View in EDS HTML Full Text PDF Full Text

Feasibility and Acceptability of Spanish-Language Parenting Interventions for Young Children with Developmental Delays

Saved in:
Bibliographic Details
Title: Feasibility and Acceptability of Spanish-Language Parenting Interventions for Young Children with Developmental Delays
Language: English
Authors: Safer-Lichtenstein, Jonathan, McIntyre, Laura Lee, Rodriguez, Geovanna, Gomez, Douglas, Puerta, Stephanie, Neece, Cameron L.
Source: Intellectual and Developmental Disabilities. 2023 61(4):307-325.
Availability: American Association on Intellectual and Developmental Disabilities. P.O. Box 1897, Lawrence, KS 66044-1897. Tel: 785-843-1235; Fax: 785-843-1274; e-mail: AJMR@allenpress.com; Web site: https://meridian.allenpress.com/aaidd
Peer Reviewed: Y
Page Count: 19
Publication Date: 2023
Document Type: Journal Articles
Reports - Research
Education Level: Adult Education
Descriptors: Young Children, Developmental Delays, Parents, Intervention, Spanish Speaking, Hispanic Americans, Latin Americans, Stress Management, Parent Education, Metacognition, Attendance, Satisfaction, Social Support Groups, Psychoeducational Methods
DOI: 10.1352/1934-9556-61.4.307
ISSN: 1934-9491
1934-9556
Abstract: Hispanic/Latinx parents of children with developmental delays/disabilities (DD) face disparities in service access and research participation. In the present study, 60 Spanish-speaking caregivers of young children with DD participated in randomly assigned stress reduction interventions (psychoeducation/support groups or Mindfulness-Based Stress Reduction [MBSR]), followed by behavioral parent training (BPT). Caregiver attendance and satisfaction ratings were measured, and focus groups gathered additional information on caregivers' takeaways from the interventions. Caregivers demonstrated high satisfaction across interventions, with slightly greater preference for psychoeducation/support groups, and qualitative data indicated that the relevance of the information and style of delivery may be responsible. Researchers and clinicians may attain greater engagement with this population by focusing on intervention services that include psychoeducation and peer support elements.
Abstractor: As Provided
Entry Date: 2023
Accession Number: EJ1400098
Database: ERIC
Full text is not displayed to guests.
FullText Links:
  – Type: pdflink
    Url: https://content.ebscohost.com/cds/retrieve?content=AQICAHj0k_4E0hTGH8RJwT4gCJyBsGNe_WN95AvKlDbXJGqwxwE78fesq_5C6Jc5pPIV4uAEAAAA4zCB4AYJKoZIhvcNAQcGoIHSMIHPAgEAMIHJBgkqhkiG9w0BBwEwHgYJYIZIAWUDBAEuMBEEDKhlZAu-VjN5yyIOCQIBEICBm_ZiME-KlZXy8Afj51pIfEKe4zHzSrIe43d6q5FlN3KeAEbn_1DTzKRIcg5sieQVjhFLTGzdQaNU2wtHO3RBBegqjkHjKJOO3fOEm0bfwc67AJK9GSvjFq_ewn0_x5XO_uQjw3nP8YeJBNkmczvudw1kW4ol9xpo1IINuf1TvGMbZA27wabu-fqNfMjBN-CURtpMPX9zBQthXLXq
Text:
  Availability: 1
  Value: <anid>AN0169767967;[394c]01aug.23;2024Aug16.14:14;v2.2.500</anid> <title id="AN0169767967-1">Feasibility and Acceptability of Spanish-Language Parenting Interventions for Young Children With Developmental Delays </title> <p>Hispanic/Latinx parents of children with developmental delays/disabilities (DD) face disparities in service access and research participation. In the present study, 60 Spanish-speaking caregivers of young children with DD participated in randomly assigned stress reduction interventions (psychoeducation/support groups or Mindfulness-Based Stress Reduction [MBSR]), followed by behavioral parent training (BPT). Caregiver attendance and satisfaction ratings were measured, and focus groups gathered additional information on caregivers' takeaways from the interventions. Caregivers demonstrated high satisfaction across interventions, with slightly greater preference for psychoeducation/support groups, and qualitative data indicated that the relevance of the information and style of delivery may be responsible. Researchers and clinicians may attain greater engagement with this population by focusing on intervention services that include psychoeducation and peer support elements.</p> <p>Keywords: developmental delay; Spanish; Hispanic/Latinx; stress reduction; behavioral parent training</p> <p>Hispanic/Latinx individuals represent the fastest growing population diagnosed with autism and other developmental delays/disabilities (DD) in the United States ([<reflink idref="bib22" id="ref1">22</reflink>]). As such, there is an increasing need to identify and provide appropriate intervention services for Hispanic youth with DDs and their caregivers (Note: The term Hispanic is used throughout the remainder of this article, as it is the preferred term of the majority of members of this community; Noe-Bustamante etal., 2020). Unfortunately, research suggests that existing service systems often fail to meet the treatment needs of Hispanics with developmental disabilities ([<reflink idref="bib34" id="ref2">34</reflink>]). Spanish-speaking families experience additional challenges including fewer intervention hours and more unmet intervention needs, with some studies showing English-language proficiency to be the single most important factor in predicting access to services ([<reflink idref="bib53" id="ref3">53</reflink>]). Culturally diverse families have also been underrepresented in DD treatment research (e.g., [<reflink idref="bib46" id="ref4">46</reflink>]; [<reflink idref="bib51" id="ref5">51</reflink>]). This underrepresentation in the literature has been attributed to cultural differences in familiarity with research, socioeconomic and language barriers, and a lack of targeted efforts to engage this population ([<reflink idref="bib41" id="ref6">41</reflink>]). One way that such disparities can be attenuated is through research to test whether widely utilized, evidence-based, DD intervention practices are feasible and acceptable when delivered in Spanish.