HEALing transgender women of color in Los Angeles: A transgender-centric adaptation of the evidence based practice Seeking Safety

Background: Transgender women of Color experience disproportionate rates of HIV, depression, and anxiety, and high rates of substance use, attempted suicide, and interpersonal verbal, physical, and sexual violence and assault. However, there are few interventions targeting transgender women of Color that address overlapping health and mental health challenges. Aims: There are two aims/research questions: (1) what are the elements of a transgender-centric translation model for adapting evidence based interventions and practices?, and (2) does HEAL improve substance use and mental health outcomes for transgender women of Color? Methods: We present a case study of the adaptation process to translate the evidence based practice Seeking Safety by Special Service for Groups/Asian Pacific AIDS Intervention Team (SSG/APAIT) to the transgender-centric HEAL (Healing, Empowering, And Living) program, and analyze baseline and three month post program participant data (n = 81). Results: The transgender-centric model of intervention adaptation consisted of multiple steps, building on existing adaptation frameworks, but also integrating the structural disadvantages experienced by transgender women of Color. Comparing baseline and three months after completion of HEAL showed significant decrease in reported alcohol use, depression, and severe anxiety. Discussion: Transgender-centric translation approaches may lead to programs that significantly improve co-occurring substance use and mental health for transgender women of Color. We recommend that organizations aiming to adapt existing programs include feedback from members of the communities that the adapted programs aim to help, and in addition, train community members to deliver the programs. The statistical results indicate that HEAL, a trauma-based program with a short program delivery timeline, may show longer term effects on substance use and mental health. We recommend that programs targeting substance use and mental health for transgender women of Color should be combined with services that address disadvantage (i.e., lack of access to housing, income/employment, health care).