A Balancing Act: Integrating Evidence-Based Knowledge and Cultural Relevance in a Program of Prevention Parenting Research with Latino/a Immigrants

Parent immigration stress predicts youth externalizing behavior trajectories among Latino families in an emerging immigrant context

According to ecodevelopmental and social learning models, Latino immigrant parents experience considerable stress associated with the immigration process, and such immigration-related stress is theorized to influence behavioral outcomes among their youth. Using a three-year longitudinal design among 217 Latino immigrant families in western Oregon, we assessed whether parents' (94% mothers, M_age  = 36.2 years) experience of immigration-related stress influenced the trajectory of their adolescents' (43% female, M_age = 13.4 years) externalizing behaviors. Controlling for covariates (gender, acculturation, age at migration, and gender), results showed that youth exhibited a normative downward trajectory for externalizing behaviors, and parents' experience of immigration stress significantly and negatively predicted this trajectory. Findings suggest that parents' experience of immigration stress may disrupt a normative trajectory of declining externalizing behaviors among Latino immigrant adolescents.

Randomized Controlled Trial of a Program to Help Latina Mothers Help Their Children Cope with Stress: Effects on Parenting, Child Coping, and Adjustment

"Madres Apoyando el Desarrollo Emocional de Sus Hijos" ("Mothers Supporting the Emotional Development of Their Children") is a parenting education program designed to help Latina mothers help their school-age children cope with stress. A previous randomized controlled trial, with a pre-post design, showed that the program had the predicted effects on mothers' knowledge, attitudes, and behavior. However, no data were collected from the children in that initial evaluation. The purpose of the present study was to determine if the program impacted children's coping and adjustment. One hundred twenty-two primarily first-generation Latina mothers from rural Washington State were randomly assigned to the intervention or to a no treatment control. Seven implementations of the program were conducted. Mothers and their 8- to 13-year-old children completed assessments 1 week before the program started, 1 week after its completion, and 3 months later. The results for maternal behavior were largely replicated: at posttest, intervention mothers, compared to controls, reported higher levels of emotion coaching, showed greater self-efficacy for helping their child cope with stress, and were more likely to report positive strategies for scaffolding their child's responses to stressful situations. Several maternal effects (e.g., emotion-coaching and maternal efficacy) continued at 3 months. Children of intervention mothers at posttest used more primary control coping strategies and reported fewer emotional symptoms; analyses of mothers' ratings of child adjustment replicated the posttest child effects for emotional symptoms, showed fewer other psychological problems at posttest, and showed greater child prosocial behavior at 3 months. The results further support the program's efficacy and provide the first evidence of its effects on child coping and adjustment.

Cultural Adaptation of Group Parenting Programs: Review of the Literature and Recommendations for Best Practices

Group parenting programs based on cognitive-behavioral and social learning principles are effective in improving child behavior problems and positive parenting. However, most programs target non-Hispanic, White, English-speaking families and are largely inaccessible to a growing Hispanic and non-White population in the United States. We sought to examine the extent to which researchers have culturally adapted group parenting programs by conducting a systematic review of the literature. We identified 41 articles on 23 distinct culturally adapted programs. Most cultural adaptations focused on language translation and staffing, with less focus on modification of concepts and methods, and on optimizing the fit between the target cultural group and the program goals. Only one of the adapted programs engaged a framework to systematically record and publish the adaptation process. Fewer than half of the culturally adapted programs were rigorously evaluated. Additional investment in cultural adaptation and subsequent evaluation of parenting programs is critical to meet the needs of all US families.

A Culturally Adapted Parenting Intervention for Mexican-Origin Immigrant Families with Adolescents: Integrating Science, Culture, and a Focus on Immigration-Related Adversity

