Effectiveness of an LGBTQ+ E-Learning Module for Social Workers: A Randomized Controlled Trial

Jason Schaub; Jolie R. Keemink; Willem J. Stander; Paul Montgomery

doi:10.1177/10497315231208199

Effectiveness of an LGBTQ+ E-Learning Module for Social Workers: A Randomized Controlled Trial

Schaub, Jason; Keemink, Jolie R.; Stander, Willem J.; Montgomery, Paul 2025-01-01 00:00:00 Purpose: To evaluate the effectiveness of an e-learning training module for improving children’s social workers’ knowledge of, and attitudes toward, LGBTQ+ young people. Methods: A pragmatic randomized, CONSORT-compliant controlled trial to compare an intervention group (N = 304) with a business-as-usual comparison group (N = 310). After attrition, the anal- ysis included 188 (intervention) and 278 (comparison) participants. The main outcome measures were the Heteronormative Attitudes and Beliefs Scale and a perceived LGBTQ+ knowledge measure, controlling for several covariates. Results: A sig- niﬁcant effect of intervention on both outcome measures, using several rigorous analysis approaches and missing data impu- tation methods. Participants who undertook the training decreased their heteronormative attitudes and beliefs and increased their perceived LGBTQ+ knowledge compared to business as usual. Conclusion: This study demonstrates the effectiveness of an e-learning training intervention in improving knowledge of, and attitudes toward, LGBTQ+ young people. Implications for research, practice, and policy are outlined. Keywords LGBTQ, young people, social work, e-learning, randomized controlled trial Until recently, little attention has been given to the experi- adverse effect on mental health outcomes (Evans et al., ences of lesbian, gay, bisexual, transgender, and queer or 2017; Ford et al., 2007). Although fewer data are available questioning (LGBTQ+) young people in the social care regarding the experiences of transgender and gender-diverse system, or the needs of social workers supporting this popu- young people, the literature suggests heightened challenges lation. A systematic scoping review of the international evi- among this group from peers, birth families, and social care professionals (Mountz et al., 2018; Schaub, Stander, et al., dence demonstrates that LGBTQ+ young people are 2022). Overall, LGBTQ+ young people are less satisﬁed disproportionately overrepresented in social care, and experi- with their out-of-home care experiences than non-LGBTQ+ ence poorer health, mental health, and well-being outcomes youth and have speciﬁc social care needs that often go compared to their cisgender and heterosexual counterparts unmet or ignored due to prevailing hetero- and cisnormative in care (Schaub, Stander, et al., 2022). It is estimated that societal values or biases (McCormick et al., 2017; Schaub, between 15.5% and 30.4% of young people in care identify Stander, et al., 2022). as LGBTQ+, and this overrepresentation is far greater for One of the most signiﬁcant challenges in supporting those from racial or ethnic minority backgrounds (Fish LGBTQ+ young people is limited knowledge and training et al., 2019; Schaub, Stander, et al., 2022). While LGBTQ+ in this area for social workers. Social work students and prac- young people enter care for the same reasons as their peers titioners report a lack of knowledge and an absence of (e.g., abuse, neglect), they often experience rejection, margin- alization, and discrimination related to their sexual orienta- Department of Social Work and Social Care, University of Birmingham, tion, gender identity, and expression (SOGIE) in different Birmingham, UK phases of contact with the care system, from initial referral Centre for Health Services Studies, University of Kent, Canterbury, UK through to aging out or leaving care (Kaasbøll et al., 2021; Department of Social Policy, Sociology and Criminology, University of Schaub, Stander, et al., 2022). This includes increased place- Birmingham, Birmingham, UK ment instability or breakdown, longer duration of time spent Corresponding Author: in care, and an overreliance on restrictive group home place- Jason Schaub, Department of Social Work and Social Care, The University of ments for LGBTQ+ youth (McCormick et al., 2017; Schaub, Birmingham, Edgbaston, Birmingham B15 2TT, UK. Stander, et al., 2022), which have been found to have an Email: [email protected] 2 Research on Social Work Practice 0(0) adequate training to meet the needs of LGBTQ+ young face-to-face training. First, e-learning training programs provide people, and trans and gender-diverse people especially ﬂexibility and easy access to learning materials from any location (Craig et al., 2016; Inch, 2017; Schaub, Stander, et al., from which the learner has access to the Internet (Akhter et al., 2022). In addition to this, social workers and social work stu- 2021; Gad, 2023). E-learning training modules may be an attrac- dents may also have neutral or even negative and homo/bi/ tive option for social workers who struggle with high workloads trans-phobic attitudes toward LGBTQ+ young people, and and caseloads. Second, this type of training can be developed do not believe that care systems are particularly protective and maintained with limited resources and as a result can be or supportive of this population (Greeno et al., 2022; offered at a low price (Akhteret al., 2021). This may be particularly Weeks et al., 2018). Indeed, LGBTQ+ young people report relevant in contexts where there are ongoing developments in the cis/heteronormative care environments, delaying disclosure policy and legal landscape concerning LGBTQ+ rights. of their SOGIE in fear of negative reactions, and harmful To the best of the authors’ knowledge, this study is the ﬁrst encounters with professionals who characterized their RCT evaluating the effectiveness of e-learning training SOGIE as pathological, predatory, and circumstantial module for improving the knowledge and attitudes of social (Kaasbøll et al., 2021; Schaub, Stander, et al., 2022; Schaub workers about LGBTQ+ young people. We also examined et al., 2023). Afﬁrming relationships with social workers is possible factors that might account for differences in particularly important to the resilience of this population primary outcomes. The literature suggests several factors and an openness and willingness to discuss SOGIE-related that may facilitate or inhibit the effectiveness of LGBTQ+ issues are strongly associated with positive outcomes knowledge programs including age, gender, religiosity, and (Álvarez et al., 2022; Paul, 2020; Ryan et al., 2009; Schaub a connection to the LGBTQ+ community. Previous studies et al., 2023). Training can thus have a signiﬁcant positive highlight the impact of intergenerational differences in under- impact on the experiences of LGBTQ+ young people; standing SOGIE among helping professionals, with younger however, there is a dearth of research in this regard. generations correlated with more positive attitudes toward Several studies have investigated the efﬁcacy of ongoing LGBTQ+ communities (Gandy-Guedes, 2018). It has also professional development and training in improving knowl- been well established that women display more favorable atti- edge, attitudes, and beliefs of helping professionals toward tudes than men toward LGBTQ+ people (Dotti Sani & LGBTQ+ individuals, and the results are promising. Recent Quaranta, 2020; Herek, 2002), and there is a close connection systematic reviews exploring the effectiveness of LGBTQ- between religious afﬁliation, or religiosity, and negative atti- related training interventions among medical, nursing, and tudes among social workers toward LGBTQ+ people mental healthcare students and providers found that educa- (Westwood, 2022). Finally, having a close friend or family tional programs can be effective at improving self-reported member who identiﬁes as LGBTQ+ has been linked to knowledge and promoting more tolerant attitudes about the greater LGBTQ+ knowledge and the potential to engage in LGBTQ+ community and LGBTQ-related healthcare supportive behaviors in a recent survey with care profession- (Bettergarcia et al., 2021; Yu et al., 2023). Similarly, als in the USA (Greeno et al., 2022). studies found that professional development training pro- The current study tested the effectiveness of an e-learning grams on LGBTQ+ issues had signiﬁcant positive effects training module for children’s social workers in England to on teachers’ and educators’ beliefs and attitudes toward support LGBTQ+ young people, compared to “business as LGBTQ+ young people (Greytak et al., 2013; Szalacha, usual.” We evaluated the impact of the training on LGBTQ 2003). Nevertheless, there is a paucity of research regarding + knowledge and heteronormative attitudes and beliefs. the training of social workers. A recent non-randomized Based on previous literature, we developed the following pre- and post-test study evaluating an LGBTQ+ competency hypotheses: training intervention (comprising of two 3-hr in-person ses- sions) with child welfare practitioners (i.e., social workers, clinicians, and group home staff) indicate that practitioners 1. Intervention group participants will increase their signiﬁcantly improved their knowledge of LGBTQ+-related LGBTQ+ knowledge, in comparison to the control issues and competencies post-training (Weeks et al., 2018). group. It is expected that the score on the LGBTQ+ Much of this work, however, originates from the USA with Knowledge Scale (KNWL) will increase between the an absence of international research and no large, robust pre- and post-test for the intervention group, and studies, such as randomized controlled trials (RCT), to date remain similar for the comparison group. evaluating the effectiveness of such training for social care 2. Intervention group participants will decrease in hetero- professionals for supporting LGBTQ+ young people (Hunt normative attitudes and beliefs, in comparison to the et al., 2019; Schaub, Stander, et al., 2022). control group. It is expected that the score on the The use of e-learning modules can be an effective strategy to Heteronormative Attitudes and Beliefs Scale (HABS) provide ongoing professional development and enhancement of will decrease between the pre- and post-test for the professionals’ knowledge in working with marginalized popula- intervention group and will remain similar for the tions. This method has several advantages over traditional control group or decrease to a lesser extent. Schaub et al. 3 Moderators taken from previous literature (described above) three key reasons: (1) The e-learning intervention is already including age, gender identity, religiosity, connection to the in wide use, making it important to test its effectiveness; (2) LGBTQ+ community, and previous training, are included a number of cohort trials of education programs suggest this as covariates. We recognize that the study is underpowered is a promising way of informing social workers about sexual- to detect such effects with statistical signiﬁcance, so these ity and gender (Inch, 2017; Schaub et al., 2017); and (3) there tests will be indicative only. was sufﬁcient recruitment power to conduct a pRCT that would provide meaningful results. Method The census-style process evaluation was conducted in accor- dance with key Medical Research Council (MRC) guidance Design (Moore et al., 2015). It was designed to assess the intervention delivery to understand and explain any identiﬁed intervention This study has a two-armed, pre- and post-test, pragmatic effects (or lack thereof; see Schaub, Montgomery, et al., 2022 pRCT design combined with a census-style process evalua- for further details on design and conduct). Additionally, it tion. PRCTs measure the effectiveness of an intervention in aims to understand the extent to which participants were satisﬁed “the real word,” more speciﬁcally, under usual conditions with different aspects of the training program and identify any of care (Zwarenstein et al., 2008). Participants were individu- suggested changes for improvement. ally randomized to either the intervention or control group. This trial was analyzed and reported in line with the Intervention participants were provided access to the Consolidated Standards of Reporting Trials for Social and Stonewall e-learning module, and the control group followed Psychological Interventions (CONSORT-SPI) reporting guid- a “business as usual” model (further details provided in ance (Montgomery et al., 2018) and a checklist is available Table 1). A pRCT design was appropriate for this study for Table 1. TIDieR Table for the Intervention Arm. Brief Name 1. The intervention was an existing e-learning training module titled Supporting LGBTQ+ Children and Young People delivered by Stonewall. Why 2. The training is speciﬁcally tailored to, and widely used by, local authorities in England and was offered to participants free of charge (normally £35 per person). This CPD-accredited e-module was designed to improve the attitudes, knowledge, skills, and conﬁdence to support LGBTQ+ youth. What 3. The training consisted of four learning units: (1) LGBTQ+ terminology, experiences, and intersecting identities; (2) the law and practice obligations in relation to LGBTQ+ inclusion; (3) strategies to prevent and tackle homo-, bi-, and transphobic bullying and language; and (4) appropriate signposting. The training can be accessed on the Stonewall website (https://www.stonewall.org.uk/supporting-lgbtq-children- and-young-people). 