What is AFFIRM?

AFFIRM is an eight session, manualized intervention that has substantial research evidence for its effectiveness. AFFIRM is focused on reducing depression and improving coping and sexual decision-making for LGBTQ+ youth and adults. AFFIRM teaches participants to recognize the link between their thoughts, feelings and behaviour, and helps them identify their strengths while learning healthy ways of coping. AFFIRM also gives participants the tools to manage their thoughts and behaviours to increase their positive feelings.

How can AFFIRM help me?

AFFIRM can help you cope better with life’s stressors, increase positive thoughts and feelings, and create a routine that integrates behaviours that affirm your sense of self. You can learn more here! It can also increase your feelings of hope for the future and your ability to deal with stress. AFFIRM will also introduce you to other LGBTQ+ folks your age and share community resources that you might find helpful.

What is affirmative CBT?

CBT stands for Cognitive Behavioural Therapy. It’s a type of therapy that uses our thoughts (the C in CBT), feelings, and behaviours (the B in CBT) to help improve our mood. CBT is considered a highly effective therapeutic treatment for depression, anxiety, and a wide range of other mental health issues. We’ve combined CBT with gender and sexuality affirming practices to make AFFIRM LGBTQ+ affirmative. What does this actually mean? We incorporate an understanding of the discrimination and stress that LGBTQ+ people face into our intervention. We talk about how anti-LGBTQ+ and other types of discrimination can create negative thoughts and feelings, and what we can do about that. AFFIRM is a CBT mental health intervention designed especially for the LGBTQ+ population.

What can CBT help with?

CBT has been demonstrated to help with anxiety, depression, OCD, bipolar, PTSD, phobias, eating disorders, substance use, pain and psychosis as well as many other mental and physical health concerns. The AFFIRM program has been shown to help with depression and anxiety, as well as increase hope and one’s ability to cope with stressful situations.

How do I sign up for AFFIRM?

Here’s how to sign up for an AFFIRM group in Ontario:

1. Find a group that fits for you! Find a group based on your age or referral agency (such as school board), and select the dates and times that work best for you.
2. Register your interest by clicking the Register button and completing the screener survey.
3. After completing the screener survey, you will receive an email within a week’s time inviting you to confirm your chosen group and to complete a pretest survey. This survey asks about your mental health and helps us get to know you better. You will receive a $25 gift card for completing this step!
4. One to two weeks before group starts, you will get an email from your group facilitators sharing more information about the group including the group’s Zoom link or location.
5. On the day of your meet-and-greet, all you have to do is attend!

For other locations, please contact agencies directly to learn more.

What is the meet-and-greet?

The meet-and-greet is a great opportunity to meet your group facilitators and other group members. It is also an opportunity to learn about more AFFIRM and ask any questions you might have in person. During the meet-and-greet we’ll do some activities to get to know each other better, discuss how AFFIRM will look, and review what we’ll be covering over the next eight weeks. Lastly, if you’re doing an online group, the meet-and-greet gives you the chance to make sure all your tech is in working order before group starts.

How does AFFIRM accommodate neurodiversity or special needs?

We have made sure that everyone who facilitates an AFFIRM group is a social worker or mental health clinician (typically LGBTQ+ themselves) with expertise in working with LGBTQ+ populations. They also have a lot of experience working with folks with a wide range of life experiences as well as neurodiversities and special needs. If you are concerned about accommodations, please reach out to our Clinical Evaluation Specialist, Rachael Pascoe to make sure we can accommodate your specific needs.

Does AFFIRM address intersectionality and other identities besides being LGBTQ+?

AFFIRM takes an intersectional approach to its groups, which means that we recognize that your LGBTQ+ identity might be just one of your multiple identities, and may not be the only minority identity that you embody. We facilitate AFFIRM grounded in the understanding that society impacts our different identities in a multitude of ways, whether we’re in queer spaces or outside of them. We will introduce ground rules at the beginning of the group and return to them throughout sessions to make sure AFFIRM feels like a safe place to participate.

