SCCAP/APA Convention/2018/Novel Approaches to Improving Evidenced-based Interventions for Ethnic Minority and Immigrant Youth

This symposium, titled, "Novel Approaches to Improving Evidenced-based Interventions for Ethnic Minority and Immigrant Youth" brings together perspectives from counseling, clinical, community psychology, and highlights the various ways these disciplines are addressing mental health disparities for ethnic minority and immigrant youth, families, and communities. Ethnic minority youth and families continue to underutilize mental health services due to social-contextual barriers including limited or no access to healthcare, language/transportation difficulties, and lack of culturally competent services. Many ethnic minority families do not engage in treatment due to perceptions that evidence-based interventions are not culturally relevant for them. This collaborative session highlights four studies addressing mental health disparities through novel methods of adapting and implementing evidence-based interventions for underserved communities. This symposium presents the various ways in which child psychologists across specialties (i.e., counseling, clinical, community) are addressing the unmet mental health needs of ethnic minority and immigrant youth in the U.S., which is particularly important given the current challenges facing these vulnerable communities.

Presenters and abstracts

Cindy Huang, Ph.D., "Enhancing the Cultural Relevance of an Evidence-based Intervention for Asian Immigrant Parents"

The Asian population is the fastest growing racial group in the U.S. Yet, disparities in access and quality of mental health services for Asians exist and persist, especially for immigrant families and youth. Little is known about factors affecting treatment engagement among Asian parents. Previous findings show that Asian immigrant parents perceive evidence-based parenting interventions to be less socially valid (i.e., acceptable) compared to White parents. Cultural factors, such as communication styles (e.g., self-disclose of personal information), stigma about mental health problems, beliefs about illness causes, and concerns about losing face may prevent Asian immigrant parents from seeking help for their children's social-emotional and behavioral difficulties. The current study examines the influence of cultural factors (e.g., self-disclosure, stigma) on the social validity of the Family Check-Up (FCU), an evidence-based, family-focused prevention intervention. The FCU has demonstrated effects on improving mental health outcomes for minority youth, but has not been studied with Asian American or Asian immigrant families. This presentation will describe a study aimed at understanding the effects of cultural factors on perceptions of social validity of the FCU.

Recruitment of 200 Asian immigrant parents from New York City's Chinatown is currently underway. Parents complete self-report measures about cultural factors (i.e., acculturation, stigma, self-disclosure, face concern, mental health literacy), their parenting behaviors (e.g., positive reinforcement, parental monitoring), and their children's social-emotional and behavioral health. They also read about the FCU and rate their perceptions of its acceptability and validity for their family. It is hypothesized that parents who report more adherence to traditional values on cultural factors (e.g., less willing to self-disclose, report more stigma about mental health) will report lower social validity ratings, and engage in fewer positive parenting behaviors. Implications on how these findings will be used to inform an adaptation of the FCU will be discussed.

Miya Barnett, Ph.D., "Training Community-Health Workers to Increase Access to Evidence-Based Treatments"

Mobilizing community-health workers (CHWs) to deliver evidence-based treatments (EBTs) is a workforce strategy to address mental health disparities for underserved ethnic minority communities. CHWs can be leveraged to support access to EBTs in a variety of ways, from conducting outreach for EBTs delivered by professional providers (e.g., psychologists) to serving as the primary treatment providers. CHWs are uniquely positioned to increase access to EBTs as they are considered to be trusted members of the community. Though CHWs have the potential to increase service parity for ethnic minority communities in the United States, they have predominately been involved in treatment delivery in low- and middle-income countries. This presentation will describe a conceptual model as to how CHWs can address drivers of service disparities for ethnic minority families in the United States, which relate to the overall supply of EBTs provided and the demand for these treatments. An illustrative case example will demonstrate how CHWs have been leveraged to increase access to one EBT, Parent-Child Interaction Therapy (PCIT), for Latina/o immigrant families in Miami, FL. Within a community academic partnership, CHWs were trained to refer families to services, prepare them for the expectations of treatment, problem solve logistical barriers to care (e.g., transportation), and provide support for home practice of targeted parenting skills. CHWs demonstrated significant skill gain over the course of training and expressed positive attitudes towards the training program. Since implementation, an increasing number of immigrant families have successfully sought and graduated from PCIT, leading to an expansion of PCIT services throughout three lowincome, high-risk communities in Miami. Challenges and recommendations regarding implementing CHW-supported or -delivered EBTs will be discussed. An emphasis will be placed on the role of psychologists in providing training and supervision to CHWs to support high quality implementation of these models.

Maryam Kia-Keating, Ph.D., "Community Participatory Prevention for Latino/a Youth: Partnership, Design, and Delivery"

Utilizing participatory approaches allows researchers to invite ethnic minority and immigrant communities as equal partners to engage in prevention and intervention research, and to play a central role in efforts that are intended to meet their mental health needs. As experts of their own lives, these communities can offer unique insights and new perspectives, and ultimately, help to find novel solutions to everyday barriers that exist for their communities, such as ways to improve access to empirically supported treatments. Using a case illustration of a mentorship-based, empirically-supported prevention program for Latino/a youth and parents, this paper will present the adaptation and implementation process undertaken in partnership as an academic-community school effort. A community-based participatory research was utilized in combination with elements of Human Centered Design (CPBR+HCD) to engage key stakeholders in generating a prototype prevention program, derived from an empirically-supported parenting intervention, to test with a population of need defined by community partners: namely, Latino/a youth ages 8-12 and their parents. Components of the prevention program, Proyecto HEROES, will be described including: psychoeducation about brain development and adverse childhood experiences (ACES), and three skill-based domains: mindfulness, restorative practices, and use of praise-reflect-imitate (PRIDE) skills during child-directed play. Promotoras (community health workers) and Latino/a near peers were trained to facilitate the parenting and youth components, respectively, of the foursession program. The mentorship-based approach was utilized to reduce barriers to treatment, increase cultural sensitivity, and build social connection to develop stronger protective and promotive factors related to positive outcomes for youth. Ethical and methodological challenges and recommendations will be discussed. Implications for using CBPR+HCD in ethnic minority and immigrant prevention research will be highlighted. This project provides directions for future efforts in improving participatory methodologies and the integration of elements of design thinking, with the ultimate goal of improving effectiveness and long-term outcomes.

May Yeh, Ph.D., "Personalizing a Behavioral Parent Training Program for Culturally Diverse Youth"

Although Behavioral Parent Training Interventions (BPTs) have proven efficacy in the treatment of young children with externalizing behavior problems, there is evidence that BPT interventions have poorer engagement and outcomes for ethnic minority families. This may be due in part to mismatches between BPTs and the parent explanatory models (PEMs) of ethnic minority families. The parent􀂶s beliefs about the child􀂶s problem causes, severity, course, impact, and/or treatment may not be compatible with the BPT. This paper will describes a research program developed to personalize an evidence-based intervention for disruptive behavior disorders in young children (Parent-Child Interaction Therapy) to increase the fit between BPTs and parent explanatory models on an individual family basis. Personalization of treatment is based upon the assessment of modifiable, culturally-influenced PEM targets prior to the start of PCIT and the provision of corresponding tools to therapists to increase the cultural congruence of the intervention with parent explanatory models. This type of method provides flexibility in the application of adaptations, tailored to the assessment of culturally-influenced constructs across racial/ethnic groups. Specific PEMs assessed by the personalization package will be highlighted, along with corresponding adaptation tools.