The dissemination of evidence-based interventions constitutes a key strategy to reduce the disproportionate burden of mental illness experienced by ethnic minority populations in the United States. Current scientific debate exists regarding the need to culturally adapt evidence-based preventive interventions prior to dissemination among at-risk ethnic minorities. This debate is known as the adaptation/balance fidelity debate. However, this debate is restricted by the limited number of rigorous empirical studies on cultural adaptation. The goal of this R34 exploratory study is to contribute to the scholarship on cultural adaptation services research by determining the minimum adaptation requirements that are necessary to integrate a culturally adapted parenting intervention characterized by high feasibility, efficacy, and cultural acceptability. The original evidence-based parenting intervention was developed with low-income and at-risk Euro-American families and it is known as Parent Management Training Oregon (PMTO). Funding for its development was provided by the National Institute of Mental Health (NIMH). The first culturally adapted intervention to be tested in this study is a Spanish version of the PMTO intervention (TO), which was translated according to a rigorous model of cultural adaptation in order to ensure cultural appropriateness of materials and intervention delivery. The second intervention integrates all the components of the TO intervention, as well as culture-specific sessions and engagement strategies aimed at enhancing the cultural relevance of the intervention (culturally adapted: CA). The target population for this exploratory study will be low-income, first generation Latino immigrant families because children in these families are likely to be exposed to intense contextual stressors. The following specific aims will guide this research: (a) Implement a pilot study aimed at refining intervention curricula and study procedures of the two differentially culturally adapted parenting interventions, (b) implement a small randomized control trial with the two differentially culturally adapted interventions, (c) utilize observation-based rating systems to measure fidelity to core PMTO components, as well as cultural competence in the delivery of both adapted interventions, and (d) systematically examine differential rates of engagement, retention, and cultural acceptability (i.e., TO vs. CA). Differential treatment efficacy will be analyzed by evaluating changes in parenting skills, levels of internalizing and externalizing behaviors in children, and parental stress. Quantitative and qualitative methods will be used to measure the impact of both interventions. This application addresses the need identified by NIMH to promote research focused on evaluating the feasibility and efficacy of novel approaches aimed at improving the mental health of vulnerable populations by bridging science to service.
This proposal is responsive to NIMH research priorities on health disparities as the primary goal of the study is to identify the minimum adaptation requirements that are required to culturally adapt an efficacious parenting intervention while also ensuring high feasibility, cultural relevance, and efficacy. The participants in this study will be low income and at-risk Latino families. This study constitutes the first step of a program of research aimed at duplicating the most useful model of cultural adaptation with additional at-risk diverse populations.