</p> <p>Interventions that support caregivers who are parenting children with DD are needed given the heightened psychological distress associated with parenting a child with a disability ([<reflink idref="bib3" id="ref7">3</reflink>]). Two interventions that target stress reduction and positive coping are Mindfulness-Based Stress Reduction (MBSR; [<reflink idref="bib14" id="ref8">14</reflink>]; [<reflink idref="bib31" id="ref9">31</reflink>]) and psychoeducation/support groups ([<reflink idref="bib5" id="ref10">5</reflink>]). MBSR is an intervention that utilizes a combination of mindfulness meditation, body awareness, and exploration of thoughts and actions, and has numerous studies providing empirical support of stress reduction benefits (see [<reflink idref="bib18" id="ref11">18</reflink>], for a meta-analysis). There is also a growing body of research that MBSR interventions may be particularly beneficial for caregivers of children with autism and DD ([<reflink idref="bib14" id="ref12">14</reflink>]; [<reflink idref="bib31" id="ref13">31</reflink>]), and that it can be effective with Hispanics ([<reflink idref="bib9" id="ref14">9</reflink>]; Neece el al., 2019). Psychoeducation groups teach caregivers broad knowledge-based content (i.e., about disabilities and how to attain services), which is often combined with support group elements, such as sharing of common experiences between caregivers ([<reflink idref="bib47" id="ref15">47</reflink>]). Psychoeducation groups may have some impact on caregiver stress (e.g., [<reflink idref="bib8" id="ref16">8</reflink>]), but this has not been studied extensively nor is it the focus of such programs. To date, one psychoeducation program has been developed for Hispanic caregivers of children with autism. This program, called Parents Taking Action, piloted a health navigator model of service delivery ([<reflink idref="bib23" id="ref17">23</reflink>]) and demonstrated improvements in caregiver knowledge of rights, but not mental health ([<reflink idref="bib21" id="ref18">21</reflink>]).</p> <p>Additionally, children with DD average three to four times the number of behavioral challenges as their typically developing peers (e.g., [<reflink idref="bib3" id="ref19">3</reflink>]). Given that challenging behavior is a frequent concern of caregivers of children with DD ([<reflink idref="bib24" id="ref20">24</reflink>]), interventions targeting the reduction of behavior problems in children with DD are common. An intervention that is considered cost-effective and easy-to-implement is Behavioral Parent Training (BPT) modified to meet the needs of children with DD ([<reflink idref="bib28" id="ref21">28</reflink>]). Furthermore, research indicates that Hispanic caregivers may benefit similarly from BPT as non-Hispanic White caregivers ([<reflink idref="bib40" id="ref22">40</reflink>]). Calzada and colleagues (2013) conducted focus groups with Hispanic mothers around BPT and found that they viewed some strategies acceptable, including specifically the use of praise and social rewards, other strategies (i.e., elimination of spanking) less acceptable, and were divided on others (i.e., time-out).</p> <p>Despite general acceptability of BPT strategies, there remain challenges for researchers in getting families to consistently attend and engage in such sessions. Thus, there is also a need to test the most cost-effective and feasible manner for delivering these types of interventions, with growing evidence supporting telehealth (Corralejo & Rodriguez, 2018). In order to begin developing the evidence base for treatments with this population, an important first step is to examine acceptability and feasibility of intervention content, study design, and procedures ([<reflink idref="bib17" id="ref23">17</reflink>]). Establishing initial acceptability and feasibility through investigating attendance, satisfaction, and alignment with cultural and familial values and norms, is essential to informing the next steps of this program of research. Once preliminary evidence of acceptability and feasibility is established, efficacy of intervention on child and caregiver outcomes can be investigated. Prior studies have indicated a link specifically between caregiver acceptability of intervention and child outcomes (e.g., [<reflink idref="bib44" id="ref24">44</reflink>]). In the present study, the feasibility and acceptability of psychoeducation, MBSR, and BPT interventions, as well as telehealth delivery modality, are investigated with Spanish-speaking Hispanic caregivers of children with DD. The data gathered from this process can address the dearth of studies examining parenting interventions for Spanish-speaking caregivers of young children with DD and inform the field about the types of interventions that can be feasibly delivered with this often underserved population.</p> <hd id="AN0169767967-2">Literature Gap and Research Questions</hd> <p>Although the aforementioned interventions (psychoeducation, MBSR, BPT) have been shown to be generally effective with White middle- to upper-socioeconomic status (SES) families, there is much less evidence of their effectiveness when delivered in Spanish to lower-SES Hispanic caregivers of children with DD. Furthermore, limited studies have looked at the effectiveness of using telehealth intervention with these families. Questions of feasibility and acceptability are especially relevant among these groups given the relative dearth of research on interventions delivered in Spanish. Specifically, we sought to examine: 1) at what rate would caregivers attend intervention groups and would there be any differences between those who participated in BPT-E and BPT-M?; and 2) how acceptable and feasible would caregivers find the interventions and would there be any group differences in acceptability or attendance?</p> <hd id="AN0169767967-3">Method</hd> <p></p> <hd id="AN0169767967-4">Study Design</hd> <p>The present study is part of a larger National Institutes of Health (NIH)-funded longitudinal, randomized control trial (RCT) examining differences between two interventions aimed at helping caregivers of young children with DD cope with stress and manage child challenging behavior ([<reflink idref="bib29" id="ref25">29</reflink>]). This RCT is ongoing and is being conducted in Portland, Oregon, and Loma Linda, California. The two interventions being compared in the larger RCT are BPT combined with MBSR (BPT-M) and BPT combined with psychoeducation/support (BPT-E). In this trial, participants are enrolled and randomized to either the BPT-M or BPT-E condition and receive their intervention in a group-delivered format. In BPT-M, participants received 6 weeks ofgroup-based MBSR intervention, followed by 10weeks of BPT. The MBSR intervention consisted of didactic training, practice exercises, and discussions about mindfulness. In BPT-E, participants received 6 weeks of group-based psychoeducation, again followed by 10 weeks of the same BPT intervention. The psychoeducation intervention was designed as a support group in which caregivers were provided with information and encouraged to discuss relevant supports and resources for their child related to their development, disability, education, therapies, and other services.