We propose to further develop and test a new Culturally-based Family Intervention for Mexican Americans (CFIMA) using the resources of the R34 mechanism. Family involvement in service interventions for persons with schizophrenia has consistently shown strong positive outcomes for patients and their families. Despite that Latino cultures are known to be more family-centered in comparison to Western-based cultures, only one controlled family-based schizophrenia model (empirically-validated for non-minorities) has been studied with Mexican Americans, and the results were mixed. There is a great need for more family work in this area because studies have consistently found that most Latino patients are more likely to live with family compared to non-minorities. Family interventions need to be developed that are socioculturally synchronous with the caregiving ideology of Latino culture and that are culturally congruent with the needs, preferences, and cultural learning styles of this largely under-served, under-researched growing population. Intervention development has been informed by both our extensive clinical experience with Latinos, the literature on protective factors, and our recent in-depth ethnographic research with Spanish-speaking Mexican origin Latinos. This data showed a lack of cultural fit between the culture of this large Latino subgroup and existing service interventions. The salient cultural resources used by Mexican Americans in coping with the impact of the illness within the family are largely untapped by existing interventions. The CFIMA employs a family group format guided by the heuristic model of family-provider cultural exchange we have developed. It cultivates cultural resources that can play an influential role in improving family and patient outcomes within 3 sequential treatment stages: cultural assessment, cultural accommodation, and cultural integration. Based on a stage model for intervention development and intervention literature on the development of culturally congruent services, we propose to (1) further develop, standardize, and manualize the CFIMA for families with a relative with schizophrenia and to (2) evaluate its preliminary effectiveness in a controlled trial (CFIMA vs. usual care) with 60 Spanish-speaking families (N=30 each condition) lasting 6 months (with baseline, 6-months, 9-month follow-ups) in real-world settings. A wide range of family and patient outcomes and consumer-derived data will be assessed in both conditions. The results will provide preliminary evidence on whether the manualized CFIMA is effective for Mexican Americans. This work will provide a model for how to integrate cultural factors into other intervention services and enhance these in real-world settings for culturally diverse groups. Results will serve as the basis for an R01 to extend this research to larger samples, across acculturation levels, other Latino subgroups and ethnic groups in community settings. ? ? ?
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