Creating Access to Resources and Economic Support (CARES)

Project Summary/Abstract Transgender people experience economic and psychosocial inequities that make them particularly vulnerable to COVID-19 pandemic-related financial and mental health harms. Sustainable, multilevel interventions are needed to address these harms and promote COVID- 19 prevention behaviors. Transgender-led organizations have been galvanized to provide emergency financial and peer support for transgender people negatively impacted by COVID- 19. However, the efficacy of these interventions have not been evaluated. Leveraging existing community partnerships and ongoing cohorts, the study seeks to assess the efficacy of feasible, acceptable, community-derived interventions to reduce economic and psychological harms experienced by transgender people in the wake of COVID-19. The specific aims of the project are to (1) compare the efficacy of microgrants with or without peer mentoring to reduce psychological distress and increase COVID-19 prevention behaviors; (2) examine mechanisms by which microgrants with or without peer mentoring may impact psychological distress; and (3) explore transgender participants' intervention experiences and perceived efficacy. These aims will be met by enrolling 360 transgender adults into an embedded, mixed methods, 3-arm, 12- month randomized controlled trial. Participants will be randomized 1:1:1 to the following arms: (a) a single microgrant plus monthly financial literacy education (usual care); (b) usual care plus monthly microgrants; or (c) usual care plus monthly microgrants combined with peer mentoring. All intervention arms will last for 6 months, and participants will complete semi-annual web- based surveys at 0, 6, and 12 months as well as text-based process measures at 3 and 6 months to meet Aims 1 and 2. A subset of 36 participants, 12 per arm, will complete longitudinal in depth interviews at 3 and 9 months to meet Aim 3. In addition to addressing the pressing impacts of the COVID-19 pandemic on a vulnerable health disparities population, this study will advance the science of minority stress and mental health inequities by testing interventions that operate on general stressors - i.e., material hardship and community connection - rather than minority stressors such as enacted stigma. This national, online study will address multilevel - structural and community - factors driving COVID-19 pandemic harms. Its equitable community partnership will ensure that study findings are actionable and disseminated rapidly to inform sustainable community-based responses to the COVID-19 pandemic as well as future emergencies.