</p> <p>The core 10-week BPT intervention for both groups was an adaptation of the Incredible Years Parent Training (IYPT) program for children with DD ([<reflink idref="bib26" id="ref26">26</reflink>]; [<reflink idref="bib27" id="ref27">27</reflink>]). This manualized intervention incorporates elements of standard BPT (i.e., positive parenting, praise, and rewards), with some modifications, such as removing content around "time out" that has proven less effective for children with DD and adding additional content on predicting and responding to challenging behaviors. Although BPT is delivered to participants in both conditions, caregivers remain in their original group assignment. The reason for this treatment order in the larger RCT is to test the additive effects of a stress reduction component prior to BPT, with MBSR directly targeting stress and psychoeducation serving as an active control. Also of note, the content of all three of the above programs was directly translated to Spanish but was not further adapted or modified. Video examples that accompany the BPT curriculum were provided dubbed inSpanish by the IYPT publishing company ([<reflink idref="bib50" id="ref28">50</reflink>]). Although the larger RCT also includes several English-speaking cohorts across sites, efficacy data across cohorts will not be disseminated until the trial is complete. The present study focused on feasibility and acceptability of the interventions for the monolingual Spanish-speaking cohort (<emph>N</emph> = 60) in Loma Linda. These groups were delivered entirely in Spanish, consistent with caregiver input that this would be of greater benefit than interventions delivered in English with live interpreters ([<reflink idref="bib32" id="ref29">32</reflink>]). Furthermore, due to the unfortunate circumstances brought on by COVID-19, intervention groups for Spanish-speaking caregivers of children with DD were delivered via telehealth for the first time ([<reflink idref="bib30" id="ref30">30</reflink>]).</p> <hd id="AN0169767967-5">Participants</hd> <p>Primary caregivers of preschool-aged children (3–5 years) were recruited to participate in this study. To be eligible, children needed to have either a medical diagnosis or early childhood special education eligibility of autism or DD, and to experience elevated behavior problems based on two screener questions (i.e., my child has behavior problems frequently and my child's behavior problems are intense in nature) on which parents had to answer somewhat true or very true. Caregivers were excluded from study participation if (a) they screened positive for active psychosis, substance abuse, or suicidality; (b) they were currently receiving any form of psychological or behavioral treatment at the time of referral (e.g., counseling, caregiver training, caregiver support group); or (c) their child had significant sensory impairments (e.g., deafness, blindness) or nonambulatory conditions that would necessitate the need for significant modifications to the study protocol. For the Spanish-speaking cohort, all caregivers were Hispanic who identified Spanish as their primary and/or only language.</p> <p>Recruitment took place through the distribution of informational flyers to regional service centers in the greater Loma Linda area. Potential participants were invited to contact the project office to express their interest in participating, and these caregivers were then contacted by a bilingual research assistant. In total, 207 Spanish-speaking caregivers expressed initial interest in this study and 60 were enrolled. See Figure 1 for additional recruitment details. Randomization occurred at baseline, as described in the following section.</p> <p>DIAGRAM: Figure 1 CONSORT Diagram of Participant Inclusion Within the Spanish CohortNote. ASD = autism spectrum disorder; DD = developmental delays/disabilities; BPT-E = behavioral parent training combined with psychoeducation/support; BPT-M = behavioral parent training combined with Mindfulness-Based Stress Reduction (MBSR).</p> <hd id="AN0169767967-6">Procedure</hd> <p>Eligible participants were assessed at baseline in an initial home visit where informed consent and demographic information were gathered. All measures were administered in Spanish by bilingual research assistants. Participants were then randomly assigned to either BPT-M or BPT-E, and completed a brief motivational interview designed to improve parent engagement in the interventions used in the study. The motivational interview was designed to elicit self-motivational statements from participants about their desire to participate and their goals and hopes for the intervention, as well as address potential barriers to engagement ([<reflink idref="bib35" id="ref31">35</reflink>]). Enrolled participants were also contacted by study staff the week before the intervention to be reminded about the upcoming groups and their goals for the intervention.</p> <p>Intervention groups were run concurrently (i.e., BPT-E on Monday and BPT-M on Wednesdays) over the course of the 16 weeks. Each session was scheduled for 2 hours and was intended to be run in-person at Loma Linda University. As recommended by [<reflink idref="bib41" id="ref32">41</reflink>], sessions were run in the evening so that caregivers were able to attend around their work schedules, snacks and childcare were provided, and research staff communicated with families via text to check-in and provide reminders about group each week. After week 6 of the intervention, coincidentally falling immediately after caregivers had completed the stress-reduction interventions (MBSR or psychoeducation), groups were paused due to COVID-19 school closures and restrictions on public gatherings. Following a 4-week pause, groups resumed with the BPT curriculum delivered in a synchronous, live telehealth format delivered via a HIPAA-protected and licensed Zoom platform. Prior to resuming the groups online, participants were surveyed by study staff about their willingness and technological capability to access groups in this manner, with the vast majority responding positively to this potential change ([<reflink idref="bib30" id="ref33">30</reflink>]).</p> <hd id="AN0169767967-7">Focus Groups</hd> <p>Participants in the Spanish cohort were invited to participate in focus groups approximately 5 months after completion of the interventions, to gather additional qualitative information about how acceptable and relevant caregivers found the intervention groups. Given the aforementioned dearth of research with this population, this mixed method design highlighted by the focus groups was critical to expand upon participant reactions to specific elements of the interventions to inform future work with this population. Focus groups were conducted 5 months after the intervention so that they did not overlap or introduce unnecessary bias into the postintervention and long-term follow-up assessments that were conducted as part of the larger RCT. Further, we wanted to determine what intervention strategies were still being used by caregivers several months after the intervention ended. A total of four focus groups were run over Zoom, with two time options each for those who took part in BPT-E and BPT-M, respectively. In order to be eligible to participate in the focus groups, participants needed to have attended at least one session of the first 6 weeks of intervention (MBSR or psychoeducation) and one session of the final 10 weeks of intervention (BPT), in order to have at least some knowledge of the content of the groups from which to base opinions. All 38 participants who met this qualification were invited.