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

Family therapists have a unique opportunity to contribute toward the reduction of widespread mental health disparities impacting diverse populations by developing applied lines of research focused on cultural adaptation. For example, although evidence‐based prevention parent training (PT) interventions have been found to be efficacious with various Euro‐American populations, there is a pressing need to understand which specific components of PT interventions are perceived by ethnic minority parents as having the highest impact on their parenting practices. Equally important is to examine the perceived cultural relevance of adapted PT interventions. This qualitative investigation had the primary objective of comparing and contrasting the perceived relevance of two culturally adapted versions of the efficacious parenting intervention known as Parent Management Training, the Oregon Model (PMTO). According to feasibility indicators provided by 112 Latino/a immigrant parents, as well as findings from a qualitative thematic analysis, the core parenting components across both adapted interventions were identified by the majority of research participants as relevant to their parenting practices. Participants exposed to the culturally enhanced intervention, which included culture‐specific sessions, also reported high satisfaction with components exclusively focused on cultural issues that directly impact their parenting practices (e.g., immigration challenges, biculturalism). This investigation illustrates the relevant contributions that family therapy scholars can offer toward addressing mental health disparities, particularly as it refers to developing community‐based prevention interventions that achieve a balance between evidence‐based knowledge and cultural relevance.     

Associations between Positive Parenting Practices and Child Externalizing Behavior in Underserved Latino Immigrant Families

This study examined whether five specific parenting practices (i.e., monitoring, discipline, skill encouragement, problem solving, and positive involvement) were associated with reduced child externalizing behaviors among a sample of Latino immigrant families. It utilized baseline data from 83 Latino couples with children participating in a larger randomized controlled trial of a culturally adapted parenting intervention. Results reveal that monitoring, discipline, skill encouragement, and problem solving each made independent contributions to the prediction of child externalizing behavior, although not all in the expected direction. Further analyses examining mothers and fathers separately suggest that mother‐reported monitoring and father‐reported discipline practices uniquely contributed to these findings. These results may have important implications for prevention and clinical intervention efforts with Latino immigrant families, including the cultural adaptation and implementation of parenting interventions with this underserved population.     

Advances in Latino Family Research: Cultural Adaptations of Evidence-Based Interventions

The stark contrast between frequent calls for research and practice that are applicable across a broad spectrum of cultural and ethnically diverse groups and the dearth of empirical knowledge about Latino families provided the impetus for this special issue on advances in Latino family research. A focus on empirically based practice frames the issue, focusing specifically on how concepts (expressed emotion, parenting style) can be used within interventions, how Latino parents perceive efforts to deliver evidence-based interventions, and how pilot projects that delivered culturally adapted interventions in three separate cities impacted family functioning. In all, the introduction highlights the complexities for researchers in meeting the needs of the field to ensure that effective interventions are applicable across cultural groups. Meeting the challenges is important to address the need of the growing Latino population. Advances in intervention research with ethnic minorities also stand to contribute to the advancement of intervention research broadly. This special issue provides examples of efforts that are underway to better understand what treatments work for Latino families, provided by whom, for what specific problems, and in which specific circumstances, paving the way to begin attempting to answer a challenge posed more than 40 years ago by Gordon Paul.     

Culturally adapting an evidence-based parenting intervention for Latino immigrants: the need to integrate fidelity and cultural relevance

Latinos constitute the largest ethnic minority group in the United States. However, the cultural adaptation and dissemination of evidence-based parenting interventions among Latino populations continues to be scarce despite extensive research that demonstrates the long-term positive effects of these interventions. The purpose of this article is threefold: (1) justify the importance of cultural adaptation research as a key strategy to disseminate efficacious interventions among Latinos, (2) describe the initial steps of a program of prevention research with Latino immigrants aimed at culturally adapting an evidence-based intervention informed by parent management training principles, and (3) discuss implications for advancing cultural adaptation prevention practice and research, based on the initial feasibility and cultural acceptability findings of the current investigation.     

Reaching Latino Families Through Pediatric Primary Care: Outcomes of the CANNE Parent Training Program

The lack of culturally adapted parenting programs for Latinos contributes to low engagement in effective parenting programs. Criando a Nuestros Niños Hacio el Éxito (CANNE), a culturally adapted program, improves family dynamics by decreasing problematic child behavior and helping parents manage stress. CANNE was delivered with 12 Latino parents of children (age 3–7). Increased attendance and participation resulted in less child behavior problems and parenting stress from preintervention to postintervention. A culturally relevant adaptation of an evidence-based parenting program improved engagement, child behavioral outcomes, and parenting stress. Implications of mental health services in primary care facilities for Latino families are addressed.     

Raising American Citizens: Socialization Goals of Low-Income Immigrant Latino Mothers and Fathers of Young Children

Based on ecocultural theory, this study utilizes focus group interviews to explore the ways Latino immigrant mothers and fathers transmit the values and beliefs they wish their young children to internalize. Findings suggest that parents purposely “pick and choose” values they deem “Latino,” such as the importance of family and values they deem “American,” such as independence, to pass on to their children. Parents recognized three main barriers that might stand in their way of teaching their children to adapt to two cultural groups: balancing work and family, low self-esteem, and lack of good parental role models. However, they also pointed out two sources of strength that can help them overcome these barriers: optimism and motivation. This study provides a basis for generating hypotheses to be tested with larger datasets and informs the development of theory and culturally sensitive interventions and measures to evaluate Latino parenting.     