4. Learners were provided with essential information, practical advice, and interactive activities that encourage consideration of how LGBTQ + inclusive practice can be embedded in their own setting. Who provided 5. The intervention was delivered by Stonewall, the leading UK charity standing for LGBTQ+ people. How 6. The training was provided online. Participants allocated to the intervention group received login details via email and could complete the training individually in their own time. Where 7. The training could be accessed on any device with internet, at work or at home. When and How Much 8. In total, it took between 2 and 4 hr to complete the training. This could be done in one sitting, or by completing sections at several time points when time allowed. Depending on when participants registered, they had between 2 weeks and 3 months to complete it. Tailoring 9. The intervention was the same for each participant. Modiﬁcations 10. There were no major modiﬁcations to the intervention. Minor modiﬁcations were made by the research team to content such as case study examples to better reﬂect social work settings or practice. How well 11. Participants could only continue to the next unit if they had completed the previous one. They were only referred to the post-test survey and offered remuneration in the form of £10 voucher if the training had been fully completed. The research team had access to Stonewall’s online training platform which allowed them to check progress. 12. Only participants who had fully completed the training were included in the analysis. 4 Research on Social Work Practice 0(0) by writing the corresponding author. This study followed a Control Arm: Business as Usual. Participants in the control published protocol (Schaub, Montgomery, et al., 2022)and uti- group received an email informing them that they would lized co-production techniques involving a range of stakehold- undergo business-as-usual (BAU) training conditions as pro- ers, including social care professionals and a group of LGBTQ vided by their employer (e.g., general Equality and Diversity + young people (16–24)withlived experiences ofsocialcare. training which is mandatory in the UK), and that they would Study design included feedback from stakeholders at different be contacted in November 2022 to capture such training and stages of development, implementation, and evaluation. We complete the post-test. There was no further contact between also solicited stakeholder perspectives on drafted practice and the control group and the research team. While this posed a policy recommendations. The trial was registered on the risk for attrition, this approach reﬂects the pragmatic nature Open Science Framework (OSF; https://osf.io/25d8z). of this trial and approximates the real-world context. We rec- ognize that there would be considerable heterogeneity within this group as BAU is likely to vary across social work depart- Participants and Procedures ments across the country. However, this variability forms a Participant recruitment was designed in response to the dis- sound, pragmatic basis from which to compare the interven- persed nature of the social care sector and the scale of the tion. It may also be the case that some participants may study. Participants were recruited using a number of comple- have accessed the intervention (contamination). mentary sampling strategies. First, the research team drew on existing connections with social work networks and connec- Measures tions to disseminate the recruitment call. Second, we under- took a social media campaign advertising the study on Measures were administered between June and November Twitter, LinkedIn and Facebook. Third, we approached indi- 2022. The primary outcome measures for this study were het- viduals based on their speciﬁc position and knowledge (crit- eronormative attitudes and beliefs and perceived LGBTQ+ ical case sampling). Lastly, we used chain sampling, asking knowledge. The pre- and post-tests aim to detect changes in participants to forward the recruitment call to other potential the two outcome measures before and after randomization. participants (Onwuegbuzie & Collins, 2007). A separate paper provides recommendations for the recruitment and reten- Outcome Measure 1: Heteronormative Attitudes and Beliefs. tion of social workers as research participants (Keemink et al., Heteronormative attitudes and beliefs are measured with the forthcoming). 16-item HABS (Habarth, 2015), which assesses participants’ The recruitment advert provided potential participants with heteronormative attitudes, as well as including elements of a registration link to a Qualtrics (2020) page where eligibility gender identity. Questions are answered on a 7-point Likert was checked. Individuals were eligible to participate if they scale, ranging from strongly disagree to strongly agree. The met all four inclusion criteria: (1) employed by a local author- HABS produces an overall score with excellent internal reli- ity in England, (2) work in children’s social care services, (3) ability (α = .91) and consists of two subscales, Essential Sex registered with Social Work England, and (4) not have previ- and Gender, which has excellent reliability (α = .92), and ously completed a Stonewall e-learning module. If criteria Normative Behavior, which has acceptable reliability (α = were met, they were sent a Qualtrics link to the pre-test survey .78). Items 1, 4, 9, 11, 12, 15 and 16 are reverse coded, and including a consent form following which they were randomized the maximum score is 112. Higher scores indicate stronger at the individual level. Participants in the intervention group heteronormative attitudes and beliefs. This scale has success- were automatically given access to the post-intervention test fully been used in previous research with UK social workers on completion of the e-learning module. Participants in the com- (Schaub et al., 2017). parison group were sent a link to the post-intervention test a month before completion of the study (November 2022). From November 2022, participants received weekly text and Outcome Measure 2: Perceived LGBTQ+ Knowledge. To assess email reminders to complete the post-test. After completion of social workers’ perceived LGBTQ+ knowledge of social the post-test, participants received a thank-you email including workers in working with LGBTQ+ populations, we used an a £10 e-voucher. Upon conclusion of the trial, participants in adapted version of a Queer Youth Cultural Competency the comparison group were allowed to access the training, but Scale (QYCC) aimed at people engaging with LGBTQ+ this incurred a cost to their organization. young people (Gandy-Guedes, 2018). This scale has excellent internal reliability (α = .94). Our version is a ﬁve-item measure adapted according to the core components of the Conditions intervention and our theory of change model (see Schaub, Intervention Arm: Stonewall E-Learning Module. We describe Montgomery, et al., 2022), and questions are answered on a the intervention in Table 1 following the Template for 5-point Likert scale, ranging from strongly agree to strongly Intervention Description and Replication (TIDieR, Hoffman disagree. The full scale was shortened to ﬁve items to limit et al., 2014). the time burden on participants. Although it was based on Schaub et al. 5 an existing, reliable scale, our adapted scale was not vali- intervention group included process evaluation questions to dated; arguably, this has consequences for its reliability. assess the training program’s acceptability, implementation, However, in similar studies, LGBTQ+ knowledge is com- mechanism, and context. The process evaluation included monly assessed using non-standardized measures speciﬁcally both open and multiple-choice questions. designed by research teams for their training programs (Morris et al., 2019). A few examples of adapted items can Randomization be found in Table 2. For our version, Items 3 and 4 are reverse scored, and the maximum score is 25. Higher scores Participants who had provided consent and completed the indicate greater knowledge about the LGBTQ+ community. pre-test were randomly assigned to the intervention group or During the pre-test, we also collected data on age, gender control group using web-based allocation. Participants were identity, sexual orientation, years of working experience, eth- individually randomized and occurred continuously through- nicity, and previous LGBTQ+ training. Additionally, data on out the trial. The research team undertook six weekly balance religiosity and connection to the LGBTQ+ community were check to ensure stratiﬁcation and identify any imbalances. gathered with the following measures. The research team was not blind to participant grouping but was unaware of allocation at the start of the trial due to the web- based allocation. This was necessary to support intervention Religiosity. Religiosity was measured with the seven-item participants with any challenges with accessing the training. Interreligious Centrality of Religiosity Scale (CRSi-7; Recommendations for trials where blinding is not appropriate Huber & Huber, 2012), which measures ﬁve core dimensions include blinded outcome assessment and robust outcomes of religiosity (intellect, ideology, public practice, private prac- (Kahan et al., 2014); Both of these were included here. tice, and experience) and is suitable for both Abrahamic and Furthermore, while participants were aware of their allocation non-Abrahamic religions. There are very high correlations (given the pragmatic nature of the intervention), they were between the measure and self-reports of religious identity (r unaware of other participants’ allocation. = .83). Responses are recorded with ﬁve-point Likert style items focussed either on frequency (very often, often, occa- sionally, rarely, never) or level of importance (very much Data Analysis so, quite a bit, moderately, not very much, not at all). Quantitative data were analyzed using IBM SPSS Statistics Version28(IBM Corp, 2021). Demographic data are presented Connection to the LGBTQ+ Community. Participants were asked using descriptive statistics. Effectiveness of the training and if they have any close friends or family who identify as LGBTQ exploration of moderators are analyzed using inferential statis- +. The response options included yes, no, or prefer not to say. tics (analysis of covariance [ANCOVA], repeated measures ANOVA). We have taken an intention-to-treat approach (ITT) Process Evaluation. In addition to the outcome data collected for the primary outcome measures (HABS and KNWL). This to analyze the effect of the intervention on heteronormative approach includes all participants who were randomized, irre- attitudes and LGBTQ+ knowledge, the post-test for the spective of group allocation and missing outcome data. This is a conservative approach, ensuring unbiased conclusions about intervention effectiveness (McCoy, 2017). Findings will Table 2. Adapted QYCC Scale Items. be reported and compared for two approaches to missing data QYCC Scale Items Adapted Items imputation: Baseline Observation Carried Forward and imputa- tion of group means. Additionally, data will be analyzed follow- I attempt to learn and use terms I feel knowledgeable about ing a per-protocol approach to compare ﬁndings. These results that reﬂect LGBTQ youth terms and stereotypes relating culture so that I communicate to LGBTQ+ young people’s can be found on OSF. more effectively with youths identities. Qualitative data from implementation and process evalua- that I interact with. tion were analyzed using conventional content analysis Adolescents (ages 12–17) are Children under the age of 13 are (Hsieh & Shannon, 2005). Coding was completed concur- not old enough to know too young to know whether rently and supported by QSR NVivo software. Relevant whether they are gay/lesbian/ they are LGBTQ+ or not. factors were identiﬁed relating to implementation outcomes bisexual or straight. and suggestions for quality improvement/practice change. Children (ages 5–11) are too These were discussed with the advisory groups to ensure young to be thinking about whether they are transgender alignment with sector applicability. or not. When possible, I do or would I know how to connect an Power Analyses connect an LGBTQ youth to LGBTQ+ young person to LGBTQ resources in the relevant LGBTQ+ resources in A paucity of similar studies in the literature meant that we community. the community. were unable to carry out a priori power analyses with suitable 6 Research on Social Work Practice 0(0) certainty. Nevertheless, a meta-analysis of anti-bias, multicul- the intervention group and 278 participants in the control tural, and moral education training programs aimed at reduc- group, making the ﬁnal sample for analysis 466. ing prejudice, concludes that a small to medium effect of d = Tables 3 and 4 present the participant characteristics for both .23 is common for large-scale samples (Paluck et al., 2021). conditions in terms of gender identity, sexual orientation, reli- Based on this effect size, it was estimated that we required