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Wright B, Brookman-Frazee L, McLeod BD, Flores A, Alegría M, Langer DA, Chavira D, Lau AS. Shared Decision-Making with Latinx Caregivers During Community Implemented Evidence-Based Practices: Determinants and Associations with Alliance. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2024:1-14. [PMID: 39058624 DOI: 10.1080/15374416.2024.2372761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
OBJECTIVE The current observational study examined shared decision-making (SDM) with caregivers of Latinx youth within the delivery of multiple evidence-based practices (EBPs) in community mental health services. The aims of the study were to (1) Identify therapist and client factors associated with increased SDM within EBP sessions and (2) Examine the association between SDM and therapeutic alliance between community therapists and Latinx caregivers. METHOD The Observing Patient Involvement in Decision-Making (OPTION) instrument measured SDM in 210 audio-recorded therapy sessions with 62 community therapists (91.94% female; 69.35% Latinx) and 109 Latinx caregivers (91.43% female) of youth who were an average age of 8.26 years (SD = 3.59). We used the Therapy Process Observational Coding System for Child Psychotherapy-Alliance scale to measure the caregiver-therapist alliance observationally. Multilevel linear regressions were conducted to examine research questions. RESULTS Greater SDM was observed within sessions where therapists targeted conduct problems versus trauma (B = -8.79, 95% CI[-14.09, -3.49], p = .001). There was a trend that SDM was higher in English-language sessions compared to Spanish. We found that the global measurement of SDM (B = .04, 95% CI[.01, .08], p = .03) and the OPTION item Integrate Preferences (B = .69, 95% CI[.07, 1.32], p = .03) were positively associated with alliance. CONCLUSIONS SDM may help foster Latinx caregiver engagement within EBP delivery. Provider training in SDM may be warranted with consideration of the specific clinical contexts (e.g., by presenting problem) that are appropriate for collaborative treatment planning. More research is needed to further establish the benefits of SDM in youth psychotherapy.
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Affiliation(s)
- Blanche Wright
- Department of Health Policy and Management, University of California, Los Angeles
- Department of Behavioral and Policy Sciences, RAND
| | - Lauren Brookman-Frazee
- Department of Psychiatry, University of California, San Diego
- Child and Adolescent Services Research Center
| | - Bryce D McLeod
- Department of Psychology, Virginia Commonwealth University
| | - Ashley Flores
- Department of Psychology, University of California, Los Angeles
| | - Margarita Alegría
- Department of Psychiatry, Harvard Medical School
- Disparities Research Unit, Massachusetts General Hospital
| | | | - Denise Chavira
- Department of Psychology, University of California, Los Angeles
| | - Anna S Lau
- Department of Psychology, University of California, Los Angeles
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Wallace DD, Hale KL, Guzman LE, Stein GL, Pérez Jolles M, Sleath BL, Thomas KC. Facilitators and Barriers to Shared Decision-Making Communication Between Latina Mothers and Pediatric Mental Healthcare Providers. HEALTH COMMUNICATION 2024:1-12. [PMID: 38982623 DOI: 10.1080/10410236.2024.2375791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/11/2024]
Abstract
This study assessed communication factors influencing shared decision-making (SDM) between language-congruent clinicians and Latina mothers of pediatric mental health patients. The sample comprised Latinx youth up to 22 years old who were enrolled in mental healthcare and attended mental health-related sessions with their parent. One hundred transcripts depicting mental health visits were coded using the Conversation Analysis framework. Coding included inductive coding that came from analyzing the structure, or orderliness, of the visits and content discussed that affects SDM. Thematic qualitative analysis revealed that facilitators to SDM included collaborative engagement, parents being active in tailoring session content, and integrating the preferences, roles, and next steps for treatment among all participants. Barriers included unskilled interpersonal interactions undermining rapport, off-topic conversations becoming the session's focus, poor time management, and irregularly integrating parent/patient preferences into the clinician's decisions regarding the child's treatment. Additionally, visit content, structure, tone, and interpersonal engagement were factors that variably facilitated or served as barriers to patient participation in SDM and were integral to collaborative, family-centered care. These findings delineated characteristics of pediatric mental health conversations and identified areas to strengthen communication between parents, patients, and clinicians to shift toward more effective SDM and improve patient outcomes among Latinx families.
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Affiliation(s)
- Deshira D Wallace
- Department of Health Behavior, University of North Carolina at Chapel Hill
| | - Kathryn L Hale
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
| | - Linda E Guzman
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University
| | | | - Mónica Pérez Jolles
- ACCORDS Dissemination and Implementation Science Program, University of Colorado Anschutz Medical Campus
| | - Betsy L Sleath
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
- Eshelman School of Pharmacy, University of North Carolina at Chapel Hill
| | - Kathleen C Thomas
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
- Eshelman School of Pharmacy, University of North Carolina at Chapel Hill
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Zerr A, McCabe K, Zhang D, Yeh M. Parent Explanatory Model Personalization as a Method of Reducing Risk for Poor Engagement and Outcomes in PCIT among Culturally Diverse Families. J Clin Med 2024; 13:3541. [PMID: 38930070 PMCID: PMC11204725 DOI: 10.3390/jcm13123541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 06/11/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024] Open
Abstract
Background/Objectives: Evidence supports the efficacy of Behavioral Parent Training (BPT) interventions such as Parent-Child Interaction Therapy (PCIT) for treating child behavior problems; however, treatment engagement and outcomes vary across ethnic groups. Risk for poor treatment engagement and outcomes may be attributed in part to misalignment between parent explanatory model components (PEMs) and the traditional BPT model, including treatment expectations, etiological explanations, parenting styles, and family support for treatment. The present study aims to examine whether personalized treatment adaptations addressing these PEM-BPT misalignments reduce risk for poor treatment engagement and outcomes. Methods: The authors previously utilized the PersIn framework to develop a personalized version of PCIT (MY PCIT) that assesses these PEMs in order to identify families at risk for poor treatment engagement and outcomes. Families were identified as high risk (due to PEM-BPT misalignment) and low risk (meaning those without identified PEM-BPT misalignment) for specific PEMs. Families at elevated risk then received tailored treatment materials designed to improve alignment between the parental explanatory model and the PCIT treatment explanatory model. A recent pilot trial of MY PCIT demonstrated positive treatment outcomes; however, the extent to which adaptations were successful in reducing the underlying risk factors has not yet been examined. Results: Findings demonstrate that the personalization approach was effective in reducing indicators of risk, and that families who were initially at high and low risk during pre-treatment reported similar levels of treatment engagement and outcomes by post-treatment. Conclusions: The findings suggest that this personalized approach has the potential to reduce risk associated with poor treatment engagement and outcomes for culturally diverse families.
