Summary:

  The purpose of the study was to examine the initial effectiveness of AFFIRM Caregiver, a 7-session, manualized intervention aimed at enhancing affirmative parenting practices among foster parents. Participants received AFFIRM Caregiver. Measures utilized include the Attitudes Towards Diverse Orientations, Attitudes Towards Diverse Gender Identities and Expressions, Behaviors Related to Working with Lesbian, Gay, and Bisexual Children/Youth (Behaviors LGB), Behaviors Related to Caring for Transgender Children/Youth (Behaviors T), and The Affirmative Caregiving Self-Efficacy Inventory (ACSI). Results indicate that there were significant improvements in affirmative caregiving attitudes, behaviors, and self-efficacy at post-test, as well as at the 3-month follow-up assessment. Limitations include lack of randomization, lack of controlled postintervention follow-up, and reliance on self-report measures. Note: This article was not used in the rating process due to the lack of a control group.

• Kaye Implementation & Evaluation. (2022, September 28). Analysis brief: Interviews with AFFIRM staff and participants [Unpublished analysis brief for the National SOGIE Center]. https://tinyurl.com/5n695hbj
• National SOGIE Center. (2024). AFFIRM Caregiver report: A Center of Excellence for LGBTQ+ Behavioral Health Equity Project (2023–2024). Unpublished report. https://tinyurl.com/mpj2b4nn
• The Institute for Innovation and Implementation (QIC-LGBTQ2S). (2021). AFFIRM Caregiver data dashboard: Cuyahoga County, OH & Allegheny County, PA (2018–2021) [Unpublished data brief for the National SOGIE Center]. https://sogiecenter.org/wp-content/uploads/2023/03/AFFIRM-Caregiver-Data-Dashboard.pdf