The goal of this open pilot trial (OPT) is to develop a Lakota-adapted Family Acceptance Project (LFAP) for Indigenous 2SLGBTQ+ youth and their caregivers. The OPT is specifically focused on acceptability, feasibility, and safety of programming and research protocols. The investigators will also examine pre- to post- changes on outcomes for the sole purposes of making sure scores on measures are changing in the hypothesized direction (e.g., depression scores are going from moderate to minimal as opposed to no change or depression scores increasing). Once enrolled in the study, participants complete a baseline survey. Then participants will engage in LFAP which is an 8-session group intervention; sessions will be scheduled once a week for eight weeks (at 2 hours per session). Participants will complete survey instruments before and immediately after the program sessions, in addition to post-program surveys and an exit interview.

Research shows that Indigenous Lesbian, Gay, Bisexual, Transgender, Queer, and Two-Spirit (2SLGBTQ+) youth experience high rates of mental health problems. A key factor that leads to these challenges is family rejection (family behaviors and reactions that minimize, deny, ridicule and attempt to prevent or change a child's sexual orientation, gender identity and gender expression).

Family rejection among Indigenous 2SLGBTQ+ youth is rooted in colonization and multiple historical traumas. This includes disrupting traditional childrearing practices by forced placement in boarding schools that with other historical traumas focused on erasing Indigenous culture, including positive Two Spirit histories. Indeed, in many traditional Indigenous communities, including among the Lakota Oyate, Two Spirit relatives held important and honorable roles.

The Family Acceptance Project® (FAP) is a research, education and intervention program that was founded more than 20 years ago to help ethnically, racially and spiritually/religiously diverse parents and caregivers to learn to support and advocate for their 2SLGBTQ+ children and youth to prevent health and mental health problems and promote well-being. FAP conducted the first research on sexual minority and gender diverse youth and families and developed the first family support model to decrease family rejection and increase acceptance and support. FAP's work is grounded in the family's culture and spirituality/faith traditions.

The overall goal of the Tiwahe Tewichaglapi ("the family loves them" in Lakota) program is to apply FAP's culture-based model in the context of Lakota culture, history, and virtues. The investigators are carrying out this working partnership with community leadership to provide key family support services to 2SLGBTQ+ Lakota youth and their caregivers.

The open pilot trial (OPT) is specifically focused on assessing acceptability, feasibility, and safety of programming and research. The investigators will also use surveys to help us learn if the program impacts the project's goals above. Investigators will also ask SGMY and caregivers to share what they liked about the program and their guidance for enhancing it. This data will be used to further refine L-FAP prior to the start of the pilot RCT.

The goals of the program are to:

1. Promote parent/caregiver acceptance, respect, and support for their 2SLGBTQ+ Lakota youth.
2. Increase family bonding, love, support, and communication.
3. Increase LGBTQ2S+ youths' feelings of pride and hope about the future.
4. Reduce problems such as depression, anxiety, substance abuse, dating violence, and suicide.
5. Promote bright, happy, and thriving futures for 2SLGBTQ+ Lakota youth.

Before receiving Tiwahe Tewichaglapi, SGMY (ages 13 to 18) and their caregivers will complete a survey. After completing this initial (baseline) survey, half of the families will participate in program sessions. Following the first round of sessions, all participants will complete an immediate follow-up survey. After this final survey, the other half of families will attend the program sessions.

The project includes an Advisory Board with representation from 2SLGBTQ+ Lakota youth, their caretakers, and professionals who work with 2SLGBTQ+ Lakota youth and their families, Elders and Spiritual Leaders. These individuals will provide input on key aspects of the project to ensure that it is culturally grounded and impactful for 2SLGBTQ+ Lakota youth and their caregivers.

Youth Inclusion Criteria:

• Identify as 2SLGBTQ+ (and their identity must be known to their participating caregiver)
• Identify as Indigenous (multiracial youth who are also Indigenous are eligible)
• Youth should be between the ages of 13 and 18 years
• Read and speak English
• Report moderate to high levels of caregiver/family rejection (as evidenced by agreement on items that assess the presence and frequency of specific family rejecting behaviors [includes ambivalent and moderately and highly rejecting caregivers]
• Report an ability and commitment to attending eight sessions at two hours a week over eight weeks with their caregiver

Participating Caregiver Inclusion Criteria:

• Caregivers are broadly defined and may include a biological parent, stepparent, grandparent, aunt/uncle, or other adult who provides care to the Indigenous 2SLGBTQ+ youth
• Must be over the age of 18
• Read and speak English
• Be aware of the SGM identity of their Indigenous 2SLGBTQ+ youth
• report an ability and commitment to attending eight sessions at two hours a week over eight weeks with their teen

Exclusion Criteria:

• We will exclude Indigenous 2SLGBTQ+ youth and caregivers at imminent risk for suicide and/or who are experiencing current psychosis symptoms as determined by results on the safety items screener.