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Affiliation(s)
- Argero Zerr
- Department of Psychology, California State University Channel Islands, 1 University Dr., Camarillo, CA 93012, USA
| | - Kristen McCabe
- Department of Psychological Sciences, University of San Diego, 5998 Alcala Park, San Diego, CA 92110, USA
- Child and Adolescent Services Research Center, San Diego, CA 92123, USA
| | - Dongbowei Zhang
- Department of Psychology, San Diego State University, 5500 Campanile Dr., San Diego, CA 92182, USA
| | - May Yeh
- Child and Adolescent Services Research Center, San Diego, CA 92123, USA
- Department of Psychology, San Diego State University, 5500 Campanile Dr., San Diego, CA 92182, USA
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Dr., La Jolla, CA 92093, USA
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Banda F, James G, Vasudeva K, Franklin M, Thoumi A, Cholera R. Building Equitable Mental Health Care for Latino Children: Perspectives from Providers and Communities. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01992-4. [PMID: 38592661 DOI: 10.1007/s40615-024-01992-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 03/23/2024] [Accepted: 03/25/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND The current pediatric mental health crisis has disproportionately impacted Latino youth in the United States (US), as demonstrated by their elevated risks of depression, substance use disorder, and anxiety. Despite this, research suggests Latino youth receive inequitable mental health services. OBJECTIVE To understand best practices, challenges, and priorities in providing accessible and equitable mental health care for Latino youth from the perspectives of front-line mental health providers and Latino community members. METHODS A bicultural, bilingual researcher conducted semi-structured interviews with 20 participants with expertise in Latino mental health. Topics included barriers and facilitators to mental health care access and cultural tailoring of treatment for Latino youth. Rapid qualitative analysis was used to identify themes. RESULTS Four themes were identified: (1) Navigating immigration concerns and acculturation, practitioners should consider immigration-related concerns and be trained to address acculturation-related stressors respectfully; (2) Adapting to the cultural needs and strengths of the communities, cultural humility education can allow providers to engage with both the strengths and needs of Latino families; (3) Engaging Latino caregivers as partners, it is critical to engage with Latino caregivers' cultural perspectives on parenting and mental health collaboratively; and (4) Addressing systemic barriers to promote access, providers must recognize and attempt to alleviate the systemic barriers that limit families from seeking care. CONCLUSIONS Participants identified several practical strategies to improve the provision of mental health services for Latino children. Future directions, policy and practice implications, and limitations are discussed.
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Affiliation(s)
- Francisco Banda
- Department of Psychological Science, University of Texas Rio Grande Valley, Edinburg, TX, USA
- Center for Health Policy, Robert J. Margolis, Duke University, 100 Fuqua Drive, Box 90120, Durham, MDNC, 27708-0120, USA
- Duke University, Durham, NC, USA
| | - Greeshma James
- Center for Health Policy, Robert J. Margolis, Duke University, 100 Fuqua Drive, Box 90120, Durham, MDNC, 27708-0120, USA
| | - Karina Vasudeva
- University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Michelle Franklin
- Center for Health Policy, Robert J. Margolis, Duke University, 100 Fuqua Drive, Box 90120, Durham, MDNC, 27708-0120, USA
- Duke Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Andrea Thoumi
- Center for Health Policy, Robert J. Margolis, Duke University, 100 Fuqua Drive, Box 90120, Durham, MDNC, 27708-0120, USA
| | - Rushina Cholera
- Center for Health Policy, Robert J. Margolis, Duke University, 100 Fuqua Drive, Box 90120, Durham, MDNC, 27708-0120, USA.
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA.
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.
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Garcini LM, Vázquez AL, Abraham C, Abraham C, Sarabu V, Cruz PL. Implications of Undocumented Status for Latinx Families During the COVID-19 Pandemic: A Call to Action. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2024; 53:10-23. [PMID: 36689639 PMCID: PMC10710880 DOI: 10.1080/15374416.2022.2158837] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND A disproportionate number of COVID-19 cases and deaths have been reported among Latinxs in the U.S. Among those most affected by the pandemic are marginalized families, including those that are undocumented and mixed-status, in which some, but not all members are undocumented. Undocumented and mixed-status families face multiple and chronic daily stressors that compromised their health and wellbeing. Salient stressors faced by undocumented Latinx families include poverty, social disadvantage, discrimination, dangerous living and working conditions, and limited access to healthcare. These stressors are frequently compounded with trauma, fear of detention, deportation, and family separation. PURPOSE Informed by the literature and insights from our community-based work to address the health needs of undocumented and mixed status Latinx families during the pandemic, this paper uses a social determinants of health lens to present a narrative summary that highlights four primary psychosocial stressors faced by these families and their implications for mental health. DISCUSSION These include stressors pertaining to (a) anti-immigrant rhetoric and actions; (b) family stressors and disruptions in family dynamics; (c) economic changes and financial losses; and (c) limited access to healthcare. Implications of the aforesaid stressors on the mental health of undocumented families and youth are also discussed. In addition, recommendations are provided for the provision of mental health services, best practices, and resources from a strengths-based approach.
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Affiliation(s)
- Luz M. Garcini
- Department of Psychological Sciences, Rice University
- Center for the United States and Mexico, Baker Institute for Public Policy, Rice University
| | | | | | - Ciciya Abraham
- Department of Sciences, University of Texas at San Antonio
| | - Vyas Sarabu
- Department of Medicine, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health Science Center at San Antonio
| | - Pamela Lizette Cruz
- Center for the United States and Mexico, Baker Institute for Public Policy, Rice University
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Guilamo-Ramos V, Johnson C, Thimm-Kaiser M, Benzekri A. Nurse-led approaches to address social determinants of health and advance health equity: A new framework and its implications. Nurs Outlook 2023; 71:101996. [PMID: 37349232 DOI: 10.1016/j.outlook.2023.101996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 05/19/2023] [Accepted: 05/23/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND The U.S. health care system is burdened by inefficiencies, longstanding health inequities, and unstainable costs. Within the nursing profession and the broader health care sector, there is growing recognition of the need for a paradigm shift that addresses persistent structural problems and advances health equity. PURPOSE Despite evidence of the importance of the social determinants of health (SDOH) in shaping inequitable health outcomes, practical tools for applying SDOH theory in the development of effective nurse-led programs to mitigate harmful SDOH remain scarce. METHODS We synthesize extant SDOH literature into a heuristic framework for conceptualizing core SDOH mechanisms, constructs, and principles. FINDINGS To illustrate how nurse scientists can use the framework to guide the development of programs for SDOH mitigation, we outline a three-step exemplar application to the U.S. Latino HIV epidemic. DISCUSSION Our framework can inform a paradigm shift toward nurse-led, multi-level SDOH mitigation across practice, education, and research.
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Affiliation(s)
- Vincent Guilamo-Ramos
- Center for Latino Adolescent and Family Health, Duke University, Durham, NC; School of Nursing, Duke University, Durham, NC; School of Medicine, Department of Family Medicine and Community Health, Department of Infectious Diseases, Duke University, Durham, NC; Presidential Advisory Council on HIV/AIDS, US Department of Health and Human Services, Washington, DC.
| | - Celia Johnson
- Center for Latino Adolescent and Family Health, Duke University, Durham, NC; School of Nursing, Duke University, Durham, NC
| | - Marco Thimm-Kaiser
- Center for Latino Adolescent and Family Health, Duke University, Durham, NC; School of Nursing, Duke University, Durham, NC
| | - Adam Benzekri
- Center for Latino Adolescent and Family Health, Duke University, Durham, NC; School of Nursing, Duke University, Durham, NC
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Seligman R. Metaphor and the politics and poetics of youth distress in an evidence-based psychotherapy. Transcult Psychiatry 2023; 60:819-834. [PMID: 34994270 DOI: 10.1177/13634615211066692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article explores the relationship between metaphors and emotion in the context of adolescent distress and psychotherapeutic treatment. Drawing on data from an ethnographic study of Mexican American adolescents receiving outpatient treatment for a variety of emotional and behavioral problems, the article examines what I call "prescribed" metaphors deployed in mainstream, manualized child and adolescent Cognitive Behavioral Therapies commonly used in mainstream clinical contexts. I explore the models of emotion communicated to youth by one such metaphor, youth responses to this metaphor, and the potential implications for young people as they take up the underlying models and affective practices embedded in the metaphor. Specifically, I examine how youth respond to messages about emotion metacognition and emotion regulation embedded in a metaphor that equates feelings with temperatures that can be monitored and objectively measured. I find that youth are at once convinced that abstract knowledge about internal states is inherently valuable because it is linked to desired forms of personhood, but also concerned about the limits of technical metaphors to capture aspects of lived experience and the flattening and homogenization of affect that might accompany the practices such metaphors help to enact. I analyze alternative interpretations of prescribed metaphors as well as the spontaneous metaphors used by youth to talk about their emotions and experiences of distress, in an effort to think through the politics and poetics of emotion metaphors in the context of an evidence-based psychotherapy for young people.