gion, age, and years of experience as a social worker. The 298 participants in each trial arm (for 80% power, 0.05 signif- average age of our sample was approximately 40 years (41.18 icance level). in the intervention group, 39.27 in the control group), which broadly aligns with the general population (GOV.UK, 2022). Ethical Considerations Data Checks Ethical approval was obtained from the University’s Ethics Before running the main analyses, data were visually Committee in April 2022. All participants provided electronic inspected and checked to meet assumptions of normality, informed consent (on Qualtrics) before participating in the homogeneity, and linearity. study and were free to withdraw at any point before the con- clusion of the study. Effectiveness of the Intervention Results At pre-test, the intervention condition scored slightly higher on the HABS scale (Intervention, M= 40.12; Control, M = Participant Flow 38.98), and slightly lower on the KNWL (Intervention, M = In total, 1,512 people registered for the study, of which 927 19.84; Control, M = 21.09). No other baseline differences were eligible to participate (see Figure 1). Exclusion were found between groups, except that an independent occurred due to not meeting the pre-speciﬁed inclusion cri- samples t-test indicated that there was only a signiﬁcant dif- teria, spam sign-ups, and non-response after invitation to ference between condition on the KNWL scale pre-test. Six hundred fourteen people completed the (Intervention M= 19.84, Control M = 21.09) on the pre-test, pre-test and were randomized, with 304 participants in the t(622) =−4.356, p < .001. Table 5 presents the means and intervention group and 310 participants in the control standard deviations for the main outcome scales on the pre- group. The post-test was completed by 188 participants in and post-test for each condition. Figure 1. Trial ﬂowchart. Schaub et al. 7 such as this one (Crutzen et al., 2015). Split by condition, it Missing Data became evident that the intervention condition had 39.5% Analysis of patterns of missing data indicated that two vari- missing data for both post-tests. Unusually, the control condi- ables had more than 1% missing data: HABS post-test tion had only 11.2% missing data for the HABS post-test, and (25.3%) and KNWL post-test (26.0%) as is typical in trials 12.5% missing data for the KNWL post-test. The analyses suggested that data were missing at random. Taken together, this means that the intervention group had an attrition rate of Table 3. Participant Gender Identity, Sexuality, Ethnicity, and 38.2% and the control group had an attrition rate of 10.3%. Religion by Condition. Differential attrition rates can be problematic for the internal validity of studies, and we have considered this in the inter- pretation of our ﬁndings. Intervention Control The following results are presented using two different (N= 188) (N= 278) imputation approaches. First, we describe analyses using the Gender identity last observation carried forward (LOCF) approach, in which Woman 85.9 86.3 missing data are imputed based on a participant’s last observed Man 12.5 12.5 score on the dependent variable(s). In this case, at baseline, we Transwoman —— only have a pre- and post-test measure. This means that the par- Transman —— ticipants for which we would impute outcome data based on Non-binary/genderqueer/agender 1.0 .6 their baseline observations automatically do not present any Don’t know —— change between pre- and post-test (regardless of condition). Prefer not to say .6 — Therefore, this is a very conservative approach to missing Other — .6 data. Additionally, we undertook and report here the analyses Sexuality using the post-test mean for each condition as imputation, Bisexual 10.3 6.4 which is a more positive approach to missing data. Each Gay 4.8 4.8 missing value on the post-test will be replaced by the mean Lesbian 4.2 4.8 of the available data for that condition. Straight 75.9 76.7 Queer 1.9 3.2 Prefer not to say 2.6 3.2 ANCOVAs Other .3 1.0 These analyses test the following hypotheses: Ethnicity White 82.6 85.3 1. Compared to control group participants, intervention Mixed/multiple 5.8 5.8 group participants will increase their LGBTQ+ knowl- Asian/British Asian 4.2 3.2 edge. It is expected that the score on the LGBTQ+ Black/African/Caribbean/Black 6.4 4.5 British KNWL will increase between the pre- and post-test Other .6 1.3 for the intervention group and will remain similar for Missing .3 — the control group. Religion 2. Compared to the control group, intervention group par- No religion 58.8 61.3 ticipants will decrease in heteronormative attitudes and Christian 33.4 29.1 beliefs. It is expected that the score on the HABS will Buddhist .3 1.0 decrease between the pre- and post-test for the interven- Muslim 2.6 1.9 tion group and will remain similar for the control group Hindu 1.0 — or decrease to a lesser extent. Jewish .3 1.3 Sikh .6 1.9 For the following analyses, we used a LOCF imputation Other 2.9 3.5 method. Table 4. Participant Age and Years of Experience by Condition. M (SD) Minimum Maximum Age Intervention 41.18 (10.37) 22 69 Control 39.27 (10.29) 22 66 Years of experience Intervention 8.98 (7.50) 0 38 Control 8.91 (8.08) 0 46 8 Research on Social Work Practice 0(0) Table 5. Means and Standard Deviations on the HABS and KNWL Scale per Condition. Intervention Control Pre Post Pre Post MSEM SE MSEMSE HABS 40.12 10.81 35.71 8.39 38.98 10.48 37.75 10.52 KNWL 19.84 3.62 24.11 2.41 21.09 3.55 21.79 3.47 Heteronormative Attitudes and Beliefs Scale. There was no dif- Table 6. F, p, and η Values of the ANCOVA Main Effect for ference between conditions on the HABS post-test score, F(1, Condition for the Different Analysis and Imputation Approaches. 615) = 1.335, p= .248, η = .002, but LGBT connection and Fp η HABS pre-test score were signiﬁcant predictors of HABS post-test score, F(1, 615) = 4.255, p = .040, η = .007; F(1, ITT Mean imputation 615) = 72.454, p < .001, η = .105. HABS 9.606 .002 .015 KNWL 116.006 <.001 .159 Perceived LGBTQ+ Knowledge Scale. An ANCOVA with the LOCF KNWL post-test score as dependent variable, condition as HABS 1.335 .248 .002 independent variable, and age, gender identity, LGBTQ+ KNWL 15.756 <.001 .025 connection, religiosity, previous LGBTQ+ training, and Per protocol KNWL pre-test score as covariates revealed a signiﬁcant HABS 5.133 .024 .011 effect of condition, F(1, 615) = 15.756, p < .001, η = .025. KNWL 61.326 <.001 .119 Participants in the intervention condition scored higher on the post-test KNWL scale (M= 22.64) than participants in the control condition (M= 21.52) when controlled for the Per protocol analyses revealed signiﬁcant effects of covariates. There was also a signiﬁcant covariate for KNWL Condition for both outcome measures, see OSF for more pre-test score, F(1, 615)= 46.727, p < .001, η = .071, indicat- details. ing there was a signiﬁcant effect of condition while controlling Table 6 provides an overview of the F, p,and η values for for the KNWL pre-test score. the different data analysis approaches (ITT vs. Per protocol) and For the following analyses, we used a mean imputation different imputation methods (LOCF and mean imputation). method. The ANCOVAs conﬁrmed both of our hypotheses. Intervention condition participants scored higher on the post- Heteronormative Attitudes and Beliefs Scale. The intervention test KNWL scale and lower on the post-test HABS scale, decreased heteronormative attitudes and beliefs since partici- compared to control condition participants. The only excep- pants in the intervention condition scored lower on the post- tion was the result on the post-test HABS scale with the test HABS scale (M= 35.68) than participants in the control LOCF imputation. All effect sizes for main effects could be condition (M= 37.78). An ANCOVA with the HABS post- considered large (Richardson, 2011). However, the effect test score as dependent variable, condition as independent sizes for the difference on the KNWL scale were larger variable, and age, gender identity, LGBTQ+ connection, reli- than the effect sizes for the HABS scale. This difference is giosity, previous LGBTQ+ training, and HABS pre-test score reﬂected in the Discussion section. as covariates revealed a signiﬁcant effect of condition, F(1, 615) = 9.606, p = .002, η = .015. Repeated Measures ANOVAs Perceived LGBTQ+ Knowledge Scale. The intervention We conducted a series of repeated measures ANOVAs to increased perceived LGBTQ+ knowledge as participants in examine whether the difference between pre- and post-test mea- the intervention condition scored higher on the post-test sures differed between the intervention and control condition. KNWL scale (M = 24.11) than participants in the control con- For the following analyses, we used a LOCF imputation dition (M= 21.79). An ANCOVA with the KNWL post-test method. score as dependent variable, condition as independent vari- able, and age, gender identity, LGBTQ+ connection, religios- Heteronormative Attitudes and Beliefs Scale. There was a dif- ity, previous LGBTQ+ training, and KNWL pre-test score as ference between the pre- and post-test on the HABS. A covariates revealed a signiﬁcant effect of condition, F(1, 615) repeated measures ANOVA with pre- and post-test scores = 116.006, p < .001, η = .159. on the HABS as within-subject factors, and condition as p Schaub et al. 9 between-subject factor only yielded a signiﬁcant main effect HABS revealed several subgroup effects. A signiﬁcant of the HABS (pre vs. post), F(1, 622) = 11.712, p < .001, effect of condition was identiﬁed for participants: η = .018. 1. with 0–10 years of experience, F(1, 426) = 6.226, p = .013, η = .014. Perceived LGBTQ+ Knowledge Scale. There was a difference 2. who identiﬁed as straight, F(1, 474) = 10.667, p= .001, between the pre- and post-test on the KNWL scale, and this η = .022. difference was larger for the Intervention condition. A 3. who identiﬁed as a woman, F(1, 535) = 8.379, p= .004, repeated measures ANOVA with pre- and post-test scores η = .015. on the KNWL scale as within-subject factors, and condition 4. who were over 35, F(1, 260) = 7.074, p= .008, η = as between-subject factor yielded a signiﬁcant main effect .026. of the KNWL scale (pre vs. post), F(1, 622) = 88.261, p < 5. who had a connection to the LGBTQ+ community, .001, η = .124, and a signiﬁcant interaction effect of the F(1, 494) = 9.277, p = .002, η = .018. KNWL × Condition, F(1, 622) = 34.747, p < .001, η = .053. For the following analyses, we used a mean imputation These groups scored lower on the HABS post-test than partic- method. ipants in the control condition compared to other subgroups, suggesting the training could be most effective for these sub- Heteronormative Attitudes and Beliefs Scale. There was a dif- groups. The effect sizes of these analyses can be considered ference between the pre- and post-test on the HABS, and large, suggesting practical signiﬁcance. this difference was larger for the Intervention condition. A repeated measures ANOVA with pre- and post-test scores Implementation and Process Evaluation on the HABS as within-subject factors, and condition as between-subject factor yielded a signiﬁcant main effect of In the post-test survey, participants (N = 188) in the interven- the HABS (pre vs. post), F(1, 622) = 28.023, p < .001, η = tion condition were asked several questions about the process .043, and a signiﬁcant interaction effect of the HABS × of undergoing the e-learning module. Both quantitative and Condition, F(1, 622) = 8.909, p = .003, η = .014. qualitative data were collected. Analysis of quantitative data revealed that participants were positive about the e-learning module. More than 90% of participants reported being very Perceived LGBTQ+ Knowledge Scale. There was a difference satisﬁed or satisﬁed with each of the four units of the training between the pre- and post-test on the KNWL scale, and this module and found it easy to enroll in the course. Having com- difference was larger for the Intervention condition. A pleted the course, 99.5% of participants think they are better repeated measures ANOVA with pre- and post-test scores able to support LGBTQ+ young people. Qualitative data indi- on the KNWL scale as within-subject factors, and condition cated participants felt their skills and conﬁdence were as between-subject factor yielded a signiﬁcant main effect improved about working with LGBTQ+ young people. of the KNWL scale (pre vs. post), F(1, 622) = 191.756, p < They described the value of tailored resources; research and .001, η = .236, and a signiﬁcant interaction effect of the case study guidance; practical recommendations/strategies KNWL × Condition, F(1, 622) = 98.956, p < .001, η = .137. to address SOGIE-related challenges; and applications of pro- The signiﬁcant main effects found in these analyses further fessional’s legal and professional responsibilities as per the conﬁrm our two hypotheses. Additionally, the signiﬁcant Equality Act 2010. interaction effects demonstrate the difference between pre- When asked about areas requiring better explanation, only and post-test measures was greater for the intervention condi- 15.7% answered yes. From this small minority of responses, tion than for the control condition, strengthening the evidence analysis showed that participants