Mental Disorders
Conditions
Keywords
child mental health, mental health services, Latino families
Brief summary
The goal of this study is to develop an intervention to teach activation skills to Latino parents who bring children for mental health services.
Detailed description
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.
Interventions
psychosocial activation curriculum
parent directed support group
Sponsors
Study design
Eligibility
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
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Patient Activation Measure | 1 and 3 months | The Patient Activation Measure (PAM) captured parent activation on behalf of their child. The PAM is an adult self-report 13-item scale with 4-level Likert responses and scores ranging from 0 to 100. Higher scores indicate higher activation. It is valid with excellent reliability. The PAM has been translated into Spanish and has been used successfully in Latina/o patient and general populations (mean=40). The PAM has also been used to measure activation of parents on behalf of their children (mean=70). A change of 4 points in the PAM is associated with improved health behaviors in the general population. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| 8-item Patient Health Questionnaire (PHQ-8) | 1 and 3 months | Parent depression was measured with the 8-item Patient Health Questionnaire (PHQ-8). The PHQ-8 is scored on a scale from 0 to 27; a higher score reflects greater severity of depression. It has excellent validity and reliability. The parent PHQ-9 has been translated into Spanish and used successfully in Latina/o populations. A change of 5 points in the PHQ-8 is associated with a shift in level of depression. |
| Parental Stress Scale | 1 and 3 months | Parent stress was measured with the 17-item Parental Stress Scale. The Parental Stress Scale is scored on a scale from 0 to 75, where higher scores reflect greater stress. It has been translated into Spanish, and has been shown to have excellent validity and reliability (for women, mean=22). |
| Parent Activation, Qualitative | 1 month | We collected qualitative data on parent-provider communication after completion of the 4-week MePrEPA (metas, preguntar, escuchar, preguntar para aclarar/goals, questioning, listening, questioning to clarify) and parent support groups, in an effort to capture observed activation. We coded when the parent disagreed with therapist and when the parent mentioned speaking with child's teacher. |
| Number of Clinic Visits Child Attended Over 4 Months | baseline to 4-month follow-up | We collected child attendance at clinic visits during a 4-month window of time, during the 3-month period parents were participating in the study and one additional month following. Child clinic visit attendance was measured by number of visits attended. |
| Child Visit No-shows Over 4 Months | baseline to 4-month follow-up | We collected child attendance at clinic visits during a 4-month window of time, during the 3-month period parents were participating in the study and one additional month following. Child clinic visit no-shows were measured by number of visits missed. |
Countries
United States
Participant flow
Recruitment details
Recruitment was from a Spanish-language mental health clinic, November 2013 through August, 2015
Pre-assignment details
Evaluation criteria were focal child not living with potential participant and evidence of urgent parent mental health needs
Participants by arm
| Arm | Count |
|---|---|
| Activation Curriculum Psycho-social curriculum teaching activation skills
activation curriculum: psychosocial activation curriculum | 87 |
| Support Group Parent-directed support group
support group: parent directed support group | 85 |
| Total | 172 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Lost to Follow-up | 20 | 13 |
Baseline characteristics
| Characteristic | Activation Curriculum | Total | Support Group |
|---|---|---|---|
| Age, Continuous | 35.3 years STANDARD_DEVIATION 6.9 | 35.8 years STANDARD_DEVIATION 6.6 | 36.4 years STANDARD_DEVIATION 6.3 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 87 Participants | 172 Participants | 85 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 0 Participants | 0 Participants | 0 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Medicaid coverage | 62 Participants | 124 Participants | 62 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Black or African American | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) White | 87 Participants | 172 Participants | 85 Participants |
| Region of Enrollment United States | 87 Participants | 172 Participants | 85 Participants |
| Sex: Female, Male Female | 84 Participants | 168 Participants | 84 Participants |
| Sex: Female, Male Male | 3 Participants | 4 Participants | 1 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 0 / 92 | 0 / 89 |
| serious Total, serious adverse events | 0 / 92 | 0 / 89 |
Outcome results
Patient Activation Measure
The Patient Activation Measure (PAM) captured parent activation on behalf of their child. The PAM is an adult self-report 13-item scale with 4-level Likert responses and scores ranging from 0 to 100. Higher scores indicate higher activation. It is valid with excellent reliability. The PAM has been translated into Spanish and has been used successfully in Latina/o patient and general populations (mean=40). The PAM has also been used to measure activation of parents on behalf of their children (mean=70). A change of 4 points in the PAM is associated with improved health behaviors in the general population.