</p> <p>A total of 24 caregivers participated in the four focus groups (14 across the two BPT-E focus groups; and 10 across the two BPT-M focus groups). These 24 participants had attended an average of 5.46 of the six initial psychoeducation or MBSR sessions, and an average of 8.29 of the 10 BPT sessions. Each group met for 1.5 hours and was facilitated by the first author and another research assistant. Focus groups utilized a semistructured format to make sure specific areas were covered adequately at each group, but participants were encouraged to discuss and expand upon topics as they wished. All focus groups began with the facilitator briefly reviewing the content of the interventions they had participated in (i.e., psychoeducation and BPT or MBSR and BPT). The remaining time of the focus groups was divided into three sections: 1) aspects of the interventions participants found most relevant and helpful to continue using 5 months later; 2) aspects of the interventions they did not like or had not been able to continue using, and barriers to implementing strategies; and 3) generally how well they felt the interventions were aligned with their individual/familial/cultural values, whether they thought other Hispanic families would find the strategies feasible and acceptable, and how the content could potentially be adapted to be more relevant to Hispanic families. Caregivers were compensated $25 for participating in the focus group.</p> <hd id="AN0169767967-8">Measures</hd> <p></p> <hd id="AN0169767967-9">Demographics</hd> <p>During the baseline assessment, all participants completed a demographic intake form with information such as caregiver and child age, biological sex, race and ethnic background, language spoken at home, highest level of caregiver educational attainment, household income, and child diagnosis. Caregiver education level was dichotomized as above or below high school graduate, as that represents a base level of education often needed for employment and other opportunities in the United States. Income was dichotomized as above or below $30,000 because it roughly represented the federal poverty threshold for a family of four or five in the years the data were collected. Finally, caregivers reported on their service utilization, including any outside services the caregiver or child was currently accessing.</p> <hd id="AN0169767967-10">Attendance</hd> <p>The number of sessions attended by each participant was averaged to create a mean attendance score for each of the two intervention groups. See Figure 2 for attendance in the Spanish cohort by group.</p> <p>PHOTO (COLOR): Figure 2 Spanish Cohort Caregiver Attendance by Intervention SessionNote. MBSR = Mindfulness-Based Stress Reduction; BPT = behavioral parent training; BPT-E = behavioral parent training combined with psychoeducation/support; BPT-M = behavioral parent training combined with Mindfulness-Based Stress Reduction (MBSR).</p> <hd id="AN0169767967-11">Acceptability</hd> <p>The acceptability, or social validity, of the intervention groups was measured at the end of the intervention phase (post-treatment) using the Parent Satisfaction Questionnaire, an adapted version of the Consumer Satisfaction Questionnaire ([<reflink idref="bib16" id="ref34">16</reflink>]). This measure has been adapted and utilized in numerous previous trials investigating versions of IYPT (i.e., [<reflink idref="bib26" id="ref35">26</reflink>]; [<reflink idref="bib49" id="ref36">49</reflink>]). Caregivers completed this measure based on the acceptability of the group leader, group dynamics, video vignettes, strategies taught to reduce stress, and strategies taught to manage child challenging behavior. Caregiver responses on 15 7-point Likert scale items are summed to create an Overall Satisfaction score between 15 and 105, with higher scores indicating greater acceptability ([<reflink idref="bib42" id="ref37">42</reflink>]). This tool has previously demonstrated adequate psychometric properties ([<reflink idref="bib26" id="ref38">26</reflink>]). The measure was collected during the final session, or week 16. Only about half of participants attended the week 16 session (<emph>n</emph> = 28) and, thus, we only have acceptability data from these caregivers.</p> <hd id="AN0169767967-12">Acculturation</hd> <p>The Vancouver Index of Acculturation (VIA; [<reflink idref="bib45" id="ref39">45</reflink>]), a 20-item scale measuring two domains—orientations towards heritage and towards mainstream cultural groups—was used to assess acculturation in the study sample. Two separate scores are generated (Heritage subscore and Mainstream subscore), with higher score indicating a positive orientation toward the specific cultural group. Internal consistency reliability for the VIA in the present sample was Chronbach's <emph>α</emph>=.88 for the Heritage subscore and Chronbach's <emph>α</emph> =.90 for the Mainstream subscore, indicating that there was high internal consistency. Unsurprisingly, VIA acculturation mainstream and heritage subscores were highly positively correlated with each other (<emph>r</emph> =.41, <emph>p</emph> <.001). We decided to examine VIA mainstream subscores, as those are likely to more accurately represent willingness to buy in and engage with an intervention delivered in the mainstream culture, as was the one used in the present study.</p> <hd id="AN0169767967-13">Parenting Stress</hd> <p>The Parenting Stress Index, Fourth Edition–Short Form (PSI-4-SF; [<reflink idref="bib1" id="ref40">1</reflink>]) Total Parenting Stress score was used to measure stress in the current sample. Internal consistency for the PSI in the present sample was high, with Chronbach's <emph>α</emph> =.88.</p> <hd id="AN0169767967-14">Child Problem Behaviors</hd> <p>Child problem behaviors were measured in this study utilizing caregiver report on the Child Behavior Checklist for children 1.5 to 5 years old (CBCL; [<reflink idref="bib2" id="ref41">2</reflink>]), Total Problems score. Internal consistency reliability for the CBCL in the present sample was Chronbach's <emph>α</emph>=.95 for the Total Problem Behaviors score, indicating that there was very high internal consistency.</p> <hd id="AN0169767967-15">Data Analysis</hd> <p></p> <hd id="AN0169767967-16">Quantitative Data</hd> <p>Descriptive analyses were run for variables of interest, including acceptability, key demographics, caregiver stress, acculturation, and child challenging behaviors. Those who had completed the Parent Satisfaction Questionnaire were compared with those who had not, examining differences in key demographics, including caregiver educational attainment and family income, caregiving stress, acculturation, and child challenging behavior. These groups were compared using chi-square tests for categorical variables (i.e., educational attainment and household income) and independent samples <emph>t</emph> tests for continuous variables (i.e., caregiver stress, acculturation, and child challenging behavior).