The Cultural Adaptation of a Transition Program for Latino Families of Youth with Autism Spectrum Disorder

During the transition to adulthood, effective and culturally relevant supports are critical for families of youth with autism spectrum disorder (ASD). There is a dearth of documented program development and research on supports for Spanish-speaking Latino families during this life stage. The present work describes the cultural adaptation process of an evidence-based transition program for Latino families of youth with ASD. A model of the actions necessary to meaningfully conduct a cultural adaptation in this context is described. After implementing the culturally adapted program titled Juntos en la Transición with five Spanish-speaking families, parents reported high social validity of the program through surveys and interviews. The cultural adaptation process followed in this work is important for the further development of programs that address the transition needs of Latino youth with ASD and their families. Our impressions may also be useful to those who aim to develop culturally sensitive and ecologically valid multifamily group intervention programs for families from cultural and linguistic minority groups.     

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.     

"Hay que ponerse en los zapatos del joven": adaptive parenting of adolescent children among Mexican-American parents residing in a dangerous neighborhood

We examined parenting of adolescents with Consensual Qualitative Research analyses of five 90-minute focus groups with 45 Mexican immigrant parents residing in a high-crime and low-income neighborhood. Parents identified gangs as their major challenge in parenting. Relatedly, they endorsed control-oriented practices to ensure the safety of their adolescents. In addition, parents used practices that aimed to build strong, trusting relationships with their adolescents. The co-occurrence of parenting strategies that promote strong parent-adolescent bonds along with strict monitoring highlights the need to conceptualize parenting with both controlling as well as supportive dimensions. Moreover, the parents' narratives pertaining to the dangers in their neighborhood suggest that interventions for Latino families should be not only consistent with their cultural heritage, but also grounded in the families' local neighborhood contexts.     

Utilizing Community Partnerships to Devise a Framework for Cultural Adaptations to Evidence-Based Mental Health Practice in Diverse Communities

Mental health disparities for diverse communities (particularly immigrants and people of color) in terms of access to evidence-based treatments, lack of education/awareness about mental health symptoms and treatment options, and lack of culturally responsive treatments have been frequently documented. Hence, diversity considerations in the diagnosis, assessment, and treatment of psychological disorders remain vital and imperative in clinical practice. There is also substantial work indicating that cultural values likely play an essential role in shaping how individuals conceptualize and experience mental or emotional health. Therefore, the present study was developed for community-engaged clinicians and researchers to outline the process by which to create a culturally responsive, evidence-based treatment framework for community mental health interventions in close partnership with communities of color. This study was conceptualized and designed collaboratively with community leaders across five different communities of color: African American/Black, Latino/a, Native American, Pacific Islander, and African immigrant communities in a major U.S. city. This paper describes the mixed methods for such a community-engaged collaboration, highlighting critical elements for ongoing culturally engaged clinical work/research, and providing recommendations for culturally adapted interventions for mental health based on specific process observations made in the current example.     

Adaptation of parent-child interaction therapy for Puerto Rican families: a preliminary study

This study examines how parent-child interaction therapy (PCIT) was adapted for Puerto Rican parents of children aged 4-6 with hyperactivity and other significant behavior problems. Four steps were followed: (1) translation and preliminary adaptation of the treatment manual, (2) application of the treatment to 9 families as part of an exploratory study using repeated measures, (3) treatment revision and refinement, and (4) in-depth interviews with parents (n=15) and clinical psychologists (n=5) from Puerto Rico who provided feedback on treatment process and components. Throughout this process, cultural elements and modifications were recommended to be incorporated into the treatment protocol. Both quantitative and qualitative results suggest that PCIT seems to be an acceptable intervention for this population, with some minor changes. Parents reported a high level of satisfaction, a significant reduction in children's externalizing behavior problems, and reduction of parenting stress and improvement in their parenting practices. Psychologists also evaluated positively the treatment protocol and recommended its use. Results from this study may inform clinicians and researchers who work with Latino families about relevant issues to be considered to promote their participation in behavioral family interventions and to enhance their acceptability and effectiveness.     

