Padres Efectivos (Parent Activation): Skills Latina Mothers Use to Get Healthcare for Their Children

Background:

Latinos are the largest and fastest growing minority population in the US; by 2050, 2 in 5
children will be Latino. Latino children are disproportionately affected by poverty and
other factors associated with increased risk of psychiatric disorder. However, Latino
children with mental health needs are half as likely to use services as children in white
non-Latino families. Latino families are more likely to report problems getting services,
lack of a usual source of care and a medical home, and dissatisfaction with the care they
receive. Unmet mental health needs, in turn, are associated with poor outcomes over the
lifespan, both economic and social. Assessing the comparative effectiveness of interventions
to overcome these disparities is a major national health priority central to PCORI's mission
and mandate.

Activation is a promising focus of research to eliminate disparities because it reflects a
set of attitudes and skills that people can use to reduce disparities. Our work provides
evidence that activation in Latino adults is associated with better quality health care and
outcomes; and in African American parents with greater child mental health service use.
There is need for further research on parent-focused interventions founded on culturally
meaningful concepts to address these needs and disparities.

Objectives:

The long-term goal of this research is to improve the mental health care and outcomes of
Latino children with mental health needs. The proposed study will examine the comparative
effectiveness of an activation intervention for Latino families raising children with mental
health needs by means of three aims:

Aim 1. To identify parent-reported facilitators of Latino child mental health service use
amenable to change through parental activation Aim 2. To test the comparative effectiveness
of an adapted psycho-educational intervention to teach activation skills adapted for Latino
mothers of children with mental health needs compared to a parent support group control Aim
3. To enhance the intervention, based on parent input and lessons learned from the first
trial, and test its comparative effectiveness with a parent support group control

Methods:

Qualitative and quantitative data from Latino mothers who have a child with mental health
needs (n=294) will be used in a difference-in-difference mixed effects approach to address
these aims.

Projected Patient Outcomes:

The proposed study will provide evidence of the comparative effectiveness of an enhanced,
culturally sensitive, advocacy skills intervention to build activation among Latino families
and improve service use of their children with mental health needs compared to a preliminary
adaptation of an existing intervention and to a usual care discussion group. Activation
skills are a promising strategy to improve child mental health service use and to bridge
cultural differences and disparities with wide-ranging impacts consistent with PCORI's
research agenda.

Inclusion Criteria:

- For children:

- seeking services at target clinic

- maximum age 22 years

- For caregivers:

- Latino ethnicity

- bringing child for services to target clinic

- able to attend a weekly class for 4 weeks

- able to give informed consent

Exclusion Criteria:

- For children:

- not living with potential participant caregiver

- For caregiver:

- not living with target child

- evidence of emergency mental health needs