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Yu SH, Kodish T, Bear L, O’Neill JC, Asarnow JR, Goldston D, Cheng KK, Wang X, Vargas SM, Lau AS. Leader and Provider Perspectives on Implementing Safe Alternatives for Teens and Youth - Acute (SAFETY-A) in Public School Districts Serving Racial/ethnic Minoritized Youth. SCHOOL MENTAL HEALTH 2023; 15:583-599. [PMID: 37622166 PMCID: PMC10449380 DOI: 10.1007/s12310-023-09572-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2023] [Indexed: 02/26/2023]
Abstract
Racial/ethnic minoritized (REM) youth represent a high-risk group for suicide, yet there are striking disparities in their use of mental health services (MHS) even after risk is identified in schools. Prior research suggests that school-based risk assessments and hospitalization encounters can be negatively experienced by REM youth and families, thus deterring likelihood of seeking follow-up care. The Safe Alternatives for Teens and Youth-Acute (SAFETY-A) is a brief, strengths-based, cognitive-behavioral family intervention demonstrated to increase linkage to MHS when implemented in emergency departments. With its focus on strengths and family engagement, SAFETY-A may cultivate a positive therapeutic encounter suited to addressing disparities in MHS by enhancing trust and family collaboration, if appropriately adapted for schools. Thirty-seven school district leaders and frontline school MHS providers from districts serving primarily socioeconomically disadvantaged REM communities participated in key informant interviews and focus groups. First, interviews were conducted to understand usual care processes for responding to students with suicidal thoughts and behaviors, and perspectives on the strengths and disadvantages of current practices. An as-is process analysis was used to describe current practices spanning risk assessment, crisis intervention, and follow-up. Second, focus groups were conducted to solicit perceptions of the fit of SAFETY-A for these school contexts. Thematic analysis of the interviews and focus groups was used to identify multilevel facilitators and barriers to SAFETY-A implementation, and potential tailoring variables for implementation strategies across school districts.
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Affiliation(s)
- Stephanie H. Yu
- Department of Psychology, University of California, Los Angeles, CA
| | - Tamar Kodish
- Department of Psychology, University of California, Los Angeles, CA
| | | | - J. Conor O’Neill
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | - Joan R. Asarnow
- Department of Psychiatry, Child, and Adolescent Psychiatry, Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA
| | - David Goldston
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | - Karli K. Cheng
- Department of Neurology, Phoenix Children’s Hospital, Phoenix, AZ
| | - Xinran Wang
- Department of Psychology, University of California, Los Angeles, CA
- Department of Psychology and Human Development, Vanderbilt University, TN
| | - Sylvanna M. Vargas
- Department of Psychology, University of California, Los Angeles, CA
- Department of Psychiatry, Child, and Adolescent Psychiatry, Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA
| | - Anna S. Lau
- Department of Psychology, University of California, Los Angeles, CA
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Hurd NM, Young AS. Introduction to the Special Issue: Advancing Racial Justice in Clinical Child and Adolescent Psychology. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2023; 52:311-327. [PMID: 37141558 PMCID: PMC10213141 DOI: 10.1080/15374416.2023.2202255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Relative to White youth, racially and ethnically marginalized youth in the U.S. are less likely to initiate treatment, stay in treatment, and receive adequate care. This special issue attends to racial injustice in clinical child and adolescent psychology. While numerous factors drive these racial disparities, this special issue focuses specifically on opportunities and responsibilities we have as mental health providers, teachers, mentors, researchers, and gatekeepers to make our field more racially just. In this introduction to the special issue, we review barriers and solutions across multiple contexts including structural, institutional, and practice-based. We also discuss challenges and opportunities to diversify our field and increase the representation of racially and ethnically marginalized practitioners and scholars in clinical child and adolescent psychology. We then briefly review the special issue articles and make final recommendations for how to move the field forward.
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Affiliation(s)
| | - Andrea S Young
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine
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Buitron V, Jiménez-Colón G, Duarté-Vélez Y. Mental health services use and social support among Latinx families with adolescents who engage in suicidal behavior. EVIDENCE-BASED PRACTICE IN CHILD AND ADOLESCENT MENTAL HEALTH 2023; 8:194-205. [PMID: 37383484 PMCID: PMC10299760 DOI: 10.1080/23794925.2023.2183433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
Latinx communities experience a significant child mental health disparity. Research is needed to examine mental health services use and social support in Latinx adolescents, with particular attention to acculturative factors and youth who have high levels of clinical severity. The current study examined whether acculturation and enculturation, and related proxies, are associated with prior history of services use and social support in Latinx families with adolescents who had a recent suicidal crisis. Participants were 110 youths, recently admitted to psychiatric hospitalization, ages 12 to 17 years and their caregivers. Results indicated that approximately 20% of the overall sample did not access any formal mental health services (e.g., outpatient mental health care, primary care support, school staff support) before high acuity hospital care. First generation status and higher caregiver enculturation were associated with a lower likelihood of formal mental health services use, even when controlling for clinical covariates. Adolescent preference for Spanish was associated with lower social support. Findings suggest that families with higher enculturation and first-generation immigrant families (both caregivers and youth born outside of the U.S.), in the context of severe clinical impairment, experience systemic and sociocultural barriers conducive to limited engagement with mental health support. Implications for improving the accessibility of mental health supports are reviewed.
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Affiliation(s)
| | - Gisela Jiménez-Colón
- Department of Psychiatry and Human Behavior, Emma Pendleton Bradley Hospital and Brown University, Coro West Suite 1.300, Box #36, 25 Hoppin St., Providence, RI 02903
| | - Yovanska Duarté-Vélez
- Department of Psychiatry and Human Behavior, Emma Pendleton Bradley Hospital and Brown University, Coro West Suite 1.300, Box #36, 25 Hoppin St., Providence, RI 02903
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Robinson T, Robertson N, Curtis F, Darko N, Jones CR. Examining Psychosocial and Economic Barriers to Green Space Access for Racialised Individuals and Families: A Narrative Literature Review of the Evidence to Date. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:745. [PMID: 36613069 PMCID: PMC9819928 DOI: 10.3390/ijerph20010745] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Social prescribing (such as green social prescribing), aims to address health disparities cross-culturally to improve well-being. However, evidence highlights racial disparities in relation to access to quality green space (including local/national parks and recreational spaces). This review aimed to identify the psycho-socioeconomic barriers to green space access for racialised individuals/families and Black Indigenous People of Colour (BIPOC), to understand what cultural adaptations might be made to help support them to access green social prescribing within the UK. METHOD A narrative systematic review was conducted to identify barriers to green space access for racialised individuals/families and BIPOC. Searches of publication databases (APA PsycInfo, Cochrane Database of Systematic Reviews [CDSR], Cochrane Central Register of Controlled Trials [CENTRAL], Cumulated Index to Nursing and Allied Health Literature [CINAHL], and SCOPUS Preview) were undertaken from January to February 2022, to identify quantitative peer reviewed studies. Of the 4493 abstracts identified, ten studies met the inclusion criteria and were included for final review. RESULTS The results suggest that interpersonal, practical (such as transportation costs, entrance fees and lodging costs) and environmental factors can act as barriers to green space access for racialised individuals/families. Most frequently reported barriers were perceptions of safety and costs associated with travel and accessing green spaces, particularly for families. CONCLUSION Factors such as diversity-friendly schemes (e.g., multiple languages on signs and additional prayer spaces in parks), funding and strategies to improve safety should be considered in the design and commissioning of green space and green social prescribing initiatives in primary care. By mitigating these barriers green space can become more accessible and improve inclusivity for racialised individuals/families. Future research could explore the inter-racial differences between racialised populations and which mechanisms reduce barriers to access and in what contexts.