</p> <p>To address the research questions, descriptive analyses were run on attendance and acceptability separately for the cohort overall, and independent samples <emph>t</emph> tests were run using intervention group as the independent variable, with satisfaction and then attendance as dependent variables.</p> <hd id="AN0169767967-17">Qualitative Data</hd> <p>All focus group recordings were transcribed verbatim and anonymized. We used thematic analysis ([<reflink idref="bib6" id="ref42">6</reflink>]) to analyze the data. As part of this process, data were initially coded separately by two bilingual graduate students (first and fourth authors) with supervision and input from a doctoral level qualitative methodologist (fifth author). During this phase, data were coded and initial discursive themes were identified. Coding involved reading through the data and re-watching the focus groups multiple times, then developing a set of broad descriptive codes based on the protocols. Code examples included: "inconsistent use," "sense of community," "cultural alignment," etc. Coders then met together to reach consensus on these codes and to identify and interpret some of the broader themes into which these codes could be grouped. The two coders identified very similar themes, and in the few instances of disagreement, differences were discussed to arrive at consensus. Codes were first collapsed within each intervention group (i.e., to establish a set of codes for BPT-E and BPT-M groups respectively), regardless of which focus group they attended. These codes were then compared against each other to identify which codes were intervention-specific, and which could apply to the overall trial. Codes were similar across groups, ultimately resulting in five themes that held across both intervention groups, and one each that was specific to BPT-E and BPT-M interventions respectively.</p> <hd id="AN0169767967-18">Results</hd> <p></p> <hd id="AN0169767967-19">Quantitative Data</hd> <p>Individuals who completed the acceptability measure were compared with those who had not. For week 16 total program acceptability, there were no baseline differences between responders and nonresponders on stress (PSI), challenging behavior (CBCL), acculturation (VIA mainstream) scores, intervention group, or education (<emph>p</emph> >.05). There were, however, statistically significant differences between responders and nonresponders on income (<emph>p</emph> =.048), with lower-income participants being less likely to have completed the measure.</p> <p>Overall, participants were well-matched across BPT-E and BPT-M conditions in this cohort, and there were no significant differences in demographic variables (see Table 1). Distribution of satisfaction scores and attendance were unimodal and approximately normal with no severe skew or outliers, and thus the use of parametric testing methods was appropriate. After week 16, ratings of satisfaction were high in both groups, with mean satisfaction scores of 95.21 and 90.31 (out of 105 maximum score) for those who participated in BPT-E and BPT-M, respectively. These equate to average item scores of 6.35 and 6.02 respectively (on a 7-point Likert scale) across the 15 items that were used to measure overall intervention satisfaction. These differences approached, but did not reach, statistical significance, <emph>t</emph>(<reflink idref="bib25" id="ref43">25</reflink>) = 1.93, <emph>p</emph> =.065. We also ran analyses on intervention attendance. There were no significant differences between BPT-E and BPT-M attendance for either the first 6-week, in-person, sessions, <emph>t</emph>(<reflink idref="bib58" id="ref44">58</reflink>) = 0.41, <emph>p</emph>=.684, or the latter 10-week, virtual BPT sessions, <emph>t</emph>(<reflink idref="bib58" id="ref45">58</reflink>) = −0.06, <emph>p</emph> =.951.</p> <p>PHOTO (COLOR)</p> <hd id="AN0169767967-20">Qualitative Analysis</hd> <p>Our thematic analysis revealed that participants found many aspects of the interventions feasible and acceptable; other aspects of the groups created greater challenges or barriers in either their relatability to families or sustainable use. Seven themes emerged from focus group discussions of intervention strategies, two of which seemed unique to their specific intervention, and five of which appeared to cut across intervention condition. The seven themes were: (<reflink idref="bib1" id="ref46">1</reflink>) BPT-M: feasibility challenges in continued use of MBSR strategies; (<reflink idref="bib2" id="ref47">2</reflink>) BPT-E: great satisfaction for discussions around school advocacy and their child's individual education program (IEP); (<reflink idref="bib3" id="ref48">3</reflink>) Both conditions: found a lot of benefit learning from other caregivers and feeling less isolated, peer-to-peer, other caregivers as models; (<reflink idref="bib4" id="ref49">4</reflink>) Both conditions: generally satisfied with behavioral strategies (i.e., praise, rewards, focus on positive/ignoring negative behaviors, strategies for virtual school during COVID); (<reflink idref="bib5" id="ref50">5</reflink>) Both conditions: experienced feasibility successes and challenges in getting other family members on board; (<reflink idref="bib6" id="ref51">6</reflink>) Both conditions: found content other than video examples culturally acceptable and appreciated groups being delivered in Spanish; (<reflink idref="bib7" id="ref52">7</reflink>) Both conditions: mixed satisfaction on delivery modality of in-person versus via telehealth. Representative participant quotes for each theme have been provided in Table 2.</p> <p>PHOTO (COLOR)</p> <hd id="AN0169767967-21">Theme 1: Inconsistent Use of MBSR Strategies</hd> <p>Participants in BPT-M reported rather differing opinions about the extent to which they found MBSR strategies, such as meditation, visualization, and breathing, to continue to be feasible in the 5 months following the completion of intervention. There were several caregivers who reported that they had been able to continue using MBSR strategies and found them helpful in both everyday life and in moments when they were feeling particularly stressed. In contrast, other caregivers described challenges they had with maintaining use of the MBSR practices beyond the intervention sessions. Even those caregivers who were not still using the MBSR strategies reported finding benefit in them at the time of the groups; however, they detailed several logistical barriers to the ongoing practice, including having trouble finding the time/space to do it and struggling to engage in meditation without the group leader to guide them.