Low-income Latina/o immigrants are very likely to experience intense contextual challenges in the USA, such as limited exposure to culturally relevant parent training (PT) prevention interventions. This prevention study consisted of an exploratory randomized controlled trial, aimed at empirically testing the implementation feasibility and initial efficacy of a culturally adapted version of the evidence-based PT intervention known as GenerationPMTO^©. The parenting intervention was adapted to overtly address immigration-related stressors, discrimination, and challenges associated with biculturalism. Seventy-one Mexican-origin immigrant mothers participated in this study and were allocated to one of two conditions: (a) culturally adapted GenerationPMTO (i.e., CAPAS-Youth) or (b) wait-list control. Measurements were completed at baseline (T1) and intervention completion (T2). When compared to mothers in the control condition at T2, CAPAS-Youth participants reported significant improvements on four of the core parenting practices delivered in the CAPAS-Youth intervention. As hypothesized, no significant differences in limit-setting skills were identified at T2. With regards to adolescents' outcomes, mothers exposed to CAPAS-Youth reported significant improvements in youth internalizing and externalizing behaviors at T2 when compared to a wait-list control condition. Mothers in both conditions also reported significant reductions in levels of immigration-related stress. Current findings indicate the feasibility of implementing CAPAS-Youth within a context of considerable adversity, as well as the beneficial impacts of the parent-based intervention on salient parenting and youth outcomes.

Biculturalism and adjustment among U.S. Latinos: A review of four decades of empirical findings

Incorporating both heritage (e.g., Latino) and national (e.g., American) cultural systems into our sense of self (i.e., bicultural identity) and developing the ability to successfully respond to demands associated with each of these systems (i.e., bicultural competence) have been theorized to be central to the development and positive adjustment of U.S. Latinos, a group that represents a large segment of the country's population. In this comprehensive review, we examined empirical research on biculturalism among U.S. Latinos spanning four decades (1980-2020), with a focus on synthesizing the field's understanding of antecedents and consequents associated with biculturalism and identifying directions for future research. Our review of 152 empirical articles revealed that this literature was characterized by multiple approaches to the conceptualization (i.e., dual-cultural adaptation, dual-cultural identity, bicultural identity integration, and bicultural competence) and subsequent operationalization of biculturalism. Although each conceptualization has different implications for the conclusions that can be drawn regarding an aspect or facet of biculturalism and potential influence on adjustment, a significant majority (78%) of studies, across conceptualizations, provided evidence supporting a positive association between biculturalism and Latinos' adjustment. In addition, a relatively small body of qualitative work was identified, and findings largely informed potential antecedents of biculturalism. We review this literature with attention to: the aspects of biculturalism that are associated with Latinos' adjustment (i.e., psychosocial and physical health), how sample characteristics may limit the generalizability of this work, and important directions for future research both in terms of conceptualization and study design.

Parenting in the Midst of Adversity: Tailoring a Culturally Adapted Parent Training Intervention According to the Parenting Experiences of Mexican-Origin Caregivers

Although parent training (PT) interventions are considered the gold standard for preventing externalizing behaviors in children and youth, their dissemination in low-income Latina/o immigrant communities continues to be scarce throughout the United States (US). An alternative to address this gap in service delivery consists of implementing culturally adapted PT interventions characterized by cultural and contextual relevance. Thus, the main objective of this qualitative study was to document salient immigration-related experiences, as well as parenting needs and challenges, as reported by 30 low-income Mexican-origin immigrant caregivers residing in an urban setting in the Southern United States. The research methodology was guided by the tenets of the Thematic Analysis approach, which involved collecting data through a series of focus group interviews. Qualitative research findings highlight the importance of culturally and contextually tailoring adapted PT prevention interventions, prior to their delivery in contexts that differ from those in which interventions were originally adapted. Specifically, parents in the current investigation provided detailed accounts of immigration-related stressors that are highly relevant to inform recruitment procedures, intervention curriculum, and intervention delivery activities.

Evaluation of a Program to Help Low-Income, Latina Mothers Help Their Children Cope With Stress

This paper describes the evaluation of a program that provides low-income Latina mothers with skills to help their children cope with stress. Based on focus groups with mothers and their school-aged children in two locations, we developed a five-week program for helping mothers identify signs of stress in their children, learn effective emotion-coaching skills, and learn how to effectively encourage their children to use coping strategies that match the controllability of the situation. We conducted a randomized controlled trial in an urban (n = 13) and rural (n = 78) location in which we randomly assigned mothers to either an intervention or a no-treatment control condition. We completed eight implementations of the program (2 in the urban sample and 6 in the rural one). To evaluate the program, we collected pre- and post-assessments of mothers' coping knowledge, emotion coaching, strategies for helping their children cope with stress, maternal self-efficacy in helping their children cope, general parenting practices, and general parenting self-efficacy. Observers assessed the fidelity of program delivery. Mothers who received the intervention, in contrast to those in the control condition, showed significant increases in their knowledge of strategies to help their children cope with stress, in reported emotion-coaching skills, and in the reported use of positive strategies for helping their children manage their behavior and emotions in stressful situations (i.e., helping their children relax and calm down, talking with their children about feelings, helping their children problem-solve, encouraging distraction, and helping their children improve their self-esteem). Post intervention, mothers reported increases in their efficacy for helping their children cope with stress. Analyses revealed no significant effects of the program on general parenting or general parenting self-efficacy, but did have the hypothesized effects on maternal knowledge, attitudes, and reported behavior. Subsequent research should examine the degree to which the program has effects over a longer time period and on children's approaches to coping with stress.