would prefer greater focus for the effectiveness of the e-learning module. Again, all on social work context (e.g., inspection criteria, local author- effect sizes for the main effects could be considered large ity requirements for social care), and more information about (Richardson, 2011). Effect sizes were higher for the differ- young people that are transgender, gender diverse, or with ence on the KNWL scale for both imputation methods. This asexual or pansexual identities. Additionally, social workers difference is examined in the Discussion section. wanted more content about two topics: working with families of origin about challenges accepting SOGIE, and what sup- Split Group Analyses ports would be effective in improving the poor mental health of LGBTQ+ young people in care. For the following analyses, we used the data set where missing values were imputed using mean imputation. We explored whether the intervention was more effective for spe- Discussion and Applications to Practice ciﬁc subgroups based on previous research (see above). For the perceived LGBTQ+ knowledge measure, no subgroup This study was the ﬁrst RCT testing the effectiveness of an differences were identiﬁed. However, analyses for the LGBTQ+ knowledge e-learning training module for 10 Research on Social Work Practice 0(0) children’s social workers. We evaluated the impact of the stronger effects on heteronormative attitudes and beliefs training on social worker’s LGBTQ+ knowledge and hetero- were found for children’s social workers who: (1) have 0– normative attitudes and beliefs compared to a control group 10 years of experience, (2) identify as straight, (3) identify experiencing “business as usual.” Following a review of the as a woman, (4) have a connection to the LGBTQ+ commu- literature, we included age, gender identity, religiosity, con- nity, or (5) are over 35 years old. However, these ﬁndings nection to the LGBTQ+ community, and previous training should be interpreted with caution, as the subgroups were as potential covariates. unequal in size and some subgroups were potentially too Our ﬁndings show the training was effective at increasing small to reach sufﬁcient power. A lack of an effect in some LGBTQ+ knowledge and reducing heteronormative attitudes of the subgroups can be explained by further exploring the and beliefs of children’s social workers, when tested in the pre-test scores. For example, we did not ﬁnd an effect of con- real world. We examined the effectiveness using best practice dition on the HABS post-test scores for those who identify as analysis approaches and found an effect of the training for all LGBTQ+, which can perhaps be attributed to the assumption approaches, except on the HABS using an ITT analysis and that LGBTQ+ participants are more likely to have fewer het- LOCF imputation method. In all analyses, the perceived eronormative attitudes and beliefs to start with regardless of LGBTQ+ KNWL yielded an effect of the intervention. We condition. also found signiﬁcant interaction effects for the two main Overall, our analyses provide substantial evidence about outcome scales and condition. These effects demonstrate the effectiveness of the e-learning training module. We the difference between pre- and post-test measures was opted for the use of several analysis approaches and greater for the intervention condition than for the control con- missing data imputation methods to explore the robustness dition, further strengthening the evidence for the effectiveness of the results. We found effects for almost every analysis of the e-learning module. Furthermore, the implementation and imputation method used. Our ﬁndings echo consistent and process evaluation suggested participants were very pos- calls within the literature for SOGIE training and the experi- itive about training access and content. Most importantly for ences of LGBTQ+ young people in care (Schaub, Stander, this study and the population under inspection, participants et al., 2022). This study supports and expands on previous felt conﬁdent that their LGBTQ+ knowledge had increased research related to training among helping professions and as a result of the training. demonstrates the effectiveness of e-learning training in Although the change in both knowledge and attitudes was improving the knowledge and attitudes of social workers signiﬁcant, the effects on knowledge were larger. This dis- regarding LGBTQ+ young people with a brief but compre- crepancy seems intuitive, as the main theory of change of hensive intervention. This information is important as it can the training was to increase participant’s knowledge about increase the accessibility of education and training speciﬁc LGBTQ+ young people and their support. An increase in to this group in highly accessible and relatively cost-effective knowledge by learning facts and concepts is likely to be ways among the wider social care workforce. These ﬁndings easier to achieve than a change in attitudes, which would are also relevant to those engaged in a range of educational involve developing new viewpoints; this change often and training settings in other helping or public sector profes- includes an emotional factor and might require contact with sions, and have implications beyond social work practice, the marginalized group (Steck & Perry, 2017). A contrasting education, and research. supposition is the difference in effect size could be attributed A notable strength of this study is that was the ﬁrst of its to the difference in scales used. The scale for perceived kind within the UK social work context succeeding in the LGBTQ+ knowledge included ﬁve answer options, whereas recruitment of a large sample of children’s social workers. the HABS scale provided seven answer options. Indeed, the Rigorous RCTs remain scarce in social care and social number of Likert scale response options may affect response work research (Dixon et al., 2013; Moody et al., 2020). We style (Weijters et al., 2010). utilized co-production techniques involving a range of stake- With respect to the covariate analyses, we only found sig- holders, including social care professionals and a group of niﬁcant effects in the ITT analyses in which we used an LOCF LGBTQ+ young people (16–24) with lived experiences of imputation method. For the HABS, a connection to the social care. LGBTQ+ community and the HABS pre-test were found to Another strength is that we were able to recruit a sample be signiﬁcant. For the perceived LGBTQ+ KNWL, the that broadly reﬂected the English social worker population. pre-test was a signiﬁcant covariate. Overall, these ﬁndings In September 2021, there were 32,500 full-time children demonstrate that the moderators that we included are not and family social workers in England (GOV.UK, 2022), so strong predictors of intervention success, suggesting that the our sample represents approximately 2%. The sample pre- intervention is relatively robust in its effectiveness. dominantly identiﬁed as female (∼86%), which corresponds Subgroup analyses only revealed differences in the HABS with the English national children’s social work workforce measure and suggested that the training might, perhaps, be (87%; GOV.UK, 2022). This also aligns with the interna- more effective in reducing heteronormative attitudes and tional workforce, for example, the USA, where 84.4% of beliefs for certain groups than others. More speciﬁcally, the workforce identiﬁed as female (Data USA, 2020). In Schaub et al. 11 our sample, 17.4% of participants were of ethnic minorities, social workers. Participants expressed a need for more which is slightly lower than the proportion in the national social work-speciﬁc content, which could be co-produced workforce (23%; GOV.UK, 2022). Not only was our with stakeholders in future work. Fourth, in the following sample similar to the population, but it was also of a studies, it could be explored how effects of this training healthy size, especially considering recruitment challenges extend to other healthcare and educational professions to reported in previous research (Acquivita et al., 2009; Canda ensure that LGBTQ+ young people are supported in all envi- et al., 2004) and the lack of research capacity in social ronments they encounter. We suggest that such tailoring is workers (Harvey et al., 2013; Wakeﬁeld et al., 2022). likely to improve the effects of these interventions. Finally, There were also some limitations to the present study. we strongly advocate for the increased use of RCTs in First, the sample was self-selecting, which may have led to social work and social care research. Although adaptions an overrepresentation of certain groups. We had a greater rep- might be required, this study demonstrates it is feasible and resentation of LGBTQ+ people than is found in the general contributes to a robust evidence base. population, suggesting a greater interest from this population. This study’s ﬁndings show that LGBTQ+ training is an However, we did ﬁnd evidence suggesting that the training essential ﬁrst step for improving the knowledge and challeng- was similarly effective for participants who had and did not ing dominant cis-heteronormative views in children’s social have a connection to the LGBTQ+ community, suggesting care (Schaub, Stander, et al., 2022). As a result, we recom- that levels of connection did not impact the intervention effec- mend mandatory and comprehensive training for all social tiveness. With regards to our methods, ﬁrstly, it could be workers in England about the experiences and needs of noted that the time between the pre- and the post-test was LGBTQ+ young people, including for pre- and post- not equal across the sample. However, this was a pragmatic qualifying social work programs. RCT, allowing us to test the effectiveness of the intervention under real-world conditions. Second, to assess perceived LGBTQ+ knowledge, we constructed our own scale. Conclusion Although it was adapted from an existing scale We can conclude that the Stonewall e-learning training (Gandy-Guedes, 2018) with excellent internal reliability (α module Supporting LGBTQ+ Children and Young People = .94), our scale was not validated. The decision for a is effective at increasing perceived LGBTQ+ knowledge shorter, unvalidated measure was made to reduce burden on and decreasing heteronormative stereotypes in children’s participants. In similar research, LGBTQ+ knowledge gains social workers in England. This study offers an important among helping professionals are typically assessed using non- foundation for the development of effective social workforce standardized measures designed by researchers speciﬁcally training on LGBTQ+ issues. Future research should test the for their training programs that employ multiple-choice, longitudinal replication of these results, as well as optimize Likert scale, or true–false formats, according to a systematic the training to make it optimally suitable for children’s review (Morris et al., 2019). Lastly, we experienced differen- social workers. tial attrition rates across conditions, which could potentially bias the results. Previous research demonstrates that a higher attrition rate in the intervention condition is common Authors’ Note (Crutzen et al., 2015), and this does not automatically bias This study was registered with the Open Science Framework (https:// the results (Hewitt et al., 2010). However, it is important to osf.io/25d8z). view these ﬁndings as initial positive evidence for the effec- tiveness of the training that should be further solidiﬁed in Declaration of Conﬂicting Interests future trials. This study offers an important building block for future The author(s) declared no potential conﬂicts of interest with respect research and provides initial evidence of the effectiveness to the research, authorship, and/or publication of this article. of the e-learning training module to increase perceived LGBTQ+ knowledge and decrease heteronormative attitudes Funding and beliefs in children’s social workers. Our ﬁndings follow several recommendations for future research. First, future The author(s) declared the following potential conﬂicts of interest studies should address the longitudinal effect of the training with respect to the research, authorship, and/or publication of this by administering follow-up measures at several intervals article: Our work was funded by What Works for Children’s after the post-test has taken place. Second, data could be col- Social Care. The views expressed here are those of the authors and lected on the impact of the training on social workers’ prac- not necessarily those of What Works for Children’s Social Care or tice. This could for instance be measured by follow-up the Department for Education (England; grant number 1001929). interviews or surveys inquiring about changes made to prac- We are most grateful to all the social workers who participated in tice as a result of the training. 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BMJ, 337, a2390. https://doi.org/10.1136/bmj.a2390 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Research on Social Work Practice SAGE http://www.deepdyve.com/lp/sage/effectiveness-of-an-lgbtq-e-learning-module-for-social-workers-a-t1TCXp3XOU

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Publisher: SAGE
Copyright: © The Author(s) 2023