</p> <hd id="AN0169767967-22">Theme 2: Satisfaction With Psychoeducation</hd> <p>Participants in BPT-E reported great benefit, including increased self-efficacy, from the discussions around school advocacy and developing their child's IEP. These participants detailed how their increased knowledge in these service systems increased their confidence in working with school teams and even changed some immediate outcomes for their children. Some of the caregivers in the BPT-E group were able provide very specific and timely examples of how they had used the information from the groups to feel confident protecting their rights in schools or other systems.</p> <hd id="AN0169767967-23">Theme 3: Satisfaction With Sense of Community</hd> <p>Participants in both intervention conditions reported learning a lot from the other caregivers in their group and seeing the other caregivers as role models who they hoped to emulate with their own parenting practices. Participants also reported feeling less isolated as a result of the groups and appreciated being able to meet and talk to other caregivers of children with developmental disabilities. Many of the caregivers felt that they learned specific techniques/strategies from the other participants in the group and found it particularly useful to hear that things worked for those with similar lived experiences to themselves. The caregivers in both intervention conditions, although slightly more in the BPT-E group where this was an explicit focus of the first 6 weeks of intervention, also noted the importance of just knowing there were so many people near them with similar stories.</p> <hd id="AN0169767967-24">Theme 4: Feasibility of Behavioral Strategies</hd> <p>The majority of participants across both intervention conditions reported that the behavioral strategies learned during the final 10 weeks of intervention (BPT) were useful and that they continued to use them. The most commonly reported strategies that caregivers were using were praise and rewards systems. Other specific behavioral strategies that participants reported continuing to use following the interventions included understanding and intervening based on functions of behavior, following the child's lead during play, and having more patience/giving fewer commands with their child.</p> <hd id="AN0169767967-25">Theme 5: Feasibility of Incorporating Other Family Members</hd> <p>Participants across groups reported successes and challenges integrating other family members into using the strategies. Although participants were allowed to bring one other caregiver with them to groups, many came by themselves and had to determine how and whether they would disseminate the information to their families. Several participants discussed benefits they had seen in being able to teach group strategies to other family members (e.g., spouses, grandparents, older children) who regularly took care of the child with DD. On the other hand, there were also participants who reported difficulties implementing strategies from the interventions because other family members who did not attend the groups did not understand or know how to use the same strategies. These participants suggested that it may be beneficial in future iterations of these interventions to make a more conscious effort to invite and encourage other family members to attend sessions, rather than just one primary caregiver.</p> <hd id="AN0169767967-26">Theme 6: Cultural Acceptability</hd> <p>Participants in both groups generally found the content culturally acceptable and appreciated having groups in Spanish. Participants did not feel that group strategies had any culturally specific leanings toward them and appreciated what they saw as "neutrality" in how different ideas were presented. Others also noted that it would be unfair to group all Hispanic parents under one umbrella set of beliefs, particularly because multiple nationalities were represented. Many participants noted that having the groups delivered in their native language of Spanish was particularly meaningful and hoped that such opportunities would continue for other Hispanic caregivers. Video examples that came as part of the IYPT curriculum were the only element reported to be inappropriate, both in terms of culture and content. These videos were over 20years old, featured predominantly children without disabilities, and included mostly White families (dubbed in Spanish), leaving some participants struggling to relate to the videos.</p> <hd id="AN0169767967-27">Theme 7: Satisfaction With Delivery Modalities</hd> <p>Participants across groups had mixed feelings with regard to intervention delivery modality of in-person versus via telehealth. Although the program was never intended to be delivered remotely, all of the BPT intervention for both groups was delivered as such due to COVID-19. The most commonly endorsed advantages of in-person delivery were the ability to meet people in person and establish better connections, and because the in-person groups provided childcare to take that burden away from caregivers during sessions. In general, the caregivers who preferred the telehealth delivery noted the convenience of being in one's own home and not having to travel to the university to receive services. As noted in the methods section, participants were traveling from an average of 25.1 miles away and attending in person required a significant time commitment for those coming from further away.</p> <hd id="AN0169767967-28">Discussion</hd> <p>A series of evidence-based parenting interventions were delivered in Spanish to Hispanic caregivers of children with DD, the group least often included in intervention studies ([<reflink idref="bib51" id="ref53">51</reflink>]). With consideration of our first research question, despite the uncertainty of both running such interventions for the first time and the impact of the COVID-19 pandemic ([<reflink idref="bib33" id="ref54">33</reflink>]), Spanish-speaking participants engaged in the interventions with attendance rates comparable to those found in the literature for BPT interventions ([<reflink idref="bib10" id="ref55">10</reflink>]). This was consistent with the findings of Ogg and colleagues (2014) and [<reflink idref="bib25" id="ref56">25</reflink>], that caregiver training groups could draw comparable attendance in Spanish. There were no major differences in our study in attendance between the BPT-E and BPT-M groups, indicating either type of intervention could result in similar engagement.