Perceptions of Portuguese parents about the acceptability of a multicomponent intervention targeted at behavioral inhibition during early childhood

High and stable behavioral inhibition during early childhood is a risk factor for later anxiety disorders. The few available interventions targeted at behavioral inhibition have not yet been implemented in European countries. Evaluating intervention acceptability is essential when introducing interventions in new cultures. This study aimed to explore the perceptions of parents about the acceptability of the multicomponent Turtle Program in Portugal. Participants were 12 parents (from seven families) of children with a positive screening on the Behavioral Inhibition Questionnaire and no diagnoses of developmental disorders/selective mutism. Children's mean age was 55.86 months and most children were female and first-born. Parents and children participated in the eight-sessions Turtle Program. After each session, parents completed weekly satisfaction checklists. Following completion of the full intervention, parents were invited to participate in individual qualitative in-depth interviews. The thematic analysis revealed that both parents perceived the intervention objectives and contents as relevant. Both parents suggested the introduction of follow-up sessions, the discussion of practical experiences, the need to be sensitive to cultural differences in positive language, and the provision of more feedback about children's activities. These findings support prior research on the acceptability and cultural tailoring needed for parenting and child socioemotional learning interventions.

Addressing Immigration-Related Stress in a Culturally Adapted Parenting Intervention for Mexican-Origin Immigrants: Initial Positive Effects and Key Areas of Improvement

Culturally adapted evidence-based parenting interventions constitute a key strategy to reduce widespread mental health disparities experienced by Latinx populations throughout the United States. Most recently, the relevance of culturally adapted parenting interventions has become more prominent as vulnerable Latinx populations are exposed to considerable contextual stressors resulting from an increasingly anti-immigration climate in the country. The current study was embedded within a larger NIMH-funded investigation, aimed at contrasting the differential impact of two culturally adapted versions of the evidence-based parenting intervention known as GenerationPMTO©. Specifically, a sample of low-income Mexican-origin immigrants was exposed either to a culturally adapted version of GenerationPMTO primarily focused on parent training components, or to an enhanced culturally adapted version in which parenting components were complemented by sessions focused on immigration-related challenges. The sample for the study consisted of 103 Mexican-origin immigrant families (190 individual parents). Descriptive analysis and generalized estimating equations (GEEs) indicated that exposure to the enhanced intervention, which included context- and culture-specific sessions, resulted in specific benefits for parents. However, the magnitude of the impact was not uniform for mothers and fathers and differed according to the type of immigration-related stress being examined (i.e., intrafamilial vs. extrafamilial stress). Overall, findings indicate the relevance of overtly addressing contextual (e.g., discrimination) and cultural challenges in culturally adapted interventions, as well as the need to increase precision according to the extent to which immigration-related stressors impact immigrant mothers and fathers in common and contrasting ways. Implications for family therapy practice and research are discussed.

Using stakeholder perspectives to guide systematic adaptation of an autism mental health intervention for Latinx families: A qualitative study

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.

A Culturally Adapted Intervention for Mexican-Origin Parents of Adolescents: The Need to Overtly Address Culture and Discrimination in Evidence-Based Practice

Latino/a populations in the United States are negatively impacted by widespread mental health disparities. Although the dissemination of culturally relevant parent training (PT) programs constitutes an alternative to address this problem, there is a limited number of efficacious culturally adapted PT prevention interventions for low-income Latino/a immigrant families with adolescents. The current manuscript describes the level of acceptability of a version of the GenerationPMTO^® intervention adapted for Latino/a immigrant families, with an explicit focus on immigration-related challenges, discrimination, and promotion of biculturalism. Qualitative reports were provided by 39 immigrant parents who successfully completed the prevention parenting program. The majority of these parents self-identified as Mexican-origin. According to qualitative findings, participants reported overall high satisfaction with immigration and culture-specific components. Parents also expressed high satisfaction with the core GenerationPMTO parenting components and provided specific recommendations for improving the intervention. Current findings indicate the need to adhere to the core components that account for the effectiveness of PT interventions. Equally important is to thoroughly adapt PT interventions according to the cultural values and experiences that are relevant to target populations, as well as to overtly address experiences of discrimination that negatively impact underserved Mexican-origin immigrant families. Due to the exploratory nature of this study, the efficacy and effectiveness of the adapted prevention intervention remains to be established in empirical research.