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Affiliation(s)
- Tila Robinson
- Department of Psychology and Vison Sciences, University of Leicester, Leicester LE1 7RH, UK
| | - Noelle Robertson
- Department of Psychology and Vison Sciences, University of Leicester, Leicester LE1 7RH, UK
| | - Ffion Curtis
- Centre for Ethnic Health, University of Leicester, Leicester LE1 7RH, UK
| | - Natalie Darko
- School of Sociology, University of Leicester, Leicester LE1 7RH, UK
| | - Ceri R. Jones
- Department of Psychology and Vison Sciences, University of Leicester, Leicester LE1 7RH, UK
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Robles-Ramamurthy B, Sandoval JF, Tobón AL, Fortuna LR. Beyond Children's Mental Health: Cultural Considerations to Foster Latino Child and Family Mental Health. Child Adolesc Psychiatr Clin N Am 2022; 31:765-778. [PMID: 36182223 PMCID: PMC9529069 DOI: 10.1016/j.chc.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Clinicians trained to assess and treat child psychopathology are facing an increasing need to expand their clinical expertise outside of traditional frameworks, which have historically focused largely on the child or the child-mother dyad. Clinicians treating children also need to be prepared to assess and address the systems of care that affect a child's mental health, starting with their family. There is a scarcity of Latino mental health providers and limited clinical opportunities or settings that serve this population by incorporating a developmental, cultural, and sociopolitical framework into high quality care of the whole family.
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Affiliation(s)
- Barbara Robles-Ramamurthy
- Department of Psychiatry and Behavioral Sciences, University of Texas Health San Antonio, 7703 Floyd Curl Drive, MC 7792, San Antonio, TX 78229, USA.
| | - Jessica F Sandoval
- Department of Psychiatry and Behavioral Sciences, University of Texas Health San Antonio, 7703 Floyd Curl Drive, MC 7792, San Antonio, TX 78229, USA
| | - Amalia Londoño Tobón
- National Institutes on Minority Health and Health Disparities, 6707 Democracy Boulevard, Suite 800, Bethesda, MD 20892-5465, USA
| | - Lisa R Fortuna
- Department of Psychiatry and Behavioral Sciences, University of California in San Francisco, 1001 Potrero Avenue, 7M16, San Francisco, CA 94110, USA
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Cultural and Telehealth Considerations for Trauma-Focused Treatment Among Latinx Youth: Case Reports and Clinical Recommendations to Enhance Treatment Engagement. COGNITIVE AND BEHAVIORAL PRACTICE 2022. [DOI: 10.1016/j.cbpra.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Hatley-Cotter A, Saad G, Brestan-Knight E. Treatment Readiness among Primarily Latine Families Seeking Parent-Child Interaction Therapy (PCIT) in an Urban Setting. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084784. [PMID: 35457656 PMCID: PMC9032165 DOI: 10.3390/ijerph19084784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 03/30/2022] [Accepted: 04/04/2022] [Indexed: 11/18/2022]
Abstract
(1) Background: Given the high prevalence of childhood mental health problems and their long-lasting negative consequences if left untreated, it is important to investigate factors that affect family engagement in psychological interventions such as Parent–Child Interaction Therapy (PCIT), including caregiver treatment readiness and readiness for change (RFC). Specifically, Latine families experience greater mental health disparities and have unique cultural factors that affect engagement. The current project examined caregiver pretreatment readiness among primarily Latine Spanish- and English-speaking families. (2) Methods: Participants were 100 caregivers (96% female) of young children ages 2 to 7 who sought PCIT services from a community mental health center in Washington, D.C. Families completed written and observational assessment measures at pretreatment and throughout PCIT, which were used for the current study. (3) Results: Caregivers reported high readiness and importance of treatment at intake, with higher RFC among Spanish-speaking caregivers. Regardless of language, caregivers who reported more frequent and problematic child misbehavior and who were from a multi-caregiver household tended to report more RFC and treatment importance at intake. Pretreatment RFC also predicted family completion of the first phase of PCIT although there was a high attrition rate for the sample as only 18% of families completed treatment. (4) Conclusions: These findings provide insight into the implementation of standard PCIT among Spanish- and English speaking families and highlight the benefits of assessing pretreatment caregiver readiness to inform clinical decision-making.
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Affiliation(s)
- Allison Hatley-Cotter
- Department of Psychological Sciences, Auburn University, 226 Thach Ave, Auburn, AL 36849, USA;
- Correspondence: ; Tel.: +1-614-722-4700
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Merced K, Ohayagha C, Grover R, Garcia-Rodriguez I, Moreno O, Perrin PB. Spanish Translation and Psychometric Validation of a Measure of Acculturative Stress among Latinx Immigrants in the USA. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052808. [PMID: 35270500 PMCID: PMC8910284 DOI: 10.3390/ijerph19052808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/16/2022] [Accepted: 02/22/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND In the United States, the Latinx community is growing at a faster rate than any other racial or ethnic minority group. Members of this community have been found to experience a number of acculturative stressors after immigrating, including xenophobia, racism, and discrimination. Although several scales have been created in recent years to measure acculturative stress in Spanish-speaking immigrants, they are long, do not have nuanced subscales, or have not been validated in an extremely diverse sample of Latinx immigrants. OBJECTIVE The purpose of the current study was to translate and psychometrically validate the Riverside Acculturative Stress Inventory (RASI) in a diverse sample of Spanish-speaking immigrants. METHODS A sample of 202 Latinx immigrants in the United States completed the RASI as well as measures of depression and anxiety. RESULTS An initial confirmatory factor analysis suggested that the overall subscale factor structure was not an ideal fit for the data. An exploratory factor analysis suggested the retention of four subscales, each with three items, forming a 12-item Spanish RASI short form. As indices of convergent validity, the RASI total score was positively associated with depression and anxiety. CONCLUSIONS The findings from the study contribute to the literature a brief and valid assessment of acculturative stress in Spanish-speaking immigrants. The RASI Spanish short form holds promise to stimulate research on the unique adversities experienced by Latinx immigrants.
