Differential Designs: A Relevant Methodological Approach in the - PowerPoint PPT Presentation

Differential Designs: A Relevant Methodological Approach in the Cultural Adaptation Field 9 th Annual Conference on the Science of Dissemination and Implementation in Health Washington, D.C., December 2016 Rubén Parra-Cardona Michigan State University

Funding Support: • National Institute of Mental Health (NIMH), Division of Services and Intervention Research, Grant #R34MH087678 • Michigan State University, Office of Vice-President for Research and Graduate Studies (OVPRGS), the MSU College of Social Science, and the Department of Health and Human Development • National Institute on Drug Abuse (NIDA), Grant # K01DA036747

Acknowledgements Co-Investigators, Consultants, and Research Staff: • Co-Investigators: Cris Sullivan, Deborah Bybee, Melanie Domenech-Rodríguez, Guillermo Bernal, Lisa Tams, • Research Consultants : Marion Forgatch, Hiram Fitzgerald, James C. Anthony (K01 Sponsor) • Interventionists: Efraín Zamudio, Mónica E. Villa, & Florys Meredith-Gonzáles • Project Managers: Gabriela López-Zerón, Ana Rocío Escobar- Chew, Kendal Holtrop, David Cordova • Data Collectors: Ana Romo-Huerta, Idali Sancen, Juan José Arredondo • Community Partners: Southwest Solutions (Brian Dates), MSU- Extension Detroit, Holly Redeemer • Curriculum Development: Ana Baumann, Nancy Amador Buenabad

Background • Ethnic minorities continue to experience widespread health and mental health disparities in the US. • Empirical research indicates that ethnic minority populations can benefit from culturally adapted (CA) interventions (Smith et al., 2011).

Cultural Adaptation Cultural adaptation refers to “the systematic modification of an evidence-based treatment (EBT) or intervention protocol to consider language, culture, and context in such a way that it is compatible with the client’s cultural patterns, meanings, and values. (Bernal, Jimenez-Chafey, & Domenech Rodriguez, 2009, p. 362)

A Comparative Design

Latino/a immigrants in Detroit

Method

Specific Aims Implement small RCT with the two culturally adapted interventions aimed at testing differential: a) Implementation feasibility b) Initial efficacy

PMTO R : Evidence-based parenting intervention aimed at improving parenting skills and reducing problematic behaviors in children 1. Positive Involvement 2. Skill Encouragement 3. Limit Setting 4. Monitoring/Supervision 5. Family Problem Solving METHOD OF DELIVERY - Role play & focus on parents

Ecological Validity Model (Bernal & Sáez-Santiago, 2006) • According to the EVM model, all research activities and procedures must be culturally adapted according to the following dimensions: 1. Language 5. Concepts 2. Persons 6. Goals 3. Metaphors 7. Methods 4. Content 8. Context

Both Adapted Interventions • Interventionists - One team for each condition, each integrated by one male community organizer and one female CSW • Advocacy - Immigration services, IPV services, mental health services job training, funeral assistance and repatriation of remains, etc.

Culturally Adapted Versions of PMTO • CAPAS Intervention - Exclusively focused on the culturally adapted core PMTO parenting components. - Cultural adaptation led by Domenech-Rodríguez with NIMH funding support. CAPAS-Enhanced Intervention - Two culture-specific sessions focused on biculturalism, immigration stress, and discrimination. - All PMTO sessions, especially role-plays, informed according to narratives of parents.

Design • Prevention Design Screening: Families with children ages 4-12; mild to moderate child behavioral problems • Parenting groups format • RCT: CAPAS-Original, b) CAPAS-Enhanced, c) Wait-list control a) • Multiple Assessment Points Quantitative: o BL (T1), Intervention Completion (T2), 6-month follow-up (T3) Qualitative: o Intervention Completion (T2)

Assessment • Parental Self-Report: o Parenting Practices  Skill Encouragement  Monitoring & Supervision  Positive Involvement  Problem Solving  Limit Setting o Child Behavior (CBCL), Internalizing and Externalizing

RCT Demographic Data Family Characteristics CAPAS-Original CAPAS-Enhanced Control Participating Families 36 35 32 Annual Family Income $20,000 or less 41.7% 22.9% 25.0% $21,000-30,000 25.0% 34.3% 37.5% $31,000-40,000 11.1% 22.9% 15.6% Greater than $40,000 13.9% 11.4% 12.5% Average Age of Children 9.44 (±3.35) 8.66 (±2.85) 9.16 (±3.18) Average Number of 2.69 ( ± 0.98) 2.63 ( ± 1.11) 3.10 ( ± 1.08) Children in Household Individual Characteristics Participating Individuals 66 64 59 Mothers 36 35 32 Fathers 30 29 23 Country of Origin: Mexico 59 57 27 35.97 ( ± 4.83) 36.97 ( ± 6.48) 36.52 ( ± 5.29) Average Parent Age 15.04 ( ± 4.88) 14.11 ( ± 5.48) 14.80 ( ± 5.72) Average Years Living in US

