Implementing LGBTQ-affirmative CBT: study protocol for an effectiveness-implementation trial at 90 LGBTQ community centers
Abstract Background Sexual and gender minorities (SGM) experience among the largest mental health disparities of any population. One driver has been the lack of evidence-based practices (EBPs) addressing the distinct mechanisms underlying SGM’s risk. LGBTQ-affirmative cognitive-behavioral therapy (C...
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2025-07-01
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| Online Access: | https://doi.org/10.1186/s12913-025-13136-3 |
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| author | John E. Pachankis Danielle Chiaramonte Hunter T. Baldwin Corey Prachniak Deborah S. Levine Shawn Van Rebekah J. Hobbs Hadley Ankrum Lauren J. Wilkins Tyler D. Harvey Audrey Harkness Skyler D. Jackson Em Matsuno Zachary A. Soulliard Briana S. Last Julian Burger Molly Delehant Xin Zhou Ashley K. Hagaman Dennis H. Li Brian Mustanski |
| author_facet | John E. Pachankis Danielle Chiaramonte Hunter T. Baldwin Corey Prachniak Deborah S. Levine Shawn Van Rebekah J. Hobbs Hadley Ankrum Lauren J. Wilkins Tyler D. Harvey Audrey Harkness Skyler D. Jackson Em Matsuno Zachary A. Soulliard Briana S. Last Julian Burger Molly Delehant Xin Zhou Ashley K. Hagaman Dennis H. Li Brian Mustanski |
| author_sort | John E. Pachankis |
| collection | DOAJ |
| description | Abstract Background Sexual and gender minorities (SGM) experience among the largest mental health disparities of any population. One driver has been the lack of evidence-based practices (EBPs) addressing the distinct mechanisms underlying SGM’s risk. LGBTQ-affirmative cognitive-behavioral therapy (CBT) is among the only EBPs specifically for SGM mental health. LGBTQ community centers represent an ideal implementation setting for LGBTQ-affirmative CBT given their wide reach. Although direct training of mental health providers at LGBTQ community centers by experts has been shown to improve providers’ LGBTQ-affirmative CBT skills, it is unclear how such training should be optimally delivered. This paper describes the protocol of a trial that seeks to compare the effectiveness of three training strategies for implementing LGBTQ-affirmative CBT, identify center-level moderators of implementation success, and examine the impact of the three strategies on client mental health through theory-informed organizational and provider mechanisms. Methods This hybrid type III effectiveness-implementation trial will randomize 90 centers to receive one of three additive strategies for implementing LGBTQ-affirmative CBT: [1] a suite of self-paced digital learning materials (Materials Only condition); [2] these materials plus weekly live webinar training for 12 weeks (Direct Training condition); or [3] the above plus one year of supervision from a local supervisor who will receive expert consultation in a train-the-trainer format (Local Supervision condition). The primary outcome will be provider fidelity assessed via simulated practice. Implementation determinants (e.g., center resources, provider/client characteristics), mediators (e.g., implementation climate, provider self-efficacy), and other outcomes (e.g., intervention adaptation, sustainment) will be captured using a mixed-methods design. Clinical effectiveness outcomes (i.e., client mental and behavioral health symptoms) will be assessed through client surveys among a subset of 15 centers. Discussion Now that LGBTQ-affirmative CBT has shown efficacy across several trials and generated high demand, research is needed to determine nationwide implementation strategies. This study will identify optimal means through which to implement this treatment innovation in the US’s large network of LGBTQ community centers, thereby producing generalizable guidance for EBP implementation across low-resource settings nationwide in which mental health disparities populations are likely to seek treatment. Trial registration NCT05890404 (05/25/2023), https://clinicaltrials.gov/study/NCT05890404 . |
| format | Article |
| id | doaj-art-a7ada33169df4d41addd84f25e677a6d |
| institution | Kabale University |
| issn | 1472-6963 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj-art-a7ada33169df4d41addd84f25e677a6d2025-08-20T04:01:53ZengBMCBMC Health Services Research1472-69632025-07-0125111610.1186/s12913-025-13136-3Implementing LGBTQ-affirmative CBT: study protocol for an effectiveness-implementation trial at 90 LGBTQ community centersJohn E. Pachankis0Danielle Chiaramonte1Hunter T. Baldwin2Corey Prachniak3Deborah S. Levine4Shawn Van5Rebekah J. Hobbs6Hadley Ankrum7Lauren J. Wilkins8Tyler D. Harvey9Audrey Harkness10Skyler D. Jackson11Em Matsuno12Zachary A. Soulliard13Briana S. Last14Julian Burger15Molly Delehant16Xin Zhou17Ashley K. Hagaman18Dennis H. Li19Brian Mustanski20Department of Social and Behavioral Sciences, Yale School of Public HealthDepartment of Social and Behavioral Sciences, Yale School of Public HealthDepartment of Social and Behavioral Sciences, Yale School of Public HealthCenterLink: The Community of LGBTQ CentersCenterLink: The Community of LGBTQ CentersDepartment of Social and Behavioral Sciences, Yale School of Public HealthDepartment of Social and Behavioral Sciences, Yale School of Public HealthDepartment of Social and Behavioral Sciences, Yale School of