Why are there surveys about the AFFIRM group?

Currently, we are studying AFFIRM to understand better how it positively impacts the wellbeing and coping of LGBTQ+ people across Canada. The surveys serve to help us gather information on how effective AFFIRM is. We already know from the last eight years of research that AFFIRM significantly reduced depression and appraising stress as a threat, as well as significantly increased reflective coping and perceiving stress as a challenge (for past participants). Participants also found AFFIRM helped them build skills to cope with life.

By participating in our research, you will have a chance to help future LGBTQ+ youth and adults access a program that reduces mental health challenges and build the evidence to support that LGBTQ-specific interventions are vitally important. We believe that we are a part of a community and, by participating in the research process, you are giving other queer youth and adults the opportunity to also benefit from AFFIRM. The results are always reviewed anonymously and we frequently update our logistics based on your suggestions. Because we value the time you dedicate to completing our questionnaires, we compensate survey completion with gift cards (although we are only able to provide gift cards to those living in Ontario due to funding). Learn more about our publications.

Who will be facilitating the groups?

AFFIRM is facilitated by skilled social workers and counsellors who have expertise in delivering support to the LGBTQ+ community as well as skills in facilitating groups. Your AFFIRM facilitators may be a part of our “internal team” (i.e., they work for Project AFFIRM), or are a skilled member of an agency we’re partnering with. All of our facilitators have completed two full-day trainings specific to AFFIRM and receive regular clinical supervision and support.

How long are AFFIRM groups?

AFFIRM groups are generally 1.5 to 2 hours (with breaks) and meet every week for a period of nine weeks (one meet-and-greet and eight AFFIRM sessions).

When are AFFIRM groups?

You can view a schedule of upcoming AFFIRM groups. We offer a couple of options for attending AFFIRM including daytime or evenings options from Monday through Friday, or during the weekends. Groups run throughout the year: the winter (January to March), spring (April to May), summer (June to July; August to September), and fall (September to October; November to December). When you find a group that best fits your schedule, sign up by completing the screener survey here. If you are unable to attend any of the scheduled groups, contact the AFFIRM Clinical Evaluation Specialist, Rachael Pascoe.

What does LGBTQ+ stand for?

LGBTQ+ stands for Lesbian, Gay, Bisexual, Transgender, and Queer while the “+” stands for other identifies under the sexual orientation and gender identity umbrella. There are many terms that LGBTQ+ people use to refer to themselves. Some of those terms are explained here, but it is also okay to respectfully ask an LGBTQ+ loved one about how they experience their identity in order to understand and help them better.

How can I help my LGBTQ+ child?

There are many ways that you can help your LGBTQ+ child. First of all, by being there, listening to them, and supporting them through any struggles that they may be experiencing is a great first step. It’s important to never question or doubt their identities and to do your own educating to make sure that you are being as culturally-aware as possible. If your child is dealing with stress from microaggressions, or what we call minority stress (everyday stress comes from societal discrimination), looking into LGBTQ+ affirmative supports can be a good option. This means counsellors with LGBTQ+ youth experience or formal programs like AFFIRM. Your child can sign up for AFFIRM by completing the screener survey on our website. PFLAG also has a helpful website with many resources for families.

What resources can I access to better support my child?

There are a number of resources available to better support you in supporting your child. Please visit our resources page for more information.

How are my LGBTQ+ child’s experiences different from straight or cisgender children?

We know from research that LGBTQ+ children and adolescents experience different kinds of stress compared to their straight or cisgender (i.e., those whose gender identity matches their sex) peers. This can come from experiences of discrimination that take place at societal, policy, social, and familial levels. We know that LGBTQ+ youth are more likely to experience harassment and bullying, and as a result, can suffer from mental health issues like depression, anxiety, self-harm, and suicidal thoughts. As a result, LGBTQ+ children and youth can benefit from therapy that is affirmative (or supportive) of their identities. AFFIRM is just one example of an affirmative intervention.