ISSN: 1049-7315
eISSN: 1552-7581
DOI: 10.1177/10497315231208199
Publisher site: See Article on Publisher Site

Abstract

Purpose: To evaluate the effectiveness of an e-learning training module for improving children’s social workers’ knowledge of, and attitudes toward, LGBTQ+ young people. Methods: A pragmatic randomized, CONSORT-compliant controlled trial to compare an intervention group (N = 304) with a business-as-usual comparison group (N = 310). After attrition, the anal- ysis included 188 (intervention) and 278 (comparison) participants. The main outcome measures were the Heteronormative Attitudes and Beliefs Scale and a perceived LGBTQ+ knowledge measure, controlling for several covariates. Results: A sig- niﬁcant effect of intervention on both outcome measures, using several rigorous analysis approaches and missing data impu- tation methods. Participants who undertook the training decreased their heteronormative attitudes and beliefs and increased their perceived LGBTQ+ knowledge compared to business as usual. Conclusion: This study demonstrates the effectiveness of an e-learning training intervention in improving knowledge of, and attitudes toward, LGBTQ+ young people. Implications for research, practice, and policy are outlined. Keywords LGBTQ, young people, social work, e-learning, randomized controlled trial Until recently, little attention has been given to the experi- adverse effect on mental health outcomes (Evans et al., ences of lesbian, gay, bisexual, transgender, and queer or 2017; Ford et al., 2007). Although fewer data are available questioning (LGBTQ+) young people in the social care regarding the experiences of transgender and gender-diverse system, or the needs of social workers supporting this popu- young people, the literature suggests heightened challenges lation. A systematic scoping review of the international evi- among this group from peers, birth families, and social care professionals (Mountz et al., 2018; Schaub, Stander, et al., dence demonstrates that LGBTQ+ young people are 2022). Overall, LGBTQ+ young people are less satisﬁed disproportionately overrepresented in social care, and experi- with their out-of-home care experiences than non-LGBTQ+ ence poorer health, mental health, and well-being outcomes youth and have speciﬁc social care needs that often go compared to their cisgender and heterosexual counterparts unmet or ignored due to prevailing hetero- and cisnormative in care (Schaub, Stander, et al., 2022). It is estimated that societal values or biases (McCormick et al., 2017; Schaub, between 15.5% and 30.4% of young people in care identify Stander, et al., 2022). as LGBTQ+, and this overrepresentation is far greater for One of the most signiﬁcant challenges in supporting those from racial or ethnic minority backgrounds (Fish LGBTQ+ young people is limited knowledge and training et al., 2019; Schaub, Stander, et al., 2022). While LGBTQ+ in this area for social workers. Social work students and prac- young people enter care for the same reasons as their peers titioners report a lack of knowledge and an absence of (e.g., abuse, neglect), they often experience rejection, margin- alization, and discrimination related to their sexual orienta- Department of Social Work and Social Care, University of Birmingham, tion, gender identity, and expression (SOGIE) in different Birmingham, UK phases of contact with the care system, from initial referral Centre for Health Services Studies, University of Kent, Canterbury, UK through to aging out or leaving care (Kaasbøll et al., 2021; Department of Social Policy, Sociology and Criminology, University of Schaub, Stander, et al., 2022). This includes increased place- Birmingham, Birmingham, UK ment instability or breakdown, longer duration of time spent Corresponding Author: in care, and an overreliance on restrictive group home place- Jason Schaub, Department of Social Work and Social Care, The University of ments for LGBTQ+ youth (McCormick et al., 2017; Schaub, Birmingham, Edgbaston, Birmingham B15 2TT, UK. Stander, et al., 2022), which have been found to have an Email: [email protected] 2 Research on Social Work Practice 0(0) adequate training to meet the needs of LGBTQ+ young face-to-face training. First, e-learning training programs provide people, and trans and gender-diverse people especially ﬂexibility and easy access to learning materials from any location (Craig et al., 2016; Inch, 2017; Schaub, Stander, et al., from which the learner has access to the Internet (Akhter et al., 2022). In addition to this, social workers and social work stu- 2021; Gad, 2023). E-learning training modules may be an attrac- dents may also have neutral or even negative and homo/bi/ tive option for social workers who struggle with high workloads trans-phobic attitudes toward LGBTQ+ young people, and and caseloads. Second, this type of training can be developed do not believe that care systems are particularly protective and maintained with limited resources and as a result can be or supportive of this population (Greeno et al., 2022; offered at a low price (Akhteret al., 2021). This may be particularly Weeks et al., 2018). Indeed, LGBTQ+ young people report relevant in contexts where there are ongoing developments in the cis/heteronormative care environments, delaying disclosure policy and legal landscape concerning LGBTQ+ rights. of their SOGIE in fear of negative reactions, and harmful To the best of the authors’ knowledge, this study is the ﬁrst encounters with professionals who characterized their RCT evaluating the effectiveness of e-learning training SOGIE as pathological, predatory, and circumstantial module for improving the knowledge and attitudes of social (Kaasbøll et al., 2021; Schaub, Stander, et al., 2022; Schaub workers about LGBTQ+ young people. We also examined et al., 2023). Afﬁrming relationships with social workers is possible factors that might account for differences in particularly important to the resilience of this population primary outcomes. The literature suggests several factors and an openness and willingness to discuss SOGIE-related that may facilitate or inhibit the effectiveness of LGBTQ+ issues are strongly associated with positive outcomes knowledge programs including age, gender, religiosity, and (Álvarez et al., 2022; Paul, 2020; Ryan et al., 2009; Schaub a connection to the LGBTQ+ community. Previous studies et al., 2023). Training can thus have a signiﬁcant positive highlight the impact of intergenerational differences in under- impact on the experiences of LGBTQ+ young people; standing SOGIE among helping professionals, with younger however, there is a dearth of research in this regard. generations correlated with more positive attitudes toward Several studies have investigated the efﬁcacy of ongoing LGBTQ+ communities (Gandy-Guedes, 2018). It has also professional development and training in improving knowl- been well established that women display more favorable atti- edge, attitudes, and beliefs of helping professionals toward tudes than men toward LGBTQ+ people (Dotti Sani & LGBTQ+ individuals, and the results are promising. Recent Quaranta, 2020; Herek, 2002), and there is a close connection systematic reviews exploring the effectiveness of LGBTQ- between religious afﬁliation, or religiosity, and negative atti- related training interventions among medical, nursing, and tudes among social workers toward LGBTQ+ people mental healthcare students and providers found that educa- (Westwood, 2022). Finally, having a close friend or family tional programs can be effective at improving self-reported member who identiﬁes as LGBTQ+ has been linked to knowledge and promoting more tolerant attitudes about the greater LGBTQ+ knowledge and the potential to engage in LGBTQ+ community and LGBTQ-related healthcare supportive behaviors in a recent survey with care profession- (Bettergarcia et al., 2021; Yu et al., 2023). Similarly, als in the USA (Greeno et al., 2022). studies found that professional development training pro- The current study tested the effectiveness of an e-learning grams on LGBTQ+ issues had signiﬁcant positive effects training module for children’s social workers in England to on teachers’ and educators’ beliefs and attitudes toward support LGBTQ+ young people, compared to “business as LGBTQ+ young people (Greytak et al., 2013; Szalacha, usual.” We evaluated the impact of the training on LGBTQ 2003). Nevertheless, there is a paucity of research regarding + knowledge and heteronormative attitudes and beliefs. the training of social workers. A recent non-randomized Based on previous literature, we developed the following pre- and post-test study evaluating an LGBTQ+ competency hypotheses: training intervention (comprising of two 3-hr in-person ses- sions) with child welfare practitioners (i.e., social workers, clinicians, and group home staff) indicate that practitioners 1. Intervention group participants will increase their signiﬁcantly improved their knowledge of LGBTQ+-related LGBTQ+ knowledge, in comparison to the control issues and competencies post-training (Weeks et al., 2018). group. It is expected that the score on the LGBTQ+ Much of this work, however, originates from the USA with Knowledge Scale (KNWL) will increase between the an absence of international research and no large, robust pre- and post-test for the intervention group, and studies, such as randomized controlled trials (RCT), to date remain similar for the comparison group. evaluating the effectiveness of such training for social care 2. Intervention group participants will decrease in hetero- professionals for supporting LGBTQ+ young people (Hunt normative attitudes and beliefs, in comparison to the et al., 2019; Schaub, Stander, et al., 2022). control group. It is expected that the score on the The use of e-learning modules can be an effective strategy to Heteronormative Attitudes and Beliefs Scale (HABS) provide ongoing professional development and enhancement of will decrease between the pre- and post-test for the professionals’ knowledge in working with marginalized popula- intervention group and will remain similar for the tions. This method has several advantages over traditional control group or decrease to a lesser extent. Schaub et al. 3 Moderators taken from previous literature (described above) three key reasons: (1) The e-learning intervention is already including age, gender identity, religiosity, connection to the in wide use, making it important to test its effectiveness; (2) LGBTQ+ community, and previous training, are included a number of cohort trials of education programs suggest this as covariates. We recognize that the study is underpowered is a promising way of informing social workers about sexual- to detect such effects with statistical signiﬁcance, so these ity and gender (Inch, 2017; Schaub et al., 2017); and (3) there tests will be indicative only. was sufﬁcient recruitment power to conduct a pRCT that would provide meaningful results. Method The census-style process evaluation was conducted in accor- dance with key Medical Research Council (MRC) guidance Design (Moore et al., 2015). It was designed to assess the intervention delivery to understand and explain any identiﬁed intervention This study has a two-armed, pre- and post-test, pragmatic effects (or lack thereof; see Schaub, Montgomery, et al., 2022 pRCT design combined with a census-style process evalua- for further details on design and conduct). Additionally, it tion. PRCTs measure the effectiveness of an intervention in aims to understand the extent to which participants were satisﬁed “the real word,” more speciﬁcally, under usual conditions with different aspects of the training program and identify any of care (Zwarenstein et al., 2008). Participants were individu- suggested changes for improvement. ally randomized to either the intervention or control group. This trial was analyzed and reported in line with the Intervention participants were provided access to the Consolidated Standards of Reporting Trials for Social and Stonewall e-learning module, and the control group followed Psychological Interventions (CONSORT-SPI) reporting guid- a “business as usual” model (further details provided in ance (Montgomery et al., 2018) and a checklist is available Table 1). A pRCT design was appropriate for this study for Table 1. TIDieR Table for the Intervention Arm. Brief Name 1. The intervention was an existing e-learning training module titled Supporting LGBTQ+ Children and Young People delivered by Stonewall. Why 2. The training is speciﬁcally tailored to, and widely used by, local authorities in England and was offered to participants free of charge (normally £35 per person). This CPD-accredited e-module was designed to improve the attitudes, knowledge, skills, and conﬁdence to support LGBTQ+ youth. What 3. The training consisted of four learning units: (1) LGBTQ+ terminology, experiences, and intersecting identities; (2) the law and practice obligations in relation to LGBTQ+ inclusion; (3) strategies to prevent and tackle homo-, bi-, and transphobic bullying and language; and (4) appropriate signposting. The training can be accessed on the Stonewall website (https://www.stonewall.org.uk/supporting-lgbtq-children- and-young-people). 