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Affiliation(s)
- Kritzia Merced
- Hunter Holmes McGuire VA Medical Center, Central Virginia Veterans Affairs Health Care System, Richmond, VA 23249, USA;
- Department of Psychology, Virginia Commonwealth University, Richmond, VA 23284, USA; (C.O.); (R.G.); (I.G.-R.); (O.M.)
| | - Chimdindu Ohayagha
- Department of Psychology, Virginia Commonwealth University, Richmond, VA 23284, USA; (C.O.); (R.G.); (I.G.-R.); (O.M.)
| | - Ria Grover
- Department of Psychology, Virginia Commonwealth University, Richmond, VA 23284, USA; (C.O.); (R.G.); (I.G.-R.); (O.M.)
| | - Isis Garcia-Rodriguez
- Department of Psychology, Virginia Commonwealth University, Richmond, VA 23284, USA; (C.O.); (R.G.); (I.G.-R.); (O.M.)
| | - Oswaldo Moreno
- Department of Psychology, Virginia Commonwealth University, Richmond, VA 23284, USA; (C.O.); (R.G.); (I.G.-R.); (O.M.)
| | - Paul B. Perrin
- Hunter Holmes McGuire VA Medical Center, Central Virginia Veterans Affairs Health Care System, Richmond, VA 23249, USA;
- Department of Psychology, Virginia Commonwealth University, Richmond, VA 23284, USA; (C.O.); (R.G.); (I.G.-R.); (O.M.)
- Correspondence:
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Simkhada B, Vahdaninia M, van Teijlingen E, Blunt H. Cultural issues on accessing mental health services in Nepali and Iranian migrants communities in the UK. Int J Ment Health Nurs 2021; 30:1610-1619. [PMID: 34291560 DOI: 10.1111/inm.12913] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 07/01/2021] [Accepted: 07/05/2021] [Indexed: 11/29/2022]
Abstract
Mental health in Black Asian and Minority Ethnic (BAME) communities is a rising public health concern in the UK, with key challenges around accessing mental health services. Our understanding of mental health issues in the growing Nepali and Iranian communities in the UK is very limited. Therefore, this study aims to explore the major factors affecting access to, and engagement with NHS mental health services. This study used a qualitative approach comprising in-depth interviews with seven Nepali, eight Iranians and six community mental health workers in the south of England. The data were analysed using a thematic approach. Six themes were identified: (1) stigma and fear; (2) gender; (3) language; (4) tradition and culture; (5) family involvement; and (6) lack of cultural awareness in health workers, all appearing to be major issues. This study contributes to a shared understanding of mental illness within two given cultural contexts to promote early interventions in UK mental health services. Developing cross-cultural perspectives in health care should be a priority in practice.
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Affiliation(s)
- Bibha Simkhada
- Department of Nursing and Midwifery, School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - Mariam Vahdaninia
- Peninsula Medical School, Faculty of Health, University of Plymouth, Plymouth, UK
| | | | - Hannah Blunt
- Dorset Healthcare, University NHS Foundation Trust, Dorset, UK
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Vázquez AL, Culianos D, Flores CMN, Alvarez MDLC, Barrett TS, Domenech Rodríguez MM. Psychometric Evaluation of a Barriers to Mental Health Treatment Questionnaire for Latina/o/x Caregivers of Children and Adolescents. CHILD & YOUTH CARE FORUM 2021; 51:847-864. [PMID: 34642563 PMCID: PMC8494628 DOI: 10.1007/s10566-021-09656-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 09/13/2021] [Accepted: 09/24/2021] [Indexed: 11/28/2022]
Abstract
Background Knowledge regarding barriers faced by Latina/o/x caregivers in accessing youth mental health services (MHS) have largely depended on resource intensive interview-based assessments. Objective We evaluated a questionnaire for Latina/o/x caregivers of youths that presents a briefer and more feasible alternative. Method We conducted a psychometric evaluation of the Barriers to Treatment Questionnaire - Latina/o/x Caregivers (BTQ-LC) with a sample of 598 Latina/o/x caregivers from across the United States. Descriptive statistics and confirmatory factor analyses were used to identify common barriers to services, confirm the factor structure of the scale, and establish construct validity. Results Descriptive statistics suggest that not knowing where and how to access services, and normalization of youth psychopathology were the most frequently reported barriers among caregivers of youth with clinically elevated problems on the CBCL. Confirmatory factor analysis suggests that the BTQ-LC was best represented by a three-factor structure: (1) structural, (2) perceptions regarding mental health problems, and (3) services. Our finding suggest that the BTQ-LC could also be used as a single factor as fit indices ranged from acceptable to poor. BTQ-LC scales were all negatively correlated with the utilization of common youth MHS (i.e., psychological counseling, medical doctors, school professionals). Conclusions The BTQ-LC represents an important step towards improving our understanding and assessment of barriers to services contributing to mental health disparities among Latina/o/x youths.
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Affiliation(s)
- Alejandro L Vázquez
- Department of Psychology, Utah State University, 2810 Old Main Hill, 84322 Logan, UT USA
| | - Demi Culianos
- Department of Psychology, Utah State University, 2810 Old Main Hill, 84322 Logan, UT USA
| | | | | | - Tyson S Barrett
- Department of Psychology, Utah State University, 2810 Old Main Hill, 84322 Logan, UT USA
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Positive Relationships with Adults and Resilience to Suicide Attempt among New Mexico Hispanic Adolescents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910430. [PMID: 34639736 PMCID: PMC8508296 DOI: 10.3390/ijerph181910430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 09/30/2021] [Accepted: 10/01/2021] [Indexed: 12/02/2022]
Abstract
Suicide is a leading cause of adolescent death and has increased in recent years. The purpose of this study was to examine the effect that relationships with adults at home and in the community had on the probability of suicide attempts of Hispanic teenagers in New Mexico. Data from the 2019 New Mexico Youth Risk and Resiliency Survey were analyzed to identify the ways in which relationships with adults influenced suicide attempts among Hispanic adolescent students. The examined factors included: relationships with adults in the home and in the community and with same-age friends, and participation in hobbies or organizations outside of school. The resiliency factors were similar for male and female Hispanic students. As positive relationships with adults at home or in the community increased, the probability of suicide attempts decreased by 37–54%. Positive relationships with same-age friends were also associated with reduced suicide attempts. Community organization involvement and hobbies affected males and females differently. Adults at home and in the community can decrease the risk of suicide for Hispanic teenagers through supportive relationships. Hybrid programs focusing on adolescent health, positive communication, and academic support, which integrate adults from home and community environments, show promise in reducing suicidal thoughts and other risk behaviors.
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Gaias LM, Arnold KT, Liu FF, Pullmann MD, Duong MT, Lyon AR. Adapting strategies to promote implementation reach and equity (ASPIRE) in school mental health services. PSYCHOLOGY IN THE SCHOOLS 2021. [DOI: 10.1002/pits.22515] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Larissa M. Gaias
- Department of Psychology University of Massachusetts Lowell Lowell Massachusetts USA
| | - Kimberly T. Arnold
- Department of Psychiatry, Perelman School of Medicine University of Pennsylvania Philadelphia Pennsylvania USA
| | - Freda F. Liu
- Psychiatry and Behavioral Medicine Seattle Children's Hospital Seattle Washington USA
- Department of Psychiatry and Behavioral Sciences University of Washington School of Medicine Seattle Washington USA
| | - Michael D. Pullmann
- Department of Psychiatry and Behavioral Sciences University of Washington School of Medicine Seattle Washington USA
| | - Mylien T. Duong
- Education, Research & Impact Committee for Children Seattle WA USA
| | - Aaron R. Lyon
- Department of Psychiatry and Behavioral Sciences University of Washington School of Medicine Seattle Washington USA
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Nadeau L, Johnson-Lafleur J, Jaimes A, Bolduc E. L’engagement dans les soins en collaboration en santé mentale jeunesse pour les familles migrantes : des lieux cliniques ancrés dans leurs contextes institutionnel et sociopolitique. SANTE MENTALE AU QUEBEC 2021. [DOI: 10.7202/1075386ar] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectifs Cet article vise à combler certaines lacunes dans la littérature concernant les conditions propices à des soins en collaboration de qualité en santé mentale jeunesse (SMJ) pour les jeunes migrants et leurs familles, dans les services de première ligne. Il examine les facteurs susceptibles de favoriser l’engagement des familles migrantes dans les services, en tenant compte des dimensions liées à la rencontre clinique, aux enjeux systémiques et aux questions institutionnelles/sociopolitiques.