How can AFFIRM help my child?

AFFIRM is a type of group therapy program that lasts eight weeks and offers an environment that is affirmative and supportive of LGBTQ+ members’ identities, while also teaching Cognitive Behavioural Therapy (CBT) skills. CBT is the gold standard therapy treatment for anxiety and depression. AFFIRM will provide adolescents with skills to understand minority stress, address unhelpful thoughts, use behaviours to change negative feelings, grow their social networks, and build hope for the future. After AFFIRM is done, if your child needs any further support, their group facilitators can help to connect them with those resources.

How can I get my child registered for AFFIRM?

Here’s how to sign your child up for an AFFIRM group in Ontario:

1. Find a group that fits for your child! Find a group based on their age or referral agency (such as school board) and the dates and times that work for them.
2. They can register their interest by clicking the Register button and completing the screener survey. This survey helps us get their basic information.
3. After completing the screener survey, they will receive an email within a week’s time inviting them to confirm their chosen group and to complete a pretest survey. This survey asks them about their mental health and helps us get to know them better. They will receive a $25 gift card for completing this step!
4. One to two weeks before group starts, they will get an email from their group facilitators sharing more information about the group including Zoom link or location.
5. On the day of their meet-and-greet, all they have to do is attend!

For other locations, please contact agencies directly to learn more.

How old does my child need to be to attend?

We run groups for different ages and developmental states. We will place your child in the group that makes the most sense for their age or geographic area. We have groups for ages:

• 12-13
• 14-18
• 19-24
• 25+

What resources can I access to support my own mental health as a parent of an LGBTQ+ child?

We know that as a caregiver of a child that may experience identity-based stigmatizing experiences, it may be a good idea for you to receive your own support as well. There are many supports available to help adults and parents. In Ontario, you can find some of those supports here. You can also get in touch with us if you’re looking for more specific suggestions.

What does the research say about how AFFIRM can help?

We have been researching AFFIRM for almost a decade. Lead researcher, Dr. Shelley Craig has worked with LGBTQ+ youth in community-based care for over 20 years. Previous research has described the systematic development of AFFIRM including: (1) clinical case studies, (2) community-based participatory research to inform the proposed AFFIRM model, (3) incorporation of participant feedback into an affirmative and developmentally relevant intervention framework described in a “living” adapted manual (4) a clinical trial.

An open pilot feasibility study found AFFIRM significantly reduced depression and appraising stress as a threat, as well as significantly increased reflective coping and perceiving stress as a challenge. A recent control trial (with a comparison group) found that LGBTQ+ youth participants had reduced depression and improved coping, stress appraisal and hope (see visual). Participants stated that they built coping skills and felt affirmed. These studies (along with others) demonstrate that AFFIRM is both evidence-based and effective in improving the mental health of LGBTQ+ populations. Research continues to shed light on and emphasize the value of the AFFIRM model.

You can see some of our publications here.

How has AFFIRM adapted to the COVID-19 pandemic?

Since the onset of pandemic restrictions in Canada starting March 2020, we have offered AFFIRM online to all age groups. This means we’ve been able to continue to support our members and each other during the stress of the pandemic, even though we can’t meet in person. For now, all of our groups remain online. Once it is safe to do so, we will offer in-person and online groups.

We live in an area without a lot of resources. What can I access for help?

You can access AFFIRM no matter where you live in Ontario, thanks to our online groups. However, if you’re looking for other Ontario-based services or resources, try finding resources through LGBT Youthline. There may be other places that offer AFFIRM – see the list here.

How long will my child need to wait before starting the AFFIRM group?

Your child will have a choice of group date and time based on their availability. After completing the screener, interested participants will receive an email within a week asking them to confirm their participation in AFFIRM by completing a pretest. They will hear from their group facilitators two weeks before their group starts.