Healing through Parenting: An Intervention Delivery and Process of Change Model Developed with Low-Income Latina/o Immigrant Families

Low-income Latinas/os are exposed to widespread mental health disparities in the United States. Most recently, a resurgence of anti-immigration narratives has led vulnerable Latina/o immigrants to experience considerable contextual stressors with multiple deleterious consequences for their overall well-being, including significant disruptions to their parenting practices. Within this context of adversity and despite the multiple benefits associated with parent training (PT) prevention interventions, the availability of contextually and culturally relevant PT interventions remains limited in underserved Latina/o communities. This paper constitutes a contribution to this gap in knowledge by presenting a model of intervention delivery utilized in the dissemination of culturally adapted versions of the evidence-based intervention known as GenerationPMTO.^© The proposed model also describes a process of change that we have documented in empirical research with low-income Latina/o immigrant parents who have been exposed to the adapted interventions. The manuscript is organized in four sections. First, an overview of the model is discussed, along with a brief summary of major theories. Next, the core components of the model are described, complemented by the presentation of a case study. Finally, implications for prevention and clinical intervention are discussed.

Strengthening a Culture of Prevention in Low- and Middle-Income Countries: Balancing Scientific Expectations and Contextual Realities

Relevant initiatives are being implemented in low- and middle-income countries (LMICs) aimed at strengthening a culture of prevention. However, cumulative contextual factors constitute significant barriers for implementing rigorous prevention science in these contexts, as defined by guidelines from high-income countries (HICs). Specifically, disseminating a culture of prevention in LMICs can be impacted by political instability, limited health coverage, insecurity, limited rule of law, and scarcity of specialized professionals. This manuscript offers a contribution focused on strengthening a culture of prevention in LMICs. Specifically, four case studies are presented illustrating the gradual development of contrasting prevention initiatives in northern and central Mexico, Panamá, and Sub-Saharan Africa. The initiatives share the common goal of strengthening a culture of prevention in LMICs through the dissemination of efficacious parenting programs, aimed at reducing child maltreatment and improving parental and child mental health. Together, these initiatives illustrate the following: (a) the relevance of adopting a definition of culture of prevention characterized by national commitments with expected shared contributions by governments and civil society, (b) the need to carefully consider the impact of context when promoting prevention initiatives in LMICs, (c) the iterative, non-linear, and multi-faceted nature of promoting a culture of prevention in LMICs, and (d) the importance of committing to cultural competence and shared leadership with local communities for the advancement of prevention science in LMICs. Implications for expanding a culture of prevention in LMICs are discussed.

Strategies to Avoid Replication Failure With Evidence-Based Prevention Interventions: Case Examples From the Strengthening Families Program

Research has found disturbing long-term effects of poor parenting on children's behavioral health including addiction, delinquency, depression/anxiety, and poorer health as adults. Poor parenting practices thus contribute substantially to the health crisis in America. However, skilled, nurturing parents, or caretakers can help youth avoid these developmental problems. A number of family and parenting evidence-based interventions (EBIs) that teach parenting skills are now available for dissemination. Unfortunately, replications of EBIs do not always produce the original positive results. Organizations that seek to use family EBIs to improve parenting and family skills need to avoid practices that create replication failure. We examine several possible factors that contribute to replication failure using examples from five replications of the EBI "Iowa Strengthening Families Program for ages 10-14." We then share six strategies conducive to avoid replication failures including (1) choosing the right program and implementation strategy for the population, (2) administering the right "dosage," (3) choosing and properly training implementers, (4) maintaining program integrity and adherence, (5) ensuring cultural sensitivity, and (6) ensuring accurate and complete reporting of evaluation results. These guidelines can advance prevention science to meet the demands of a growing public health agenda.