</p> <p>In examining our second research question on intervention acceptability, as measured by participant satisfaction ratings, there was a slight preference for BPT-E over BPT-M, perhaps indicating the importance of psychoeducation for this population. Qualitative data gathered from the focus groups also corroborated these findings. Participants in the Spanish language BPT-E group reported that they felt increased parenting self-efficacy and knowledge of their parental rights stemming from implementing the information they had learned in this group, consistent with the existing literature on psychoeducation groups with this population ([<reflink idref="bib21" id="ref57">21</reflink>]; [<reflink idref="bib23" id="ref58">23</reflink>]). These findings indicate the importance of providing underserved caregiver groups, such as Spanish-speaking Hispanics, the information to be able to feel confident in advocating for their child, as they may be less likely to gain that knowledge from other sources ([<reflink idref="bib11" id="ref59">11</reflink>]). In terms of specific psychoeducation topics that may be particularly valuable for this population, focus group participants repeatedly referenced the importance of being able to advocate in school via the IEP process. A literature review by [<reflink idref="bib52" id="ref60">52</reflink>] highlighted the complexities of the IEP process as being especially difficult for culturally and linguistically diverse families, in part due to insufficient information on how to become involved and advocate. Therefore, it makes sense that school advocacy would be a highly desired, and often overlooked, area of knowledge for these families.</p> <p>Focus group data indicated MBSR practices may have been slightly more challenging, as participants in this study were mixed in the degree to which they continued to use MBSR strategies several months after the intervention, with multiple caregivers expressing they did not have time in their daily lives to carve out for such self-care activities or were not able to do the activities without the group leader to guide them. Although it is unclear if the barriers to implementing MBSR practice were related to the impact the COVID-19 pandemic had on family daily life, future iterations of MBSR for this population could be enhanced. For example, more information about the importance of establishing a self-care routine could be added, as well as building in more scaffolded practice opportunities so caregivers could feel more comfortable using the strategies at home without the group leader present.</p> <p>Participants in both intervention groups reported appreciating and benefitting from meeting other caregivers with similar stories to their own (i.e., other Spanish-speaking Hispanic caregivers of a child with a disability), learning what strategies others had found effective, and viewing fellow participants as role models from which to base their own parenting behaviors and attitudes. Taken together, these principles can be viewed under the common umbrella of learning through community or collective experience, referred to in the literature as <emph>convivencia</emph>. Although the term <emph>convivencia</emph> does not translate directly to any one word in English, Jasis and Ordonez-Jasis (2004) define it as "the flowing moments of collective creation and solidarity, the bonding that developed from a joint, emerging moral quest against the backdrop of experiential learning" (p. 35). This process of coming together as a group to learn from one another speaks to the importance of group-based interventions for Spanish-speaking populations. It also highlights the value of allowing participants to share their own stories and experiences as part of the intervention process, rather than simply treating an intervention as passing along information.</p> <p>Overall, behavioral strategies were rated favorably in both the quantitative satisfaction ratings and the focus group elaborations. This was generally aligned with the literature on how Hispanic caregivers view common, "evidence-based," parenting strategies. Consistent with the findings of Calzada and colleagues (2013), the majority of caregivers in the present study found the praise and rewards to be acceptable and beneficial. Strategies that mothers in the [<reflink idref="bib7" id="ref61">7</reflink>] study found less acceptable, such as using time-out and eliminating spanking, were not explicitly addressed as part of the adapted IYPT curriculum ([<reflink idref="bib26" id="ref62">26</reflink>]) used in this trial. Our promising findings on the acceptability of BPT strategies with this population correspond with what prior studies have found. Although they utilized a different behaviorally based parenting intervention, Parent Child Interaction Therapy (PCIT), separate studies by [<reflink idref="bib25" id="ref63">25</reflink>] and Ramos and colleagues (2018) both found Hispanic caregivers demonstrated high levels of satisfaction and buy-in with the strategies presented. DuBay and colleagues (2018) similarly found that Hispanic caregivers of children with autism considered the majority of behaviorally based strategies acceptable.</p> <p>Another important takeaway from the present study is around the importance of family, or <emph>familismo</emph>, in these interventions. <emph>Familismo</emph>, or strong bonds among the nuclear and extended family members, is a commonly identified value in Hispanic parenting literature (e.g., [<reflink idref="bib40" id="ref64">40</reflink>]). [<reflink idref="bib15" id="ref65">15</reflink>] found that Hispanic families with a child with autism relied on more members of the family than just the parents as caregivers, including grandparents, aunts/uncles, and older children. During the focus groups, participants reported both successes and challenges with incorporating other members of the family in using the strategies that they had learned during the groups. One caregiver suggested that future projects make it a greater priority to invite the whole family to participate. Although the study did allow primary caregivers to bring one alternative caregiver with them to groups, this consideration of the importance of the whole family, and how to best get extended family members more involved, could be of significance for maximizing the effectiveness of these programs.