Méthode Utilisant un devis multiphase en méthodes mixtes, l’article présente séquentiellement les résultats qualitatifs et quantitatifs spécifiques aux familles migrantes, d’un vaste programme de recherche sur les soins en collaboration en SMJ dans des quartiers culturellement et socioéconomiquement diversifiés. Ces résultats proviennent de données collectées à Montréal au cours de la dernière décennie par le biais de questionnaires, d’entrevues semi-structurées, de groupes de discussion, d’observation participante et de documentation. Les participants à la recherche étaient des enfants, des adolescents et des parents de familles migrantes, des cliniciens et des gestionnaires.
Résultats Les résultats suggèrent que le macrosystème sociopolitique et institutionnel structure l’espace de la clinique et influence le processus de soins. En particulier, les réformes successives du système de santé posent des défis de taille aux institutions et aux équipes en SMJ quant à leur capacité à créer un environnement favorable à la continuité des soins et au partenariat interinstitutionnel et à la collaboration interprofessionnelle, des facteurs associés à l’engagement des familles dans les soins. Cet engagement est également tributaire des représentations que les familles migrantes se font de la santé mentale et des services. Ces représentations sont façonnées par leur expérience des soins, mais aussi par ce que leur environnement socioculturel et les discours publics leur permettent d’imaginer de ces services. Cela invite à considérer une intégration de dimensions culturelles et sociopolitiques dans le concept d’engagement. Enfin, les résultats suggèrent également que les écoles jouent un rôle important pour favoriser l’engagement dans les soins de santé mentale.
Conclusion La qualité des soins de santé mentale pour les enfants et adolescents migrants dépend de l’engagement des familles dans les services, et aussi de l’engagement réciproque des cliniciens et des institutions. Les contextes politiques où des tensions entre les groupes majoritaires et minoritaires sont présentes peuvent également faire obstacle aux soins. Étant donné que les familles migrantes s’engagent moins dans les services par rapport aux familles non migrantes, ces considérations appellent à un examen important des moyens pour faciliter l’engagement des familles migrantes dans les soins en collaboration en SMJ. L’article propose certaines avenues pour favoriser cet engagement.
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Affiliation(s)
- Lucie Nadeau
- MD, M. Sc., Professeure agrégée, Université McGill, Institut universitaire SHERPA ; pédopsychiatre, CUSM
| | - Janique Johnson-Lafleur
- Ph. D.(c), M. Sc., Université McGill ; coordonnatrice de recherche, Institut universitaire SHERPA
| | - Annie Jaimes
- Ph. D., chercheure postdoctorale, Université York ; chercheure-praticienne, Institut universitaire SHERPA
| | - Emmanuelle Bolduc
- MBA, M. Sc., Coordonnatrice de programme CoVivre, Institut universitaire SHERPA
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Brent DA, Porta G, Rozenman MS, Gonzalez A, Schwartz KTG, Lynch FL, Dickerson JF, Iyengar S, Weersing VR. Brief Behavioral Therapy for Pediatric Anxiety and Depression in Primary Care: A Follow-up. J Am Acad Child Adolesc Psychiatry 2020; 59:856-867. [PMID: 31278996 PMCID: PMC6940557 DOI: 10.1016/j.jaac.2019.06.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 06/12/2019] [Accepted: 06/28/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To report on the 32-week outcome of the Brief Behavioral Therapy (BBT) for Pediatric Anxiety and Depression in Primary Care clinical trial. METHOD A total of 185 youths aged 8 to 17 years with anxiety and/or depression identified through 9 pediatric primary care (PPC) settings in San Diego and Pittsburgh were randomized to receive Assisted Referral to Care (ARC) or up to 12 sessions of BBT over 16 weeks. The primary outcome was clinical response across anxiety and depression, defined as a Clinical Global Impressions-Improvement Score of ≤2. Secondary outcomes included interview-rated functioning, depression, and anxiety. Here, we report on outcomes at 32 weeks after randomization. All analyses with primary outcomes are corrected for multiple comparisons using the false discovery rate procedure. RESULTS At 32 weeks, BBT was superior to ARC with respect to response (67.5% versus 43.1%, q = 0.03, number needed to treat [NNT] = 5) and functioning (d = 0.49, q = 0.04). BBT was superior to ARC with respect to its impact on anxiety (f = 0.21) but not depressive symptoms (f = 0.05). These findings persisted after controlling for the number of sessions received. Ethnicity moderated the impact of BBT on outcome (NNT for Hispanic youths = 2), because of a much lower response rate to ARC in Hispanic than in non-Hispanic youths (16.7% versus 49.2%, p = 0.04). CONCLUSION BBT is a promising intervention that can be effectively delivered in PPC and may be particularly effective for Hispanic patients. Further work is indicated to improve its impact on depressive symptoms and to test BBT against other treatments delivered in pediatric primary care. CLINICAL TRIAL REGISTRATION INFORMATION Brief Cognitive Behavioral Therapy (CBT) for Pediatric Anxiety and Depression in Primary Care; http://clinicaltrials.gov; NCT01147614.
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Barnett ML, Kia-Keating M, Ruth A, Garcia M. Promoting Equity and Resilience: Wellness Navigators' Role in Addressing Adverse Childhood Experiences. CLINICAL PRACTICE IN PEDIATRIC PSYCHOLOGY 2020; 8:176-188. [PMID: 34194889 DOI: 10.1037/cpp0000320] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objective Adverse childhood experiences (ACEs) have demonstrable negative effects on long-term physical and mental health. Racial and ethnic minority children disproportionally experience ACEs due to the impacts of structural inequality and discrimination, which could drive health disparities. Pediatric settings offer an opportune context to address ACEs and improve health equity, and to link families to the necessary resources to promote resilience. Wellness navigators (WNs), who can reflect patients' cultural, linguistic, and other shared characteristics, have the potential to improve patient care and integrated behavioral health services to mitigate the public health impact of ACEs. In the current study, bilingual and bicultural WNs helped to deliver an ACEs screening and response to predominately Latinx patients in a pediatric service setting. Methods Quantitative data on referrals made by WNs and qualitative interviews were analyzed to understand the role of WNs in ACEs screening. Results Among families (infants and caregivers) that screened positive for ACEs, WNs addressed social determinants of health and, based on individual needs assessments, made referrals to community resources in over half of the cases. Insurance, childcare, and housing were the most frequent referral sources. WNs supported caregivers in initiating services with 94% of the referrals that were made. Qualitative interviews with medical providers and caregivers underscored WNs' role in the ACEs screening process. Implications for ACEs screening, trauma-responsive pediatric care, and integrating WNs into an integrated behavioral health team are discussed.