Time frame: 1 and 3 months
Population: Completed a baseline interview
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Activation Curriculum | Patient Activation Measure | patient activation measure 1-month | 88.08 scores on a scale | Standard Deviation 12.13 |
| Activation Curriculum | Patient Activation Measure | patient activation measure 3-months | 92.75 scores on a scale | Standard Deviation 10.52 |
| Support Group | Patient Activation Measure | patient activation measure 1-month | 84.73 scores on a scale | Standard Deviation 12.65 |
| Support Group | Patient Activation Measure | patient activation measure 3-months | 91.63 scores on a scale | Standard Deviation 11.13 |
8-item Patient Health Questionnaire (PHQ-8)
Parent depression was measured with the 8-item Patient Health Questionnaire (PHQ-8). The PHQ-8 is scored on a scale from 0 to 27; a higher score reflects greater severity of depression. It has excellent validity and reliability. The parent PHQ-9 has been translated into Spanish and used successfully in Latina/o populations. A change of 5 points in the PHQ-8 is associated with a shift in level of depression.
Time frame: 1 and 3 months
Population: Completed a baseline interview
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Activation Curriculum | 8-item Patient Health Questionnaire (PHQ-8) | patient health questionnaire-8 1-month | 4.63 scores on a scale | Standard Deviation 5.91 |
| Activation Curriculum | 8-item Patient Health Questionnaire (PHQ-8) | patient health questionnaire-8 3-months | 3.89 scores on a scale | Standard Deviation 4.63 |
| Support Group | 8-item Patient Health Questionnaire (PHQ-8) | patient health questionnaire-8 1-month | 3.49 scores on a scale | Standard Deviation 4.34 |
| Support Group | 8-item Patient Health Questionnaire (PHQ-8) | patient health questionnaire-8 3-months | 3.47 scores on a scale | Standard Deviation 4.43 |
Child Visit No-shows Over 4 Months
We collected child attendance at clinic visits during a 4-month window of time, during the 3-month period parents were participating in the study and one additional month following. Child clinic visit no-shows were measured by number of visits missed.
Time frame: baseline to 4-month follow-up
Population: Target child with any scheduled visits
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Activation Curriculum | Child Visit No-shows Over 4 Months | 0.7 visits | Standard Deviation 0.9 |
| Support Group | Child Visit No-shows Over 4 Months | 0.6 visits | Standard Deviation 1 |
Number of Clinic Visits Child Attended Over 4 Months
We collected child attendance at clinic visits during a 4-month window of time, during the 3-month period parents were participating in the study and one additional month following. Child clinic visit attendance was measured by number of visits attended.
Time frame: baseline to 4-month follow-up
Population: Target child with any scheduled clinic visits
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Activation Curriculum | Number of Clinic Visits Child Attended Over 4 Months | 4.2 visits | Standard Deviation 2.8 |
| Support Group | Number of Clinic Visits Child Attended Over 4 Months | 4.0 visits | Standard Deviation 2.8 |
Parent Activation, Qualitative
We collected qualitative data on parent-provider communication after completion of the 4-week MePrEPA (metas, preguntar, escuchar, preguntar para aclarar/goals, questioning, listening, questioning to clarify) and parent support groups, in an effort to capture observed activation. We coded when the parent disagreed with therapist and when the parent mentioned speaking with child's teacher.
Time frame: 1 month
Population: Completed baseline interview and had an audio-recorded visit
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Activation Curriculum | Parent Activation, Qualitative | parent disagreed with therapist | 4 Participants |
| Activation Curriculum | Parent Activation, Qualitative | parent mentioned speaking with child's teacher | 16 Participants |
| Support Group | Parent Activation, Qualitative | parent disagreed with therapist | 5 Participants |
| Support Group | Parent Activation, Qualitative | parent mentioned speaking with child's teacher | 16 Participants |
Parental Stress Scale
Parent stress was measured with the 17-item Parental Stress Scale. The Parental Stress Scale is scored on a scale from 0 to 75, where higher scores reflect greater stress. It has been translated into Spanish, and has been shown to have excellent validity and reliability (for women, mean=22).
Time frame: 1 and 3 months
Population: Completed a baseline interview
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Activation Curriculum | Parental Stress Scale | parental stress scale 1-month | 28.51 scores on a scale | Standard Deviation 7.63 |
| Activation Curriculum | Parental Stress Scale | parental stress scale 3-months | 26.68 scores on a scale | Standard Deviation 6.69 |
| Support Group | Parental Stress Scale | parental stress scale 1-month | 29.97 scores on a scale | Standard Deviation 6.9 |
| Support Group | Parental Stress Scale | parental stress scale 3-months | 27.25 scores on a scale | Standard Deviation 6.61 |