Helping Latino Parents Learn Skills to Manage Their Children's Mental Health Care [Internet]

Excerpt

Background: Latina/o children with mental health needs are half as likely to use services as other children. Activation is a promising strategy to eliminate disparities. Evidence on parent activation in this underserved population is sparse.

Objective: This study examines the comparative effectiveness of MePrEPA (metas, preguntar, escuchar, preguntar para aclarar/goals, questioning, listening, questioning to clarify), an activation intervention for Latina/o parents raising children with mental health needs.

Secondary analyses explore the association of parent activation and child self-reported outcomes using the child Patient Reported Outcomes Measurement Information System (cPROMIS).

Methods: We conducted a randomized controlled trial (n = 172) in a Spanish-language mental health clinic to assess the effectiveness of MePrEPA compared with a parent support group.

Inclusion criteria were Latina/o parents raising a child with mental health needs receiving services and able to attend weekly sessions. After completion of the trial, we tested feasibility of a refined version of the intervention MePrEPAv2 in a nonrandomized sample (n = 114). The primary outcome was parent-reported activation; secondary outcomes were parent mental health, observed parent activation, and child visit attendance. We added 2 additional secondary outcomes midtrial. Education activation explores parents' activation regarding their child's education (n = 134). Quality of school involvement captures the parents' report of their rapport with the child's teacher (n = 134). Six cPROMIS measures captured child-reported anger, anxiety, depression, fatigue, pain interference, and peer relationships (n = 97). We tested effectiveness of MePrEPA with a difference-in-difference approach estimating linear mixed models.

We examined heterogeneity of treatment effect. We assessed concurrent and discriminant validity of cPROMIS scores with Pearson correlations and independent sample t tests. We used linear mixed models to assess the relationship between change in parent activation and cPROMIS scores over time.

Results: Among consented randomized controlled trial participants, 3-month completion rates ranged from 82% to 87%. The impact of MePrEPA compared with the parent support group was significant for the primary outcome parent activation (β = 5.98; CI, 1.42-10.53) as well as secondary outcomes education activation (β = 7.98; CI, 3.01-12.94) and quality of school involvement (β = 1.83; CI, 0.14-3.52). We observed no statistically significant intervention effects for secondary outcomes parent stress (β = −.21; CI, −1.99 to 1.58) or depression (β = .25; CI, −1.32 to 1.82). Tests for heterogeneity of treatment effect on outcomes did not indicate significant differences by subgroups. Chi-square and F tests indicated no association between treatment arm and secondary outcomes observed parent activation (P = .76) or child attendance (P = .26), respectively. The cPROMIS measures show good concurrent and discriminant validity in a population of Latino children receiving mental health services.

Improved parent outcomes show trends toward association with improved child-reported cPROMIS outcomes on pain interference (β = −.203; CI, −.40 to −.01; β = −.493; CI, −.96 to −.02), anger (β = −.702; CI, −1.23 to −.17), and peer relationships (β = .380; CI, −.01 to .77). However, after adjustment for multiple comparisons on cPROMIS outcomes, findings suggest only that increases in parent and education activation were associated with poorer cPROMIS outcomes on anxiety (β = .350; CI, .10-.60; β = .410; CI, .14-.68, respectively).

Conclusions: MePrEPA increased activation among Latina/o parents who bring children for mental health services. Moreover, MePrEPA is a psychoeducational intervention that mental health clinics can readily incorporate in their current practices. Findings support the use of cPROMIS scores to assess child outcomes, but no conclusions can be drawn about distal impacts of the MePrEPA intervention on the cPROMIS scores. Findings underscore the importance of parent partnerships in the clinical process and at school as well as managing child mental health needs at home.

Limitations and Subpopulation Considerations: These outcomes are based on parent self-reporting of perceived activation and may not reflect actual skill level. Future work should replicate these findings in a large number of sites, adding behavioral measures and distal impacts while examining MePrEPA's effects across settings, populations, and time.