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Affiliation(s)
- Miya L Barnett
- University of California, Santa Barbara, Department of Counseling, Clinical, & School Psychology
| | - Maryam Kia-Keating
- University of California, Santa Barbara, Department of Counseling, Clinical, & School Psychology
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Chlebowski C, Hurwich-Reiss E, Wright B, Brookman-Frazee L. Using stakeholder perspectives to guide systematic adaptation of an autism mental health intervention for Latinx families: A qualitative study. JOURNAL OF COMMUNITY PSYCHOLOGY 2020; 48:1194-1214. [PMID: 31816103 PMCID: PMC7261618 DOI: 10.1002/jcop.22296] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 09/27/2019] [Accepted: 11/18/2019] [Indexed: 05/30/2023]
Abstract
Embedded within a Hybrid Type 1 randomized effectiveness-implementation trial in publicly funded mental health services, the current study identified stakeholder recommendations to inform cultural adaptations to An Individualized Mental Health Intervention for Autism Spectrum Disorder (AIM HI) for Latinx and Spanish-speaking families. Recommendations were collected through focus groups with therapists (n = 17) and semi-structured interviews with Latinx parents (n = 29). Relevant themes were identified through a rapid assessment analysis process and thematic coding of interviews. Adaptations were classified according to the Framework for Reporting Adaptations and Modifications-Enhanced (FRAME) to facilitate fit, acceptability, and sustained implementation of AIM HI and classify the content, nature, and goals of the adaptations. Recommended adaptations were classified through FRAME as tailoring training and intervention materials, changing packaging or materials, extending intervention pacing, and integrating supplemental training strategies. Goals for adaptations included improving fit for stakeholders, increasing parent engagement, and enhancing intervention effectiveness. The current study illustrates the process of embedding an iterative process of intervention adaptation within a hybrid effectiveness-implementation trial. The next steps in this study are to integrate findings with implementation process data from the parent trial to develop a cultural enhancement to AIM HI and test the enhancement in a Hybrid Type 3 implementation-effectiveness trial.
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Affiliation(s)
- Colby Chlebowski
- Department of Psychiatry, University of California San Diego, San Diego, California
- Child and Adolescent Services Research Center, San Diego, CA
| | - Eliana Hurwich-Reiss
- Department of Psychiatry, University of California San Diego, San Diego, California
- Child and Adolescent Services Research Center, San Diego, CA
| | - Blanche Wright
- Department of Psychology, University of California Los Angeles, Los Angeles, California
| | - Lauren Brookman-Frazee
- Department of Psychiatry, University of California San Diego, San Diego, California
- Child and Adolescent Services Research Center, San Diego, CA
- Autism Discovery Institute, Rady Children's Hospital, San Diego, CA
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Malkoff AC, Grace M, Kapke TL, Gerdes AC. Family Functioning in Latinx Families of Children with ADHD: The Role of Parental Gender and Acculturation. JOURNAL OF CHILD AND FAMILY STUDIES 2020; 29:1108-1122. [PMID: 33343179 PMCID: PMC7747796 DOI: 10.1007/s10826-019-01673-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVES It has been well-established that parents of children with ADHD report significantly higher levels of parenting stress and home chaos, and lower levels of parental efficacy than parents of children without ADHD. Unfortunately, most of the extant ADHD literature has focused on European American children and families, resulting in a paucity of research focusing on ethnic minority families of children with ADHD. The current study aimed to expand what is known about Latinx parents of children with ADHD by exploring contextual and cultural factors, such as parental gender and acculturation, which may account for variations in parenting experiences within this population. METHODS The present study utilized secondary data analysis to analyze ratings of parenting stress, home chaos, and parental efficacy among a sample of Latinx mothers and fathers of children with ADHD (n = 46 dyads). RESULTS Results indicated that Latinx mothers of children with ADHD reported higher levels of parenting stress than Latinx fathers of children with ADHD; however, no significant parental gender differences were found in ratings of parental efficacy or home chaos. Additionally, several significant relationships were found between parental acculturation and family functioning variables. CONCLUSIONS Latinx families of children with ADHD are an understudied and underserved population within the field of clinical psychology. The current study provides critical information on Latinx family functioning within the context of ADHD treatment, specifically pertaining to the complex interplay of parenting and acculturation variables.
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Affiliation(s)
- Anne C Malkoff
- Psychology Department, Marquette University, Milwaukee, WI, USA
| | - Margaret Grace
- Psychology Department, Marquette University, Milwaukee, WI, USA
| | - Theresa L Kapke
- Psychology Department, Marquette University, Milwaukee, WI, USA
| | - Alyson C Gerdes
- Psychology Department, Marquette University, Milwaukee, WI, USA
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Hale KL, Wallace DD, Blanco-Durán D, Annis IE, Guzman LE, García SJ, Pérez Jolles M, Sleath BL, Elwyn G, Stein GL, Thomas KC. Conversations between Latina mothers and their child's mental health provider: An observational study of shared decision-making regarding pediatric patient mental health needs. PATIENT EDUCATION AND COUNSELING 2020; 103:96-102. [PMID: 31447200 DOI: 10.1016/j.pec.2019.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 08/07/2019] [Accepted: 08/08/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To evaluate shared decision-making (SDM) and delineate SDM processes in audio-recorded conversations between language congruent Spanish-/English-speaking clinicians and parents of pediatric mental health patients. METHODS Transcripts from audio-recorded consultations were rated using the 5-Item Observing Patient Involvement in Decision Making (Observer OPTION5) instrument. One hundred encounters between seventeen clinicians and 100 parents were rated. Interrater reliability for total score was 0.98 between two trained coders (ICC range: 0.799-0.879). RESULTS Scores ranged between 0 and 70 on a 100-point scale, with an average total Observer OPTION5 score of 33.2 (SD = 17.36). This corresponded to modest success at mutual shared decision-making. Clinicians and parents both showed effort at identifying a problem with treatment options and engaging in team talk. However, preference elicitation and integration were largely lacking. CONCLUSION The present sample performed on par with other populations studied to date. It expands the evaluation of observed SDM to include Latino patients and new clinician populations. PRACTICE IMPLICATIONS Use of the Observer OPTION5 Item instrument highlights that eliciting and integrating parent/patient preferences is a skill that requires attention when delivering culturally competent interventions.
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Affiliation(s)
- Kathryn L Hale
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
| | - Deshira D Wallace
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Izabela E Annis
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Linda E Guzman
- Department of Psychological Science, University of Arkansas, Fayetteville, Arkansas, USA
| | - San Juanita García
- Department of Chicana and Chicano Studies, University of California, Santa Barbara, Santa Barbara, California, USA
| | - Mónica Pérez Jolles
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California, USA
| | - Betsy L Sleath
- Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, USA
| | - Gabriela L Stein
- Department of Psychology, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | - Kathleen C Thomas
- Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Wright B, Lau AS, Brookman-Frazee L. Factors Associated With Caregiver Attendance in Implementation of Multiple Evidence-Based Practices in Youth Mental Health Services. Psychiatr Serv 2019; 70:808-815. [PMID: 31159663 PMCID: PMC6718317 DOI: 10.1176/appi.ps.201800443] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The implementation of evidence-based practices (EBPs) in community mental health settings for youths has consistently yielded weakened effects compared with controlled trials. There is a need to feasibly measure the quality of large-scale implementation efforts to inform improvement targets. This study used therapist-reported caregiver attendance in treatment sessions as a quality indicator in the community implementation of EBPs. METHODS Data were collected from therapists practicing in agencies contracted to provide publicly funded children's mental health services following a system-driven implementation of multiple EBPs. Community therapists (N=101) provided information about youth clients (N=267) and psychotherapy sessions (N=685). Multivariable binomial logistic regressions were conducted to examine associations between caregiver attendance and therapist factors (e.g., licensure status, education), youth factors (e.g., gender, age), and the type of EBP delivered. RESULTS Caregiver attendance occurred in 42% of sessions. The following factors were associated with increased odds of caregiver attendance: younger client age, male sex of client, externalizing presenting problem, and delivery of an EBP that prescribes caregiver attendance at all sessions. Caregiver attendance at sessions targeting trauma or externalizing disorders appeared to explain the differences between boys and girls in levels of caregiver engagement. CONCLUSIONS Overall, the patterns of actual caregiver attendance appeared consistent with empirically informed practice parameters for involvement of caregivers in treatment. Still, the rates of caregiver attendance in externalizing-focused sessions were suboptimal, and the gender difference in these rates-which clearly disfavored girls-suggests targeted areas for quality improvement. Potential reasons for these quality gaps are discussed.
