Addressing Adversity and Discrimination in Intervention Curriculum and Delivery: Lessons Learned in Parenting Prevention Research with Low-Income Latinx Immigrant Families

Background and Purpose: Low-income Latinx immigrant families are exposed to multiple immigration-related challenges. These stressors place Latinx youth at high risk for experiencing various problematic behaviors (e.g., drug use). An alternative to address this public health problem consists of disseminating culturally adapted parent training (PT) prevention interventions among immigrant families. However, the dissemination of efficacious culturally adapted PT interventions in underserved Latinx immigrant communities continues to be scarce throughout the US. This presentation will describe strategies to effectively engage and retain underserved Latinx families in community-based parenting prevention programs.

Methods: The first set of reflections will be drawn from an NIMH-funded study focused on the cultural adaptation of the evidence-based parenting intervention known as Parent Management Training, the Oregon Model (PMTO^©). In this randomized controlled trial, we compared two adapted parenting interventions: (a) a culturally adapted version of PMTO exclusively focused on parenting components, and (b) a culturally-enhanced version of PMTO, in which specific contextual challenges impacting Latinxs were overtly addressed (e.g., discrimination). Initial efficacy was examined by analyzing quantitative outcome data from 190 parents, according to a multilevel modeling data analytical approach. A second set of reflections are derived from a NIDA-funded study in which the PMTO-Enhanced intervention was adapted for Latinx immigrant families with adolescent children. In this intervention, the implementation of case management services was essential to retain families in the intervention. Further, participants’ reports of increasing immigration-related adversity gradually informed the intervention curriculum to increase its contextual relevance.

Findings: Findings from the NIMH study, indicated that at 6-month follow-up, the overall family retention rate was 83%. Parents in both adapted interventions significantly improved quality of all parenting practices when compared to the control condition. Effect sizes were in the medium (d = .50) to high range (d = 1.12). However, statistically significant higher improvements on child internalizing and externalizing behaviors were associated with the intervention in which issues of contextual adversity were overtly addressed. Qualitative findings indicated that the incremental effects were associated with parents being able to adapt their parenting practices according to specific immigration stressors. In the NIDA study, the overall family retention rate was 87% at intervention completion. Preliminary efficacy findings indicated that when compared to the control condition, parents exposed to the parenting intervention increased quality of parenting skills, whereas youth increased perception of harm associated with alcohol intake (d = .30, p < .05). Concerning qualitative findings also indicated that current anti-immigration narratives in the US are impacting Latinx immigrant families in significantly deleterious ways.

Conclusions and implications: We propose that the positive outcomes observed in both trials are related to two main factors. First, there is a need to overtly address specific dimensions of contextual adversity experienced by target populations (e.g., discrimination). In addition, prevention initiatives should include strategies to help families cope with intense contextual adversity. Examples of these include offering family advocacy services, training members of target communities as interventionists, and delivering interventions in community-based settings highly trusted by target populations (e.g., faith-based organizations).