Feasibility and Initial Efficacy Findings

Retention and Dosage At 6-month follow-up: Retention Families = 87% Retention Fathers = 85% n = 119 parents Number of CAPAS-Original CAPAS-Enhanced Sessions Fathers Mothers Fathers Mothers 12 19% 29% 32% 27% 10-11 39% 48% 28% 60% 42% 23% 36% 13% 7-9 0% 0% 4% 0% 6

Satisfaction Ratings All Parenting Waves (Scale1-5) CAPAS-Original Mean CAPAS-Enhanced Mean Rating Rating 1 Introduction Being a Latino 4.63 4.69 Immigrant Parent 2 Giving Good Directions Giving Good Directions 4.51 4.57 3 Encouragement I Encouragement I 4.45 4.53 4 Encouragement II Encouragement II 4.43 4.56 5 Booster Setting Limits I 4.47 4.51 6 Setting Limits I Setting Limits II 4.60 4.64 7 Setting Limits II Setting Limits III 4.50 4.52 8 Setting Limits III Booster 4.52 4.58 9 Booster Monitoring 4.58 4.52 10 Monitoring Problem Solving 4.56 4.56 11 Problem Solving Parenting Between 4.51 4.60 Two Cultures Average Average 4.52 4.57* * t (6) = -.670, p = .528

Parenting Skills CAPAS & CAPAS-Enhanced sig higher than Control 6-months Control CAPAS adapted 3.5 CAPAS enhanced Parenting Practices (Mean) 3.4 3.3 3.2 3.1 3.0 2.9 2.8 2.7 0 1 2 3 4 5 6 7 8 9 10 11 12 Months after pre-intervention

Limit Setting CAPAS & CAPAS-Enhanced sig higher than Control at 6-month follow-up Control Mother Control Father 4.25 CA Mother Discipline - Limit-setting CA Father CE Mother 4.05 CE Father 3.85 3.65 3.45 3.25 3.05 2 4 6 8 10 12 Months

Preliminary Effect Size Results (Feingold, 2009; Raudenbush & Lui, 2001) Between-condition differences at 6-month FU CE vs Control CA vs Control CE vs CA Outcome Variables d p d p d p Skill Encouragement 0.815 <.001 0.505 0.002 0.308 0.103 Supervision 0.948 <.001 0.659 0.002 0.286 0.131 Family Problem Solving 0.832 <.001 0.706 <.001 0.124 0.483 Positive Involvement 0.520 0.001 0.706 <.001 0.187 0.168 Discipline - Limit Setting 1.122 <.001 0.807 <.001 0.316 0.089

Child Internalizing and Externalizing CAPAS Enhanced sig higher than CAPAS and Control 6-months Control CAPAS adapted 12.5 CAPAS enhanced 11.5 Child Behavior (Mean) 10.5 9.5 8.5 7.5 6.5 5.5 4.5 0 1 2 3 4 5 6 7 8 9 10 11 12 Months after pre-intervention

Parent-Reported Child Behavior Internalizing CAPAS-Enhanced, main effect sig lower than Control at 6-month follow-up 2.76 Control Mother Control Father CA Mother 2.56 CBCL Internalizing (Log) CA Father CE Mother 2.36 CE Father 2.16 1.96 1.76 1.56 1.36 1.16 0 2 4 6 8 10 12 Months

Preliminary Effect Size Results (Feingold, 2009; Raudenbush & Lui, 2001) Between-condition differences at 6-month FU CE vs Control CA vs Control CE vs CA Outcome Variables d p d p d p CBCL Internalizing Main Effect -1.447 0.016 -0.878 0.154 -0.573 0.330

Parent-Reported Child Behavior Externalizing For fathers only, CAPAS-Enhanced significantly lower than CAPAS & Control at 6-month follow-up Control Mother 2.72 Control Father CA Mother 2.52 CBCL Externalizing (Log) CA Father CE Mother 2.32 CE Father 2.12 1.92 1.72 1.52 1.32 1.12 0 2 4 6 8 10 12 Months

Preliminary Effect Size Results (Feingold, 2009; Raudenbush & Lui, 2001) Between-condition differences at 6-month FU CE vs Control CA vs Control CE vs CA Outcome Variables d p d p d p CBCL Externalizing Main Effect -0.409 0.261 -0.396 0.221 -0.011 0.971 CBCL Externalizing Fathers -1.075 0.011 0.074 0.827 -1.155 0.007

Summary: Qualitative Findings

Intervention Satisfaction: Positive Involvement & Skill Encouragement “ I learned that I was the one who had to change, rather than expecting my child to change . Before, my son would approach me and I would evade him. Now, he approaches me and I express my love to him.” (CA mother) “ I always had problems with my daughter doing her homework. From giving 25 orders at once. Now, with the incentive chart, it is only five steps. It has helped me a lot.” (CE father)

Limit Setting I was not close to my children. I would only yell at them, “Do this!” “Do that!” I learned here that one thing is respect and another fear…they were afraid of me (CE mother) “ Learning how to discipline my kid has helped me because I can use authority but without hurting him ” (CA father)