How can I support my child during their group?

AFFIRM facilitators work hard to offer support in group while it is being offered. We can also offer some limited support between groups during the week. If you have any concerns, you are welcome to reach out to us, but generally we have had a lot of success working directly with kids and teens through the group. The support you can offer them during the group can include providing them an opportunity to talk about their experiences if they wish to do so, encourage them to try out AFFIRM activities between groups and continue to be an open, present, and loving caregiver.

Who can I contact if we have a problem or question?

Please contact the AFFIRM Clinical Evaluation Specialist, Rachael Pascoe, MSW.

Where can I go if my child is in an emergency?

In case of an emergency, please call 911 or go to your nearest hospital emergency room. Unfortunately, AFFIRM is not a crisis service, and we will not be able to support you in case of an emergency.

Will everything I talk about in AFFIRM be confidential?

We take your privacy and confidentiality very seriously at AFFIRM. All the AFFIRM facilitators are registered social workers with experience working in groups with LGBTQ+ folks. Your name and other identifying information will be kept strictly confidential by both our AFFIRM facilitators and researchers. Our research process has received University of Toronto Research Ethics Board approval, meaning that we have permission from experts at the university to conduct our research as long as we remain ethical and confidential. You can see our ethics approval here (link). Even though everything you share in group is confidential, there are situations in which your group facilitators may need to breach your confidentiality for your safety. These situations include disclosures of intention to harm yourself or someone else or the abuse of a child under the age of 18. In these cases, your AFFIRM facilitator will work with you to make sure that you are aware of the process and the proper authorities who will be notified (i.e., Children’s Aid Society, 911, or the nearest Emergency Department). If you have questions about this, you can contact the AFFIRM Clinical Evaluation Specialist, Rachael Pascoe.

Is AFFIRM created for LGBTQ+ youth?

After working with LGBTQ+ youth in community-based care for over 20 years, Dr. Shelley Craig created AFFIRM with her friend Dr. Ashley Austin. AFFIRM is a therapeutic intervention made for queer youth with the input of queer youth. Based on our research and clinical experience, we know that LGBTQ+ youth from a diversity of backgrounds and across different cities, towns, and regions have benefitted from participating in AFFIRM. Throughout the years AFFIRM has been offered, LGBTQ+ youth have been contributing their feedback to make the AFFIRM intervention relevant and specific to their lives, and their support makes it easier for future generations to access the intervention.

How can AFFIRM help me?

AFFIRM can help you cope better with life’s stressors, increase positive thoughts and feelings, and create a routine that integrates behaviours that affirm your sense of self. See a visual representation of the ways AFFIRM can help you here. It can also increase your feelings of hope for the future and your ability to deal with stress. AFFIRM will also introduce you to other LGBTQ+ youth and share community resources that you might find helpful.

Will I have to miss school for AFFIRM?

You shouldn’t have to miss school to participate in AFFIRM. We offer AFFIRM after school hours or on weekends.

Can I invite friends to participate in AFFIRM?

Yes, we love receiving referrals from friends! Please send them our website and let them know we’ll be happy to answer any questions they have.

I’m still not sure if AFFIRM is for me. What have past youth participants said about AFFIRM?

No problem! We have many testimonials from past AFFIRM participants, as well past and present facilitators, you can watch here. If you’re still unsure, feel free to contact us with any questions you might have.

Are adults able to participate in AFFIRM groups?

Yes! We have adapted Youth AFFIRM to work with all age groups. We know from our research that AFFIRM is effective for adults of all age ranges.

Will AFFIRM fit my schedule?

We offer a variety of times to attend AFFIRM groups for you to choose from depending on your schedule. If you do not see a time that fits for you, please contact the AFFIRM Clinical Evaluation Specialist, Rachael Pascoe to discuss additional options.

Is AFFIRM for adults different than AFFIRM for kids?