Public HealthDepartment of Social and Behavioral Sciences, Yale School of Public HealthDepartment of Social and Behavioral Sciences, Yale School of Public HealthSchool of Nursing and Health Studies, University of MiamiDepartment of Social and Behavioral Sciences, Yale School of Public HealthDepartment of Psychology, Arizona State UniversityDepartment of Psychology, Miami UniversityDepartment of Psychology, Stony Brook UniversityDepartment of Social and Behavioral Sciences, Yale School of Public HealthDepartment of Medical Social Sciences, Feinberg School of Medicine, Northwestern UniversityDepartment of Social and Behavioral Sciences, Yale School of Public HealthDepartment of Social and Behavioral Sciences, Yale School of Public HealthDepartment of Medical Social Sciences, Feinberg School of Medicine, Northwestern UniversityDepartment of Medical Social Sciences, Feinberg School of Medicine, Northwestern UniversityAbstract Background Sexual and gender minorities (SGM) experience among the largest mental health disparities of any population. One driver has been the lack of evidence-based practices (EBPs) addressing the distinct mechanisms underlying SGM’s risk. LGBTQ-affirmative cognitive-behavioral therapy (CBT) is among the only EBPs specifically for SGM mental health. LGBTQ community centers represent an ideal implementation setting for LGBTQ-affirmative CBT given their wide reach. Although direct training of mental health providers at LGBTQ community centers by experts has been shown to improve providers’ LGBTQ-affirmative CBT skills, it is unclear how such training should be optimally delivered. This paper describes the protocol of a trial that seeks to compare the effectiveness of three training strategies for implementing LGBTQ-affirmative CBT, identify center-level moderators of implementation success, and examine the impact of the three strategies on client mental health through theory-informed organizational and provider mechanisms. Methods This hybrid type III effectiveness-implementation trial will randomize 90 centers to receive one of three additive strategies for implementing LGBTQ-affirmative CBT: [1] a suite of self-paced digital learning materials (Materials Only condition); [2] these materials plus weekly live webinar training for 12 weeks (Direct Training condition); or [3] the above plus one year of supervision from a local supervisor who will receive expert consultation in a train-the-trainer format (Local Supervision condition). The primary outcome will be provider fidelity assessed via simulated practice. Implementation determinants (e.g., center resources, provider/client characteristics), mediators (e.g., implementation climate, provider self-efficacy), and other outcomes (e.g., intervention adaptation, sustainment) will be captured using a mixed-methods design. Clinical effectiveness outcomes (i.e., client mental and behavioral health symptoms) will be assessed through client surveys among a subset of 15 centers. Discussion Now that LGBTQ-affirmative CBT has shown efficacy across several trials and generated high demand, research is needed to determine nationwide implementation strategies. This study will identify optimal means through which to implement this treatment innovation in the US’s large network of LGBTQ community centers, thereby producing generalizable guidance for EBP implementation across low-resource settings nationwide in which mental health disparities populations are likely to seek treatment. Trial registration NCT05890404 (05/25/2023), https://clinicaltrials.gov/study/NCT05890404 .https://doi.org/10.1186/s12913-025-13136-3Implementation scienceMental healthSexual and gender minorityCognitive-behavioral therapyStigma |
| spellingShingle | John E. Pachankis Danielle Chiaramonte Hunter T. Baldwin Corey Prachniak Deborah S. Levine Shawn Van Rebekah J. Hobbs Hadley Ankrum Lauren J. Wilkins Tyler D. Harvey Audrey Harkness Skyler D. Jackson Em Matsuno Zachary A. Soulliard Briana S. Last Julian Burger Molly Delehant Xin Zhou Ashley K. Hagaman Dennis H. Li Brian Mustanski Implementing LGBTQ-affirmative CBT: study protocol for an effectiveness-implementation trial at 90 LGBTQ community centers BMC Health Services Research Implementation science Mental health Sexual and gender minority Cognitive-behavioral therapy Stigma |
| title | Implementing LGBTQ-affirmative CBT: study protocol for an effectiveness-implementation trial at 90 LGBTQ community centers |
| title_full | Implementing LGBTQ-affirmative CBT: study protocol for an effectiveness-implementation trial at 90 LGBTQ community centers |
| title_fullStr | Implementing LGBTQ-affirmative CBT: study protocol for an effectiveness-implementation trial at 90 LGBTQ community centers |
| title_full_unstemmed | Implementing LGBTQ-affirmative CBT: study protocol for an effectiveness-implementation trial at 90 LGBTQ community centers |
| title_short | Implementing LGBTQ-affirmative CBT: study protocol for an effectiveness-implementation trial at 90 LGBTQ community centers |
| title_sort | implementing lgbtq affirmative cbt study protocol for an effectiveness implementation trial at 90 lgbtq community centers |
| topic | Implementation science Mental health Sexual and gender minority Cognitive-behavioral therapy Stigma |
| url | https://doi.org/10.1186/s12913-025-13136-3 |
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