Parenting Styles in a Cultural Context: Observations of "Protective Parenting" in First-Generation Latinos

Current literature presents four primary parenting styles: authoritative, authoritarian, permissive, and neglectful. These styles provide an important shortcut for a constellation of parenting behaviors that have been characterized as consisting of warmth, demandingness, and autonomy granting. Empirically, only warmth and demandingness are typically measured. Research reporting on parenting styles in Latino samples has been equivocal leading to questions about conceptualization and measurement of parenting styles in this ethnic/cultural group. This lack of consensus may result from the chasm between concepts (e.g., authoritarian parenting) and observable parenting behaviors (e.g., warmth) in this ethnic group. The present research aimed to examine parenting styles and dimensions in a sample of Latino parents using the two usual dimensions (warmth, demandingness) and adding autonomy granting. Traditional parenting styles categories were examined, as well as additional categorizations that resulted from adding autonomy granting. Fifty first-generation Latino parents and their child (aged 4–9) participated. Parent–child interactions were coded with the Parenting Style Observation Rating Scale (P-SOS). In this sample, the four traditional parenting categories did not capture Latino families well. The combination of characteristics resulted in eight possible parenting styles. Our data showed the majority (61%) of Latino parents as "protective parents." Further, while mothers and fathers were similar in their parenting styles, expectations were different for male and female children. The additional dimensions and implications are discussed. The importance of considering the cultural context in understanding parenting in Latino families is emphasized, along with directions for future research.     

A Community‐Responsive Adaptation to Reach and Engage Latino Families Affected by Maternal Depression

As family researchers and practitioners seek to improve the quality and accessibility of mental health services for immigrant families, they have turned to culturally adapted interventions. Although many advancements have been made in adapting interventions for such families, we have yet to understand how the adaptation can ensure that the intervention is reaching families identified to be in greatest need within a local system of care and community. We argue that reaching, engaging, and understanding the needs of families entails a collaborative approach with multiple community partners to ensure that adaptations to intervention content and delivery are responsive to the sociocultural trajectory of families within a community. We describe a cultural adaptation framework that is responsive to the unique opportunities and challenges of identifying and recruiting vulnerable families through community partnerships, and of addressing the needs of families by incorporating multiple community perspectives. Specifically, we apply these principles to the cultural adaptation of an intervention originally developed for low‐income African American and White families facing maternal depression. The new intervention, Fortalezas Familiares (Family Strengths), was targeted to Latino immigrant families whose mothers were in treatment for depression in mental health and primary care clinics. We conclude with key recommendations and directions for how family researchers and practitioners can design the cultural adaptation of interventions to be responsive to the practices, preferences, and needs of underserved communities, including families and service providers.     

Training of interventionists and cultural adaptation procedures: A systematic review of culturally adapted evidence-based parenting programs in Africa

There has been an increase in the implementation of evidence-based parenting programs from high-income countries to several African countries. In this review, we systematically evaluated intervention studies of culturally adapted parenting programs in nine African countries with the objective of examining the quality of training for interventionists and cultural adaptation procedures. A total of 18 studies, obtained from an electronic search of 6 databases, met the inclusion criteria and were evaluated following PRISMA guidelines. The Ecological Validity Model was adopted to organize data on cultural adaptation procedures. Sixteen of the 18 studies reported information regarding the clinical training of interventionists and the cultural adaptations undertaken. Live and interactive workshops were the most common format used to train interventionists in the focal intervention. Overall, cultural adaptations in most studies included translation of intervention protocols into the local language. However, studies varied in the way cultural adaptation procedures were reported with some studies failing to report on cultural adaptation procedures. Concurring with previous literature, attending to issues of culture, power, privilege, access, sustainability, and other relevant concepts to increase the cultural relevance is highly encouraged in parent intervention studies in Africa. This review provides a baseline upon which future training and adaptation procedures can be built.     

Cultural Diversity: Do We Need a New Wake-Up Call for Parent Training?

In 1996, Forehand and Kotchick concluded that parent-training (PT) interventions largely ignored cultural influences on parenting behavior. They reasoned that the failure to integrate the influence of ethnicity into theories of parenting behavior could result in culturally biased and less effective interventions. The present article addresses whether their “wake-up call” went unheard. We review research on PT treatment studies and examine (a) the rate of inclusion of ethnic minority parents in PT research, (b) the effectiveness of PT across ethnic groups, and (c) the effectiveness of culturally adapted PT interventions. Results show that there has been an increase in the ethnic diversity of PT treatment studies over the past three decades, yet only one methodologically sound study directly examined ethnicity as a moderator of PT treatment outcome. Despite the paucity of evidence that ethnicity is a moderator of parent-training outcomes, a number of culturally adapted PT treatments have been developed. These adapted interventions have rarely been tested against the unadapted interventions on which they are based. The results fail to support the current emphasis on ethnicity in efforts to improve the effectiveness of PT. We present methodological and conceptual limitations in the existing literature and provide recommendations for researchers studying the effects of ethnicity on PT outcomes.     

Shared ancestry, evolving stories: similar and contrasting life experiences described by foreign born and U.S. born Latino parents

As the Latino population in the United States continues to increase, so does the necessity for in-depth knowledge about their life experiences. This qualitative study sought to privilege the voices of Latino parents by utilizing focus group discussions. Specifically, participants described the life experiences that have the greatest influence on their parenting efforts. Similar and contrasting themes were identified based on participant country of origin (i.e., foreign born vs. U.S. born). Findings described the participants' commitment to being good parents, as well as the ways in which their parenting efforts are influenced by experiences of adversity and discrimination, Latino cultural values, gender roles, and resilience. The results of this investigation can inform researchers and mental health professionals working with Latino families.