4. Learners were provided with essential information, practical advice, and interactive activities that encourage consideration of how LGBTQ + inclusive practice can be embedded in their own setting. Who provided 5. The intervention was delivered by Stonewall, the leading UK charity standing for LGBTQ+ people. How 6. The training was provided online. Participants allocated to the intervention group received login details via email and could complete the training individually in their own time. Where 7. The training could be accessed on any device with internet, at work or at home. When and How Much 8. In total, it took between 2 and 4 hr to complete the training. This could be done in one sitting, or by completing sections at several time points when time allowed. Depending on when participants registered, they had between 2 weeks and 3 months to complete it. Tailoring 9. The intervention was the same for each participant. Modiﬁcations 10. There were no major modiﬁcations to the intervention. Minor modiﬁcations were made by the research team to content such as case study examples to better reﬂect social work settings or practice. How well 11. Participants could only continue to the next unit if they had completed the previous one. They were only referred to the post-test survey and offered remuneration in the form of £10 voucher if the training had been fully completed. The research team had access to Stonewall’s online training platform which allowed them to check progress. 12. Only participants who had fully completed the training were included in the analysis. 4 Research on Social Work Practice 0(0) by writing the corresponding author. This study followed a Control Arm: Business as Usual. Participants in the control published protocol (Schaub, Montgomery, et al., 2022)and uti- group received an email informing them that they would lized co-production techniques involving a range of stakehold- undergo business-as-usual (BAU) training conditions as pro- ers, including social care professionals and a group of LGBTQ vided by their employer (e.g., general Equality and Diversity + young people (16–24)withlived experiences ofsocialcare. training which is mandatory in the UK), and that they would Study design included feedback from stakeholders at different be contacted in November 2022 to capture such training and stages of development, implementation, and evaluation. We complete the post-test. There was no further contact between also solicited stakeholder perspectives on drafted practice and the control group and the research team. While this posed a policy recommendations. The trial was registered on the risk for attrition, this approach reﬂects the pragmatic nature Open Science Framework (OSF; https://osf.io/25d8z). of this trial and approximates the real-world context. We rec- ognize that there would be considerable heterogeneity within this group as BAU is likely to vary across social work depart- Participants and Procedures ments across the country. However, this variability forms a Participant recruitment was designed in response to the dis- sound, pragmatic basis from which to compare the interven- persed nature of the social care sector and the scale of the tion. It may also be the case that some participants may study. Participants were recruited using a number of comple- have accessed the intervention (contamination). mentary sampling strategies. First, the research team drew on existing connections with social work networks and connec- Measures tions to disseminate the recruitment call. Second, we under- took a social media campaign advertising the study on Measures were administered between June and November Twitter, LinkedIn and Facebook. Third, we approached indi- 2022. The primary outcome measures for this study were het- viduals based on their speciﬁc position and knowledge (crit- eronormative attitudes and beliefs and perceived LGBTQ+ ical case sampling). Lastly, we used chain sampling, asking knowledge. The pre- and post-tests aim to detect changes in participants to forward the recruitment call to other potential the two outcome measures before and after randomization. participants (Onwuegbuzie & Collins, 2007). A separate paper provides recommendations for the recruitment and reten- Outcome Measure 1: Heteronormative Attitudes and Beliefs. tion of social workers as research participants (Keemink et al., Heteronormative attitudes and beliefs are measured with the forthcoming). 16-item HABS (Habarth, 2015), which assesses participants’ The recruitment advert provided potential participants with heteronormative attitudes, as well as including elements of a registration link to a Qualtrics (2020) page where eligibility gender identity. Questions are answered on a 7-point Likert was checked. Individuals were eligible to participate if they scale, ranging from strongly disagree to strongly agree. The met all four inclusion criteria: (1) employed by a local author- HABS produces an overall score with excellent internal reli- ity in England, (2) work in children’s social care services, (3) ability (α = .91) and consists of two subscales, Essential Sex registered with Social Work England, and (4) not have previ- and Gender, which has excellent reliability (α = .92), and ously completed a Stonewall e-learning module. If criteria Normative Behavior, which has acceptable reliability (α = were met, they were sent a Qualtrics link to the pre-test survey .78). Items 1, 4, 9, 11, 12, 15 and 16 are reverse coded, and including a consent form following which they were randomized the maximum score is 112. Higher scores indicate stronger at the individual level. Participants in the intervention group heteronormative attitudes and beliefs. This scale has success- were automatically given access to the post-intervention test fully been used in previous research with UK social workers on completion of the e-learning module. Participants in the com- (Schaub et al., 2017). parison group were sent a link to the post-intervention test a month before completion of the study (November 2022). From November 2022, participants received weekly text and Outcome Measure 2: Perceived LGBTQ+ Knowledge. To assess email reminders to complete the post-test. After completion of social workers’ perceived LGBTQ+ knowledge of social the post-test, participants received a thank-you email including workers in working with LGBTQ+ populations, we used an a £10 e-voucher. Upon conclusion of the trial, participants in adapted version of a Queer Youth Cultural Competency the comparison group were allowed to access the training, but Scale (QYCC) aimed at people engaging with LGBTQ+ this incurred a cost to their organization. young people (Gandy-Guedes, 2018). This scale has excellent internal reliability (α = .94). Our version is a ﬁve-item measure adapted according to the core components of the Conditions intervention and our theory of change model (see Schaub, Intervention Arm: Stonewall E-Learning Module. We describe Montgomery, et al., 2022), and questions are answered on a the intervention in Table 1 following the Template for 5-point Likert scale, ranging from strongly agree to strongly Intervention Description and Replication (TIDieR, Hoffman disagree. The full scale was shortened to ﬁve items to limit et al., 2014). the time burden on participants. Although it was based on Schaub et al. 5 an existing, reliable scale, our adapted scale was not vali- intervention group included process evaluation questions to dated; arguably, this has consequences for its reliability. assess the training program’s acceptability, implementation, However, in similar studies, LGBTQ+ knowledge is com- mechanism, and context. The process evaluation included monly assessed using non-standardized measures speciﬁcally both open and multiple-choice questions. designed by research teams for their training programs (Morris et al., 2019). A few examples of adapted items can Randomization be found in Table 2. For our version, Items 3 and 4 are reverse scored, and the maximum score is 25. Higher scores Participants who had provided consent and completed the indicate greater knowledge about the LGBTQ+ community. pre-test were randomly assigned to the intervention group or During the pre-test, we also collected data on age, gender control group using web-based allocation. Participants were identity, sexual orientation, years of working experience, eth- individually randomized and occurred continuously through- nicity, and previous LGBTQ+ training. Additionally, data on out the trial. The research team undertook six weekly balance religiosity and connection to the LGBTQ+ community were check to ensure stratiﬁcation and identify any imbalances. gathered with the following measures. The research team was not blind to participant grouping but was unaware of allocation at the start of the trial due to the web- based allocation. This was necessary to support intervention Religiosity. Religiosity was measured with the seven-item participants with any challenges with accessing the training. Interreligious Centrality of Religiosity Scale (CRSi-7; Recommendations for trials where blinding is not appropriate Huber & Huber, 2012), which measures ﬁve core dimensions include blinded outcome assessment and robust outcomes of religiosity (intellect, ideology, public practice, private prac- (Kahan et al., 2014); Both of these were included here. tice, and experience) and is suitable for both Abrahamic and Furthermore, while participants were aware of their allocation non-Abrahamic religions. There are very high correlations (given the pragmatic nature of the intervention), they were between the measure and self-reports of religious identity (r unaware of other participants’ allocation. = .83). Responses are recorded with ﬁve-point Likert style items focussed either on frequency (very often, often, occa- sionally, rarely, never) or level of importance (very much Data Analysis so, quite a bit, moderately, not very much, not at all). Quantitative data were analyzed using IBM SPSS Statistics Version28(IBM Corp, 2021). Demographic data are presented Connection to the LGBTQ+ Community. Participants were asked using descriptive statistics. Effectiveness of the training and if they have any close friends or family who identify as LGBTQ exploration of moderators are analyzed using inferential statis- +. The response options included yes, no, or prefer not to say. tics (analysis of covariance [ANCOVA], repeated measures ANOVA). We have taken an intention-to-treat approach (ITT) Process Evaluation. In addition to the outcome data collected for the primary outcome measures (HABS and KNWL). This to analyze the effect of the intervention on heteronormative approach includes all participants who were randomized, irre- attitudes and LGBTQ+ knowledge, the post-test for the spective of group allocation and missing outcome data. This is a conservative approach, ensuring unbiased conclusions about intervention effectiveness (McCoy, 2017). Findings will Table 2. Adapted QYCC Scale Items. be reported and compared for two approaches to missing data QYCC Scale Items Adapted Items imputation: Baseline Observation Carried Forward and imputa- tion of group means. Additionally, data will be analyzed follow- I attempt to learn and use terms I feel knowledgeable about ing a per-protocol approach to compare ﬁndings. These results that reﬂect LGBTQ youth terms and stereotypes relating culture so that I communicate to LGBTQ+ young people’s can be found on OSF. more effectively with youths identities. Qualitative data from implementation and process evalua- that I interact with. tion were analyzed using conventional content analysis Adolescents (ages 12–17) are Children under the age of 13 are (Hsieh & Shannon, 2005). Coding was completed concur- not old enough to know too young to know whether rently and supported by QSR NVivo software. Relevant whether they are gay/lesbian/ they are LGBTQ+ or not. factors were identiﬁed relating to implementation outcomes bisexual or straight. and suggestions for quality improvement/practice change. Children (ages 5–11) are too These were discussed with the advisory groups to ensure young to be thinking about whether they are transgender alignment with sector applicability. or not. When possible, I do or would I know how to connect an Power Analyses connect an LGBTQ youth to LGBTQ+ young person to LGBTQ resources in the relevant LGBTQ+ resources in A paucity of similar studies in the literature meant that we community. the community. were unable to carry out a priori power analyses with suitable 6 Research on Social Work Practice 0(0) certainty. Nevertheless, a meta-analysis of anti-bias, multicul- the intervention group and 278 participants in the control tural, and moral education training programs aimed at reduc- group, making the ﬁnal sample for analysis 466. ing prejudice, concludes that a small to medium effect of d = Tables 3 and 4 present the participant characteristics for both .23 is common for large-scale samples (Paluck et al., 2021). conditions in terms of gender identity, sexual orientation, reli- Based on this effect size, it was estimated that we required gion, age, and years of experience as a social worker. The 298 participants in each trial arm (for 80% power, 0.05 signif- average age of our sample was approximately 40 years (41.18 icance level). in the intervention group, 39.27 in the control