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Affiliation(s)
- Blanche Wright
- Department of Psychology, University of California, Los Angeles (Wright, Lau); Child and Adolescent Services Research Center, Department of Psychiatry, University of California, San Diego (Brookman-Frazee)
| | - Anna S Lau
- Department of Psychology, University of California, Los Angeles (Wright, Lau); Child and Adolescent Services Research Center, Department of Psychiatry, University of California, San Diego (Brookman-Frazee)
| | - Lauren Brookman-Frazee
- Department of Psychology, University of California, Los Angeles (Wright, Lau); Child and Adolescent Services Research Center, Department of Psychiatry, University of California, San Diego (Brookman-Frazee)
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Guo Y, Rousseau J, Renno P, Kehoe P, Daviss M, Flores S, Saunders K, Phillips S, Chen I, Ng HS, Evangelista LS. Hispanic Mothers' Experiences with School-Based Emotional Health Curriculum and Perspectives of Their Own Mental Health Needs. Issues Ment Health Nurs 2019; 40:720-724. [PMID: 29505324 PMCID: PMC6197933 DOI: 10.1080/01612840.2017.1386745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
An Emotional Health Curriculum (EHC) was developed to promote positive mental health in primarily Hispanic elementary school-aged children. In order to further expand the EHC, the mothers' experiences with the curriculum were examined. Eighteen mothers participated in two focus groups. Mothers reported that they valued this curriculum as a preventive program. Importantly, all mothers wished to extend their involvement to not only assisting their child in completing the curriculum homework but also attending a proposed parenting program. This study provides preliminary evidence that mothers embraced the EHC as an accessible community mental health service for their children and sought greater involvement.
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Affiliation(s)
- Yuqing Guo
- a Sue & Bill Gross School of Nursing , University of California Irvine , Irvine , California , USA
| | - Julie Rousseau
- a Sue & Bill Gross School of Nursing , University of California Irvine , Irvine , California , USA
| | - Patricia Renno
- b Department of Psychiatry and Biobehavioral Sciences , University of California, Los Angeles , Los Angeles , California , USA
| | - Priscilla Kehoe
- a Sue & Bill Gross School of Nursing , University of California Irvine , Irvine , California , USA
| | - Monique Daviss
- c El Sol Science and Arts Academy of Santa Ana , Santa Ana , California , USA
| | - Sara Flores
- c El Sol Science and Arts Academy of Santa Ana , Santa Ana , California , USA
| | - Kathleen Saunders
- a Sue & Bill Gross School of Nursing , University of California Irvine , Irvine , California , USA
| | - Susanne Phillips
- a Sue & Bill Gross School of Nursing , University of California Irvine , Irvine , California , USA
| | - Irene Chen
- a Sue & Bill Gross School of Nursing , University of California Irvine , Irvine , California , USA
| | - Ho-Si Ng
- a Sue & Bill Gross School of Nursing , University of California Irvine , Irvine , California , USA
| | - Lorraine S Evangelista
- a Sue & Bill Gross School of Nursing , University of California Irvine , Irvine , California , USA
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Champine RB, Rozas LW, Schreier A, Kaufman JS. Examining the service-related experiences and outcomes of caregivers involved in a system of care who experienced everyday discrimination. JOURNAL OF COMMUNITY PSYCHOLOGY 2019; 47:544-562. [PMID: 30370935 DOI: 10.1002/jcop.22137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 08/30/2018] [Accepted: 09/25/2018] [Indexed: 06/08/2023]
Abstract
Individuals who report everyday experiences of discrimination are at heightened risk for adverse health outcomes and tend to report underutilization of health services. Systems of care (SOCs) have the potential to engage members of minority groups and to reduce health disparities. We examined the service-related experiences of predominantly Latinx caregivers enrolled in a SOC for their children with severe psychological health needs. We used independent samples t-tests and regression analyses to compare relations among service access, perceived service characteristics, and caregiver stress according to whether caregivers reported frequent or infrequent discrimination. The frequent discrimination group scored significantly higher on dimensions of stress and had greater dosage than the infrequent group. There were no differences in relations between service characteristics and outcomes by group. Findings indicated important differences in the service-related experiences and outcomes of caregivers who reported frequent and infrequent discrimination. We discuss limitations and implications.
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Affiliation(s)
- Robey B Champine
- Yale School of Medicine
- Child Health and Development Institute of Connecticut, Inc
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Chlebowski C, Magaña S, Wright B, Brookman-Frazee L. Implementing an intervention to address challenging behaviors for autism spectrum disorder in publicly-funded mental health services: Therapist and parent perceptions of delivery with Latinx families. CULTURAL DIVERSITY & ETHNIC MINORITY PSYCHOLOGY 2018; 24:552-563. [PMID: 30024185 PMCID: PMC6188834 DOI: 10.1037/cdp0000215] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
OBJECTIVES As implementation of evidence-based practices (EBPs) in publicly funded children's mental health services has become increasingly common, concerns have been raised about the appropriateness of specific EBPs to the diverse client populations served in these settings. Exploring stakeholder perspectives can provide direction for refinements of EBPs when delivered with Latinx families. The current study used qualitative methods to examine therapist and Latinx parent perceptions of therapist-parent interactions and the intervention process when therapists are trained to deliver AIM HI (An Individualized Mental Health Intervention for ASD), a structured, parent-mediated intervention for autism spectrum disorder (ASD). METHOD Therapist and parent participants were a subset of participants from a large-scale community effectiveness trial. Perceptions were gathered through focus groups with therapists (n = 17) and semistructured interviews with Latinx parents (n = 29). Therapists were 94% female, 35% Latinx, and 47% were fluent in Spanish. Parents were 93% female, 100% Latinx, and 66% preferred Spanish. A coding, consensus, co-occurrence and comparison approach was used to analyze data. RESULTS Three primary themes emerged: (a) limited parental knowledge about ASD and the need to address knowledge gaps; (b) differing perceptions regarding parental participation in treatment; and (c) identification of influences on parent-therapist interaction, including the cultural value of respeto/deference (emphasized by therapists), and importance of personalismo/personal connection (emphasized by parents). CONCLUSIONS The themes provide specific direction for enhancements to AIM HI to maximize engagement of Latinx families. The themes also have broader implications for intervention development and community implementation including refinement of EBPs to facilitate fit and sustained implementation. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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The Role of Religion and Spirituality in the Association Between Hope and Anxiety in a Sample of Latino Youth. CHILD & YOUTH CARE FORUM 2017. [DOI: 10.1007/s10566-017-9421-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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