Providing LGBTQIA plus Affirming Mental Health Services in Schools: A Cultural Adaptation of Dialectical Behavior Therapy Skills Training for Emotional Problem Solving for Adolescents (DBT STEPS-A)

Despite growing concerns related to the youth mental health crisis and the well-being of sexual and gender minority youth, specifically, most mental health interventions fail to meet the unique needs of this population. Research and clinical guidance have recommended that approaching mental health treatments through a lens of minority stress and intersectionality can be particularly helpful in addressing the mental health concerns of LGBTQIA+ (lesbian, gay, bisexual, transgender, questioning/queer, intersex, and asexual, with the '+' capturing other identities within the gender and sexually diverse population) youth. Because many adolescents do not have access to mental health care, schools have an important role to play in meeting the mental health needs of LGBTQIA+ youth. To address these issues, we propose LGBTQIA+ affirming adaptations to the dialectical behavior therapy (DBT) Skills Training for Emotional Problem Solving for Adolescents (STEPS-A) curriculum using Pachankis et al.'s (2023) Adaptation Model to provide practitioners with a culturally affirming model of this social-emotional curriculum, while highlighting the utility of this framework in adapting other evidence-based interventions in schools. We walk readers through each module of DBT STEPS-A and provide rationale for adapting these skills for LGBTQIA+ youth. We offer specific adaptations that facilitators can make through psychoeducation and skills training. For example, we provide sample dialectics that mirror the experience of minority stress and propose examples of coping skills that are relevant for LGBTQIA+ youth (e.g., distracting and self-soothing to tolerate distress). Finally, the role of school psychologists in meeting the mental health needs of LGBTQIA+ youth is discussed along with implications for practice and future research.