group), which broadly aligns with the general population (GOV.UK, 2022). Ethical Considerations Data Checks Ethical approval was obtained from the University’s Ethics Before running the main analyses, data were visually Committee in April 2022. All participants provided electronic inspected and checked to meet assumptions of normality, informed consent (on Qualtrics) before participating in the homogeneity, and linearity. study and were free to withdraw at any point before the con- clusion of the study. Effectiveness of the Intervention Results At pre-test, the intervention condition scored slightly higher on the HABS scale (Intervention, M= 40.12; Control, M = Participant Flow 38.98), and slightly lower on the KNWL (Intervention, M = In total, 1,512 people registered for the study, of which 927 19.84; Control, M = 21.09). No other baseline differences were eligible to participate (see Figure 1). Exclusion were found between groups, except that an independent occurred due to not meeting the pre-speciﬁed inclusion cri- samples t-test indicated that there was only a signiﬁcant dif- teria, spam sign-ups, and non-response after invitation to ference between condition on the KNWL scale pre-test. Six hundred fourteen people completed the (Intervention M= 19.84, Control M = 21.09) on the pre-test, pre-test and were randomized, with 304 participants in the t(622) =−4.356, p < .001. Table 5 presents the means and intervention group and 310 participants in the control standard deviations for the main outcome scales on the pre- group. The post-test was completed by 188 participants in and post-test for each condition. Figure 1. Trial ﬂowchart. Schaub et al. 7 such as this one (Crutzen et al., 2015). Split by condition, it Missing Data became evident that the intervention condition had 39.5% Analysis of patterns of missing data indicated that two vari- missing data for both post-tests. Unusually, the control condi- ables had more than 1% missing data: HABS post-test tion had only 11.2% missing data for the HABS post-test, and (25.3%) and KNWL post-test (26.0%) as is typical in trials 12.5% missing data for the KNWL post-test. The analyses suggested that data were missing at random. Taken together, this means that the intervention group had an attrition rate of Table 3. Participant Gender Identity, Sexuality, Ethnicity, and 38.2% and the control group had an attrition rate of 10.3%. Religion by Condition. Differential attrition rates can be problematic for the internal validity of studies, and we have considered this in the inter- pretation of our ﬁndings. Intervention Control The following results are presented using two different (N= 188) (N= 278) imputation approaches. First, we describe analyses using the Gender identity last observation carried forward (LOCF) approach, in which Woman 85.9 86.3 missing data are imputed based on a participant’s last observed Man 12.5 12.5 score on the dependent variable(s). In this case, at baseline, we Transwoman —— only have a pre- and post-test measure. This means that the par- Transman —— ticipants for which we would impute outcome data based on Non-binary/genderqueer/agender 1.0 .6 their baseline observations automatically do not present any Don’t know —— change between pre- and post-test (regardless of condition). Prefer not to say .6 — Therefore, this is a very conservative approach to missing Other — .6 data. Additionally, we undertook and report here the analyses Sexuality using the post-test mean for each condition as imputation, Bisexual 10.3 6.4 which is a more positive approach to missing data. Each Gay 4.8 4.8 missing value on the post-test will be replaced by the mean Lesbian 4.2 4.8 of the available data for that condition. Straight 75.9 76.7 Queer 1.9 3.2 Prefer not to say 2.6 3.2 ANCOVAs Other .3 1.0 These analyses test the following hypotheses: Ethnicity White 82.6 85.3 1. Compared to control group participants, intervention Mixed/multiple 5.8 5.8 group participants will increase their LGBTQ+ knowl- Asian/British Asian 4.2 3.2 edge. It is expected that the score on the LGBTQ+ Black/African/Caribbean/Black 6.4 4.5 British KNWL will increase between the pre- and post-test Other .6 1.3 for the intervention group and will remain similar for Missing .3 — the control group. Religion 2. Compared to the control group, intervention group par- No religion 58.8 61.3 ticipants will decrease in heteronormative attitudes and Christian 33.4 29.1 beliefs. It is expected that the score on the HABS will Buddhist .3 1.0 decrease between the pre- and post-test for the interven- Muslim 2.6 1.9 tion group and will remain similar for the control group Hindu 1.0 — or decrease to a lesser extent. Jewish .3 1.3 Sikh .6 1.9 For the following analyses, we used a LOCF imputation Other 2.9 3.5 method. Table 4. Participant Age and Years of Experience by Condition. M (SD) Minimum Maximum Age Intervention 41.18 (10.37) 22 69 Control 39.27 (10.29) 22 66 Years of experience Intervention 8.98 (7.50) 0 38 Control 8.91 (8.08) 0 46 8 Research on Social Work Practice 0(0) Table 5. Means and Standard Deviations on the HABS and KNWL Scale per Condition. Intervention Control Pre Post Pre Post MSEM SE MSEMSE HABS 40.12 10.81 35.71 8.39 38.98 10.48 37.75 10.52 KNWL 19.84 3.62 24.11 2.41 21.09 3.55 21.79 3.47 Heteronormative Attitudes and Beliefs Scale. There was no dif- Table 6. F, p, and η Values of the ANCOVA Main Effect for ference between conditions on the HABS post-test score, F(1, Condition for the Different Analysis and Imputation Approaches. 615) = 1.335, p= .248, η = .002, but LGBT connection and Fp η HABS pre-test score were signiﬁcant predictors of HABS post-test score, F(1, 615) = 4.255, p = .040, η = .007; F(1, ITT Mean imputation 615) = 72.454, p < .001, η = .105. HABS 9.606 .002 .015 KNWL 116.006 <.001 .159 Perceived LGBTQ+ Knowledge Scale. An ANCOVA with the LOCF KNWL post-test score as dependent variable, condition as HABS 1.335 .248 .002 independent variable, and age, gender identity, LGBTQ+ KNWL 15.756 <.001 .025 connection, religiosity, previous LGBTQ+ training, and Per protocol KNWL pre-test score as covariates revealed a signiﬁcant HABS 5.133 .024 .011 effect of condition, F(1, 615) = 15.756, p < .001, η = .025. KNWL 61.326 <.001 .119 Participants in the intervention condition scored higher on the post-test KNWL scale (M= 22.64) than participants in the control condition (M= 21.52) when controlled for the Per protocol analyses revealed signiﬁcant effects of covariates. There was also a signiﬁcant covariate for KNWL Condition for both outcome measures, see OSF for more pre-test score, F(1, 615)= 46.727, p < .001, η = .071, indicat- details. ing there was a signiﬁcant effect of condition while controlling Table 6 provides an overview of the F, p,and η values for for the KNWL pre-test score. the different data analysis approaches (ITT vs. Per protocol) and For the following analyses, we used a mean imputation different imputation methods (LOCF and mean imputation). method. The ANCOVAs conﬁrmed both of our hypotheses. Intervention condition participants scored higher on the post- Heteronormative Attitudes and Beliefs Scale. The intervention test KNWL scale and lower on the post-test HABS scale, decreased heteronormative attitudes and beliefs since partici- compared to control condition participants. The only excep- pants in the intervention condition scored lower on the post- tion was the result on the post-test HABS scale with the test HABS scale (M= 35.68) than participants in the control LOCF imputation. All effect sizes for main effects could be condition (M= 37.78). An ANCOVA with the HABS post- considered large (Richardson, 2011). However, the effect test score as dependent variable, condition as independent sizes for the difference on the KNWL scale were larger variable, and age, gender identity, LGBTQ+ connection, reli- than the effect sizes for the HABS scale. This difference is giosity, previous LGBTQ+ training, and HABS pre-test score reﬂected in the Discussion section. as covariates revealed a signiﬁcant effect of condition, F(1, 615) = 9.606, p = .002, η = .015. Repeated Measures ANOVAs Perceived LGBTQ+ Knowledge Scale. The intervention We conducted a series of repeated measures ANOVAs to increased perceived LGBTQ+ knowledge as participants in examine whether the difference between pre- and post-test mea- the intervention condition scored higher on the post-test sures differed between the intervention and control condition. KNWL scale (M = 24.11) than participants in the control con- For the following analyses, we used a LOCF imputation dition (M= 21.79). An ANCOVA with the KNWL post-test method. score as dependent variable, condition as independent vari- able, and age, gender identity, LGBTQ+ connection, religios- Heteronormative Attitudes and Beliefs Scale. There was a dif- ity, previous LGBTQ+ training, and KNWL pre-test score as ference between the pre- and post-test on the HABS. A covariates revealed a signiﬁcant effect of condition, F(1, 615) repeated measures ANOVA with pre- and post-test scores = 116.006, p < .001, η = .159. on the HABS as within-subject factors, and condition as p Schaub et al. 9 between-subject factor only yielded a signiﬁcant main effect HABS revealed several subgroup effects. A signiﬁcant of the HABS (pre vs. post), F(1, 622) = 11.712, p < .001, effect of condition was identiﬁed for participants: η = .018. 1. with 0–10 years of experience, F(1, 426) = 6.226, p = .013, η = .014. Perceived LGBTQ+ Knowledge Scale. There was a difference 2. who identiﬁed as straight, F(1, 474) = 10.667, p= .001, between the pre- and post-test on the KNWL scale, and this η = .022. difference was larger for the Intervention condition. A 3. who identiﬁed as a woman, F(1, 535) = 8.379, p= .004, repeated measures ANOVA with pre- and post-test scores η = .015. on the KNWL scale as within-subject factors, and condition 4. who were over 35, F(1, 260) = 7.074, p= .008, η = as between-subject factor yielded a signiﬁcant main effect .026. of the KNWL scale (pre vs. post), F(1, 622) = 88.261, p < 5. who had a connection to the LGBTQ+ community, .001, η = .124, and a signiﬁcant interaction effect of the F(1, 494) = 9.277, p = .002, η = .018. KNWL × Condition, F(1, 622) = 34.747, p < .001, η = .053. For the following analyses, we used a mean imputation These groups scored lower on the HABS post-test than partic- method. ipants in the control condition compared to other subgroups, suggesting the training could be most effective for these sub- Heteronormative Attitudes and Beliefs Scale. There was a dif- groups. The effect sizes of these analyses can be considered ference between the pre- and post-test on the HABS, and large, suggesting practical signiﬁcance. this difference was larger for the Intervention condition. A repeated measures ANOVA with pre- and post-test scores Implementation and Process Evaluation on the HABS as within-subject factors, and condition as between-subject factor yielded a signiﬁcant main effect of In the post-test survey, participants (N = 188) in the interven- the HABS (pre vs. post), F(1, 622) = 28.023, p < .001, η = tion condition were asked several questions about the process .043, and a signiﬁcant interaction effect of the HABS × of undergoing the e-learning module. Both quantitative and Condition, F(1, 622) = 8.909, p = .003, η = .014. qualitative data were collected. Analysis of quantitative data revealed that participants were positive about the e-learning module. More than 90% of participants reported being very Perceived LGBTQ+ Knowledge Scale. There was a difference satisﬁed or satisﬁed with each of the four units of the training between the pre- and post-test on the KNWL scale, and this module and found it easy to enroll in the course. Having com- difference was larger for the Intervention condition. A pleted the course, 99.5% of participants think they are better repeated measures ANOVA with pre- and post-test scores able to support LGBTQ+ young people. Qualitative data indi- on the KNWL scale as within-subject factors, and condition cated participants felt their skills and conﬁdence were as between-subject factor yielded a signiﬁcant main effect improved about working with LGBTQ+ young people. of the KNWL scale (pre vs. post), F(1, 622) = 191.756, p < They described the value of tailored resources; research and .001, η = .236, and a signiﬁcant interaction effect of the case study guidance; practical recommendations/strategies KNWL × Condition, F(1, 622) = 98.956, p < .001, η = .137. to address SOGIE-related challenges; and applications of pro- The signiﬁcant main effects found in these analyses further fessional’s legal and professional responsibilities as per the conﬁrm our two hypotheses. Additionally, the signiﬁcant Equality Act 2010. interaction effects demonstrate the difference between pre- When asked about areas requiring better explanation, only and post-test measures was greater for the intervention condi- 15.7% answered yes. From this small minority of responses, tion than for the control condition, strengthening the evidence analysis showed that participants would prefer greater focus for the effectiveness of the e-learning module. Again, all on social work context (e.g., inspection criteria, local author- effect sizes for the main effects could be considered large ity requirements for social care), and more