"But We Want to Work": The Movement of Child Workers in Peru and the Actions for Reducing Child Labor

The program Edúcame Primero (Educate Me First) is an evidence-based practice for eradicating child labor that has been applied with positive results in Colombia, Peru, and several Central American countries. In this article, we describe the difficulties of implementing the program in two poor areas of Lima (Peru) between 2014 and 2016. Specifically, we discuss three ethical challenges faced during the implementation of the program: (a) the existence of a movement of working children that defends the right of children to work; (b) the polarization of some community-based associations and government institutions on how to deal with the problems of working children; and (c) the use of network indicators in the evaluation of the community's level of cohesion. Taking the Code of Ethics of the General Council of Associations of Psychologists in Spain as a guide, we adopted a consensus approach in planning and research design, combining different criteria of value with the participation of different stakeholders. The implementation of the program in Peru gave preference to developing skills in children over changing attitudes in relation to child protection, although the intervention openly declared its aims when engaging institutions and families. Finally, we address how social network research places special ethical demands on conventional ethical standards. Our experience with this project shows the importance of acting as a bridge between different stakeholders and assessing how all of them benefit from the intervention.

Acculturation Conflict, Cultural Parenting Self-Efficacy, and Perceived Parenting Competence in Asian American and Latino/a Families

Parents from immigrant backgrounds must deal with normative parenting demands as well as unique challenges associated with acculturation processes. The current study examines the independent and interactive influences of acculturation conflict and cultural parenting self-efficacy (PSE; e.g., parents' confidence in instilling heritage, American, and bicultural values in their children) on perceptions of general parenting competence. Using data from 58 Asian American and 153 Latin American parents of children in grades 6-12, ethnic differences were also explored. Results suggest that lower acculturation conflict is associated with higher perceptions of general parenting competence for both Asian and Latin American parents. Higher cultural PSE is associated with higher perceived general parenting competence for Latino/a parents only. One significant interaction was found, and only for Asian Americans, whereby the negative association between acculturation conflict and perceptions of parenting competence was weaker for those who felt efficacious in transmitting heritage messages. Results are discussed in light of clinical implications and the need for further recognition and study of culturally relevant factors and frameworks among families from immigrant backgrounds.

Fostering resilience in National Guard and Reserve families: A contextual adaptation of an evidence-based parenting program

Military deployment of a parent is a risk factor for children's internalizing and externalizing problems. This risk may be heightened in National Guard and Reserve (NG/R) families who tend to be isolated from other NG/R families and do not benefit from the centralized support system available to active duty families living on military bases. Isolation and trauma-related disorders may complicate the adjustment of military families during reintegration. An evidence-based parent training intervention was modified to meet the unique needs of recently deployed NG/R parents and their spouses, and the modified program was evaluated in a randomized controlled trial. The current study examines engagement and satisfaction with the program. Modifications such as employment of military-connected facilitators sought to maximize engagement in and satisfaction with the program. Engagement and satisfaction were examined between mothers and fathers, as well as between groups led by a military-connected facilitator and those led by civilian facilitators. Significantly greater engagement was noted for groups that were led by a military-connected facilitator (p = .01). There were no differences between genders in attendance rates, though greater positive group experiences were reported by mothers versus fathers (p = .01). Results are discussed in the context of engagement and satisfaction reported for similar programs. Implications for working with military families are also considered. (PsycINFO Database Record

Parent Management Training-Oregon Model: Adapting Intervention with Rigorous Research

Parent Management Training-Oregon Model (PMTO(®) ) is a set of theory-based parenting programs with status as evidence-based treatments. PMTO has been rigorously tested in efficacy and effectiveness trials in different contexts, cultures, and formats. Parents, the presumed agents of change, learn core parenting practices, specifically skill encouragement, limit setting, monitoring/supervision, interpersonal problem solving, and positive involvement. The intervention effectively prevents and ameliorates children's behavior problems by replacing coercive interactions with positive parenting practices. Delivery format includes sessions with individual families in agencies or families' homes, parent groups, and web-based and telehealth communication. Mediational models have tested parenting practices as mechanisms of change for children's behavior and found support for the theory underlying PMTO programs. Moderating effects include children's age, maternal depression, and social disadvantage. The Norwegian PMTO implementation is presented as an example of how PMTO has been tailored to reach diverse populations as delivered by multiple systems of care throughout the nation. An implementation and research center in Oslo provides infrastructure and promotes collaboration between practitioners and researchers to conduct rigorous intervention research. Although evidence-based and tested within a wide array of contexts and populations, PMTO must continue to adapt to an ever-changing world.