Understanding Mental Health Literacy to Enhance Child Mental Health Service Engagement for Latino Parents

Background. Limited culturally relevant information about mental health, in combination with stigma and fear of rejection by families and communities (McKay et al., 2010), are factors often linked to urban poor Latino parents’ delay in seeking child mental health services (Alegria, Canino, Ramirez, Lai, Chavez, 2004). Thus, there is a need for interventions to address knowledge gaps about what child mental health service use entails with Latino parents.  Using a CBPR approach and focus groups as method of inquiry, a team of community and academic partners collaboratively developed Todos a Bordo (TAB), a culturally informed media based intervention that aims to help providers to simultaneously educate, engage, and sustain urban poor Latino parents in child mental health services (Umpierre et al 2014).  In this paper we will describe the implementation and testing of TAB in seven urban child mental health clinics.

Methods: Data was collected from 41 Latino caregivers in seven community mental health clinics. To minimize disruption to each clinic’s work flow, providers were randomly assigned to one of two groups, intervention (TAB) or service as usual. Demographic information was collected and outcomes were assessed using the Child Mental Health Stigma Scale, the Parent Activation Measure, and the Parent Stress Index. Bivariate and multivariate analyses were conducted to examine differences in parents’ outcomes on stigma, stress, and help seeking behaviors between treatment and control groups. In addition, individual structured interviews were conducted with treatment providers to explore their perceptions and acceptability of the intervention.  

 Results: Study participants were ethnically diverse: Puerto Rican (39%), Dominican (29%) and Mexican (20%). Most caregivers (73%) were not born in the United States, resided in the United States an average of 15 years, and spoke and read Spanish (59%). The average age of the caregivers was 42 years and of their children, 11 years. Caregivers identified as mothers (83%), and 51% of children were boys. Most caregivers were single (41%), 34% married or divorced, and 21% separated; 59% had high school education or less, and 51% were employed. The median family income was less than $9,999. Bivariate analyses indicated significant effects of the intervention on the following outcomes: decreases in parents’ stigma towards mental health (t(39) = 2.14, p < .05) and increases in help-seeking behavior (t(39) = 1.63, p < .10). Multivariate analyses indicated caregivers of boys benefited from this program and were more likely to decrease their perceptions of barriers of help seeking behavior (b=-.40; SD=.17; p<.05), and stigma (b=.-.37; SD=.12; p<.05) than caregivers of girls. Providers were receptive to using the media based intervention. 

 Implications:

Study findings address the potential usefulness of this intervention for Latino caregivers, especially those caring for boys. Supporting caregivers with culturally relevant mental health literacy resources may help to reduce stigma, parenting stress, enhance engagement, and sustain Latino children in care. The results of this study are promising and a larger scale study is warranted to further evaluate the effectiveness of TAB, and further examine the gender differences of this collaboratively designed media-based intervention.