information about (Richardson, 2011). Effect sizes were higher for the differ- young people that are transgender, gender diverse, or with ence on the KNWL scale for both imputation methods. This asexual or pansexual identities. Additionally, social workers difference is examined in the Discussion section. wanted more content about two topics: working with families of origin about challenges accepting SOGIE, and what sup- Split Group Analyses ports would be effective in improving the poor mental health of LGBTQ+ young people in care. For the following analyses, we used the data set where missing values were imputed using mean imputation. We explored whether the intervention was more effective for spe- Discussion and Applications to Practice ciﬁc subgroups based on previous research (see above). For the perceived LGBTQ+ knowledge measure, no subgroup This study was the ﬁrst RCT testing the effectiveness of an differences were identiﬁed. However, analyses for the LGBTQ+ knowledge e-learning training module for 10 Research on Social Work Practice 0(0) children’s social workers. We evaluated the impact of the stronger effects on heteronormative attitudes and beliefs training on social worker’s LGBTQ+ knowledge and hetero- were found for children’s social workers who: (1) have 0– normative attitudes and beliefs compared to a control group 10 years of experience, (2) identify as straight, (3) identify experiencing “business as usual.” Following a review of the as a woman, (4) have a connection to the LGBTQ+ commu- literature, we included age, gender identity, religiosity, con- nity, or (5) are over 35 years old. However, these ﬁndings nection to the LGBTQ+ community, and previous training should be interpreted with caution, as the subgroups were as potential covariates. unequal in size and some subgroups were potentially too Our ﬁndings show the training was effective at increasing small to reach sufﬁcient power. A lack of an effect in some LGBTQ+ knowledge and reducing heteronormative attitudes of the subgroups can be explained by further exploring the and beliefs of children’s social workers, when tested in the pre-test scores. For example, we did not ﬁnd an effect of con- real world. We examined the effectiveness using best practice dition on the HABS post-test scores for those who identify as analysis approaches and found an effect of the training for all LGBTQ+, which can perhaps be attributed to the assumption approaches, except on the HABS using an ITT analysis and that LGBTQ+ participants are more likely to have fewer het- LOCF imputation method. In all analyses, the perceived eronormative attitudes and beliefs to start with regardless of LGBTQ+ KNWL yielded an effect of the intervention. We condition. also found signiﬁcant interaction effects for the two main Overall, our analyses provide substantial evidence about outcome scales and condition. These effects demonstrate the effectiveness of the e-learning training module. We the difference between pre- and post-test measures was opted for the use of several analysis approaches and greater for the intervention condition than for the control con- missing data imputation methods to explore the robustness dition, further strengthening the evidence for the effectiveness of the results. We found effects for almost every analysis of the e-learning module. Furthermore, the implementation and imputation method used. Our ﬁndings echo consistent and process evaluation suggested participants were very pos- calls within the literature for SOGIE training and the experi- itive about training access and content. Most importantly for ences of LGBTQ+ young people in care (Schaub, Stander, this study and the population under inspection, participants et al., 2022). This study supports and expands on previous felt conﬁdent that their LGBTQ+ knowledge had increased research related to training among helping professions and as a result of the training. demonstrates the effectiveness of e-learning training in Although the change in both knowledge and attitudes was improving the knowledge and attitudes of social workers signiﬁcant, the effects on knowledge were larger. This dis- regarding LGBTQ+ young people with a brief but compre- crepancy seems intuitive, as the main theory of change of hensive intervention. This information is important as it can the training was to increase participant’s knowledge about increase the accessibility of education and training speciﬁc LGBTQ+ young people and their support. An increase in to this group in highly accessible and relatively cost-effective knowledge by learning facts and concepts is likely to be ways among the wider social care workforce. These ﬁndings easier to achieve than a change in attitudes, which would are also relevant to those engaged in a range of educational involve developing new viewpoints; this change often and training settings in other helping or public sector profes- includes an emotional factor and might require contact with sions, and have implications beyond social work practice, the marginalized group (Steck & Perry, 2017). A contrasting education, and research. supposition is the difference in effect size could be attributed A notable strength of this study is that was the ﬁrst of its to the difference in scales used. The scale for perceived kind within the UK social work context succeeding in the LGBTQ+ knowledge included ﬁve answer options, whereas recruitment of a large sample of children’s social workers. the HABS scale provided seven answer options. Indeed, the Rigorous RCTs remain scarce in social care and social number of Likert scale response options may affect response work research (Dixon et al., 2013; Moody et al., 2020). We style (Weijters et al., 2010). utilized co-production techniques involving a range of stake- With respect to the covariate analyses, we only found sig- holders, including social care professionals and a group of niﬁcant effects in the ITT analyses in which we used an LOCF LGBTQ+ young people (16–24) with lived experiences of imputation method. For the HABS, a connection to the social care. LGBTQ+ community and the HABS pre-test were found to Another strength is that we were able to recruit a sample be signiﬁcant. For the perceived LGBTQ+ KNWL, the that broadly reﬂected the English social worker population. pre-test was a signiﬁcant covariate. Overall, these ﬁndings In September 2021, there were 32,500 full-time children demonstrate that the moderators that we included are not and family social workers in England (GOV.UK, 2022), so strong predictors of intervention success, suggesting that the our sample represents approximately 2%. The sample pre- intervention is relatively robust in its effectiveness. dominantly identiﬁed as female (∼86%), which corresponds Subgroup analyses only revealed differences in the HABS with the English national children’s social work workforce measure and suggested that the training might, perhaps, be (87%; GOV.UK, 2022). This also aligns with the interna- more effective in reducing heteronormative attitudes and tional workforce, for example, the USA, where 84.4% of beliefs for certain groups than others. More speciﬁcally, the workforce identiﬁed as female (Data USA, 2020). In Schaub et al. 11 our sample, 17.4% of participants were of ethnic minorities, social workers. Participants expressed a need for more which is slightly lower than the proportion in the national social work-speciﬁc content, which could be co-produced workforce (23%; GOV.UK, 2022). Not only was our with stakeholders in future work. Fourth, in the following sample similar to the population, but it was also of a studies, it could be explored how effects of this training healthy size, especially considering recruitment challenges extend to other healthcare and educational professions to reported in previous research (Acquivita et al., 2009; Canda ensure that LGBTQ+ young people are supported in all envi- et al., 2004) and the lack of research capacity in social ronments they encounter. We suggest that such tailoring is workers (Harvey et al., 2013; Wakeﬁeld et al., 2022). likely to improve the effects of these interventions. Finally, There were also some limitations to the present study. we strongly advocate for the increased use of RCTs in First, the sample was self-selecting, which may have led to social work and social care research. Although adaptions an overrepresentation of certain groups. We had a greater rep- might be required, this study demonstrates it is feasible and resentation of LGBTQ+ people than is found in the general contributes to a robust evidence base. population, suggesting a greater interest from this population. This study’s ﬁndings show that LGBTQ+ training is an However, we did ﬁnd evidence suggesting that the training essential ﬁrst step for improving the knowledge and challeng- was similarly effective for participants who had and did not ing dominant cis-heteronormative views in children’s social have a connection to the LGBTQ+ community, suggesting care (Schaub, Stander, et al., 2022). As a result, we recom- that levels of connection did not impact the intervention effec- mend mandatory and comprehensive training for all social tiveness. With regards to our methods, ﬁrstly, it could be workers in England about the experiences and needs of noted that the time between the pre- and the post-test was LGBTQ+ young people, including for pre- and post- not equal across the sample. However, this was a pragmatic qualifying social work programs. RCT, allowing us to test the effectiveness of the intervention under real-world conditions. Second, to assess perceived LGBTQ+ knowledge, we constructed our own scale. Conclusion Although it was adapted from an existing scale We can conclude that the Stonewall e-learning training (Gandy-Guedes, 2018) with excellent internal reliability (α module Supporting LGBTQ+ Children and Young People = .94), our scale was not validated. The decision for a is effective at increasing perceived LGBTQ+ knowledge shorter, unvalidated measure was made to reduce burden on and decreasing heteronormative stereotypes in children’s participants. In similar research, LGBTQ+ knowledge gains social workers in England. This study offers an important among helping professionals are typically assessed using non- foundation for the development of effective social workforce standardized measures designed by researchers speciﬁcally training on LGBTQ+ issues. Future research should test the for their training programs that employ multiple-choice, longitudinal replication of these results, as well as optimize Likert scale, or true–false formats, according to a systematic the training to make it optimally suitable for children’s review (Morris et al., 2019). Lastly, we experienced differen- social workers. tial attrition rates across conditions, which could potentially bias the results. Previous research demonstrates that a higher attrition rate in the intervention condition is common Authors’ Note (Crutzen et al., 2015), and this does not automatically bias This study was registered with the Open Science Framework (https:// the results (Hewitt et al., 2010). However, it is important to osf.io/25d8z). view these ﬁndings as initial positive evidence for the effec- tiveness of the training that should be further solidiﬁed in Declaration of Conﬂicting Interests future trials. This study offers an important building block for future The author(s) declared no potential conﬂicts of interest with respect research and provides initial evidence of the effectiveness to the research, authorship, and/or publication of this article. of the e-learning training module to increase perceived LGBTQ+ knowledge and decrease heteronormative attitudes Funding and beliefs in children’s social workers. Our ﬁndings follow several recommendations for future research. First, future The author(s) declared the following potential conﬂicts of interest studies should address the longitudinal effect of the training with respect to the research, authorship, and/or publication of this by administering follow-up measures at several intervals article: Our work was funded by What Works for Children’s after the post-test has taken place. Second, data could be col- Social Care. The views expressed here are those of the authors and lected on the impact of the training on social workers’ prac- not necessarily those of What Works for Children’s Social Care or tice. This could for instance be measured by follow-up the Department for Education (England; grant number 1001929). interviews or surveys inquiring about changes made to prac- We are most grateful to all the social workers who participated in tice as a result of the training. 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Research on Social Work Practice – SAGE

Published: Jan 1, 2025

Keywords: LGBTQ; young people; social work; e-learning; randomized controlled trial

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Effectiveness of an LGBTQ+ E-Learning Module for Social Workers: A Randomized Controlled Trial

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Effectiveness of an LGBTQ+ E-Learning Module for Social Workers: A Randomized Controlled Trial

Effectiveness of an LGBTQ+ E-Learning Module for Social Workers: A Randomized Controlled Trial

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