Narratives as mirrors and doors: A multiple-method pilot evaluation of an online, family-level intervention for families with transgender and/or nonbinary youth.

Transgender and/or nonbinary (TNB) youth experience substantial stigma and discrimination in comparison to cisgender peers. While family support can buffer negative psychological effects of stigma and discrimination, TNB youth experience lower levels of family support. Family-level and narrative-based interventions are understudied strategies for addressing this challenge. We conducted a pilot test of the feasibility and acceptability of the Trans Teen and Family Narratives (TTFN) Conversation Toolkit, an online, narrative-based intervention for families of TNB youth. Participants included seven mental health providers (MHPs), nine TNB youth ages 13-21 years, and 21 parents/caregivers and siblings in the United States. TNB youth participants included two girls, three boys, and four nonbinary youth. Of 28 Caregivers, siblings, and MHPs, 16 were cisgender women. Most participants were White. We conducted surveys from 2021-2022 at multiple timepoints (baseline, end-of-testing, and 3- and 6-month follow-ups) and conducted interviews at end-of-testing. We analyzed interviews using immersion/crystallization and thematic analysis. Major themes included: 1) external and intrapersonal factors affecting toolkit usage, 2) participant experiences of character identification within toolkit content, and 3) participant recommendations. At end-of-testing, 24 of 34 retained participants watched six or more of the toolkit's eight digital stories and 28 used the toolkit for the expected amount of time. The TTFN Conversation Toolkit is a feasible and acceptable tool for TNB youth and families. The toolkit may serve as a resource to enhance clinical practice and mitigate the impacts of a harmful sociopolitical climate on TNB youth mental health.