The cores philosophies underpinning AFFIRM and the skills are the same in AFFIRM for adults as it is for youth. However, when you sign up, you will be placed in an adult specific group and the facilitators adapt the group material to be relevant to the specific needs and experiences of adults.

What does your research say about AFFIRM for adults?

Our research on adults who have completed AFFIRM shows that this intervention has the same benefits for adults as it does for youth participants. We have been researching AFFIRM for almost a decade. Lead researcher, Dr. Shelley Craig has worked with LGBTQ+ youth in community-based care for over 20 years. Previous research has described the systematic development of AFFIRM including: (1) clinical case studies, (2) community-based participatory research to inform the proposed AFFIRM model, (3) incorporation of participant feedback into an affirmative and developmentally relevant intervention framework described in a “living” adapted manual (4) a clinical trial.

An open pilot feasibility study found AFFIRM significantly reduced depression and appraising stress as a threat, as well as significantly increased reflective coping and perceiving stress as a challenge. A recent control trial (with a comparison group) found that LGBTQ+ youth participants had reduced depression and improved coping, stress appraisal and hope (see visual). Participants stated that they built coping skills and felt affirmed. These studies (along with others) demonstrate that AFFIRM is both evidence-based and effective in improving the mental health of LGBTQ+ populations. Research continues to shed light on and emphasize the value of the AFFIRM model.

You can see some of our publications here.

Can I offer AFFIRM at my agency in Ontario?

Yes! We love making AFFIRM more accessible to participants. In order to offer AFFIRM through your agency, at least one of your team members will have to participate in an AFFIRM training session. Once trained, our research team will connect with you to discuss how we can best support you in getting AFFIRM up and running through your agency. Since we are still researching AFFIRM, we want to note that each agency in Ontario implementing AFFIRM participates in the research process (as this is how we’re able to offer AFFIRM). AFFIRM has been approved through the University of Toronto Research Ethics Approved evaluation process and some agencies will also have their own internal ethics process. Agencies can help cofacilitate the group (a requirement for fidelity) for the first time with a member of our internal team for support and further training. They will also be able to participate in the AFFIRM research process (including the pre- and post-test surveys), get access to our Queer Gear Swag packages mailed to each AFFIRM group member, and receive a customized report of AFFIRM results at your agency. As a team we will support you through the process and will do all of the research legwork, leaving you to focus on co-facilitating the group and supporting participants. We would be happy to talk more about opportunities to offer AFFIRM at your agency. Please contact the AFFIRM Clinical Evaluation Specialist, Rachael Pascoe.

What is process for referring my client(s) to AFFIRM?

Even if your agency doesn’t offer AFFIRM, we recommend referring your clients to an AFFIRM group by sending them the link or helping them sign up through our screener. They will be placed into one of groups, based on their needs or age group.

Can I learn how to facilitate an AFFIRM group?

Yes! Dr. Shelley Craig (University of Toronto) and Dr. Ashley Austin (Barry University), who developed AFFIRM, offer trainings approximately once a year. You can sign up for training updates here.

I work with a special population. Can AFFIRM be implemented for LGBTQ+ clients with intersectional identities?

The more people who can benefit from AFFIRM the better! Contact the AFFIRM Clinical Evaluation Specialist, Rachael Pascoe to discuss how to best implement AFFIRM for your clients and how we can support you.

What is the ASSET manual and how can I request it?

ASSET (Affirmative Supportive Safe and Empowering Talk) is an empowering group intervention for LGBTQ+ youth created by Dr. Shelley Craig specifically to promote the resiliency of multiethnic sexual minority youth delivered in school settings. Facilitators offering this program have permission to download the manual and copy and distribute the handouts for use by participants. Otherwise, no part of this work may be reproduced or transmitted (for profit or otherwise) in any form or by any means electronic or mechanical, including photocopying and recording, or by any information storage and retrieval system without permission (except for a brief quotation in a review or professional work). The ASSET manual is available to request.