</p> <p>Additionally, although the current study did not make any explicit cultural adaptations beyond the direct translation of the interventions and program materials, the majority of participants reported that the program was well aligned with their cultural and familial values. It is often assumed that interventions that have been primarily developed and utilized with one population (i.e., higher SES and White) inherently will not work as well with other groups (Parra Cardona etal., 2012). Although there is evidence that parent training programs culturally adapted for ethnic minority caregivers are effective at improving parenting behavior ([<reflink idref="bib48" id="ref66">48</reflink>]), they may not necessarily be better than directly translated evidence-based interventions ([<reflink idref="bib25" id="ref67">25</reflink>]). As predicted, participants in the present study greatly appreciated being able to receive this intervention in their native and felt the interventions had generally been appropriate despite no other tailoring. Some participants even noted that they appreciated that the content was not specifically culturally targeted to Hispanic populations. Although intervention strategies have been developed primarily from one cultural lens, they may be more generalizable than believed. Participants did specifically note that video examples used in the intervention could be made to be more representative and relevant for Hispanic populations. This may point to a need to increase representation in examples, if not necessarily the need to completely overhaul content, to improve buy-in.</p> <p>Finally, there remain a lot of unknowns with regard to delivery modality of interventions for this population. Participants had mixed reactions to the intervention delivery via telehealth, with several notable pros (i.e., not having to drive to intervention sessions, more comfortable at home) and cons (i.e., increased distractibility at home, lack of child care, difficulty with technology). Telehealth may reduce barriers to intervention access particularly for those living in more rural areas ([<reflink idref="bib4" id="ref68">4</reflink>]). Participants in this cohort were traveling an average of 50 miles round trip, which likely added to the perceived benefits of telehealth for those individuals. Also of note is that the participants in the present trial did not originally sign up for treatment to be delivered remotely via telehealth, but were rather thrust into it as necessitated by COVID-19. Therefore, their opinions may differ from individuals who originally agree to be included in a telehealth study and must be treated with caution. [<reflink idref="bib30" id="ref69">30</reflink>] provides a deeper look into the adaptations that were made to move this intervention to telehealth, the technology support provided to participants, and the reactions of participants to these changes.</p> <hd id="AN0169767967-29">Limitations</hd> <p>There are several limitations to the present study, many of which relate to attendance/response rates of participants within the study. Attendance was less than desired with both intervention groups, averaging about 50% across the study, despite efforts to increase buy-in and engagement through motivational interviewing. Although approximately 50% attendance was below the goal for this study, it is within the range of typical attendance in BPT interventions in general, with a review finding BPT attendance to vary between 37% and 98% across studies for those who attend at least one session ([<reflink idref="bib10" id="ref70">10</reflink>]). An additional limitation is that intervention satisfaction data were collected only from those who attended the final session; thus, we only have that data from 28 of the 60 (47%) participants who completed the intervention. A power analysis indicated analyses were slightly underpowered for analyses involving satisfaction, which had fewer respondents, but were sufficient for the analyses of attendance. Overall, the sample size reflected the exploratory/pilot nature of the research.</p> <p>We also did have slight income differences between those who completed the satisfaction survey and those who did not, which may impact generalization of these results. Similarly, with the focus groups, the participant pool was limited to those who attended a minimum of one session from the first 6 weeks and one session from the final 10weeks. Thus, these data may not represent study participants at-large. Finally, the present study does not examine any intervention outcomes or effects, i.e., caregiver stress and child behavior, as these are aims of the larger NIH-funded grant ([<reflink idref="bib29" id="ref71">29</reflink>]) and, thus, will not be analyzed until all cohorts are completed. Despite these limitations, this study makes a valuable contribution by piloting several parenting interventions for the first time with Spanish-speaking caregivers of preschool-aged children with DD, laying the groundwork for critical future research.</p> <hd id="AN0169767967-30">Future Directions</hd> <p>The future directions of this study will involve completing analyses of key outcomes (caregiver stress, caregiving behavior, and child behavior), including comparisons between the Spanish and English cohorts. These data will be used in conjunction with the satisfaction and focus group results to further develop and adapt these interventions for this population. This study further illuminated the value that Spanish-speaking Hispanic caregivers of children with DD place on being able to meet and learn from others like them; this format should be retained in future iterations. Similarly, incorporating psychoeducation or knowledge of how best to advocate for the rights of their children may be of greater benefit for these families, and should continue to be interwoven within intervention work.</p> <p>Additionally, future iterations of these interventions with this population should consider the use of greater cultural adaptation of program materials and strategies ([<reflink idref="bib20" id="ref72">20</reflink>]). Based on the high levels of satisfaction and positive feedback from those who participated in the present study, it is unclear whether the content of these interventions needs a total "cultural adaptation." One specific idea would be to incorporate video vignettes that are better tailored to the participants, include Hispanic caregivers and children with DD, and are set more recently. In their present forms, the interventions used in this study would be considered a surface-level cultural adaptation, as they are matched to "superficial" characteristics of the target population such as names and languages ([<reflink idref="bib43" id="ref73">43</reflink>]). In order to achieve a deeper, structural, adaptation, the interventions would need to more consciously target the values, beliefs, context, etc., of the population. This process involves developing, piloting, and receiving feedback on a surface-level adaptation, which we have now done with the focus groups in the present study, and using that data to inform a later iteration that attempts deep-structure adaptation. Furthermore, there are increasing calls in the field to directly test the effectiveness of surface-level and deep-level adaptations against one another ([<reflink idref="bib38" id="ref74">38</reflink>]). A critical future study could involve examining the additive benefits of a deep-structure cultural adaptation of BPT-E and BPT-M compared to the surface-level/directly translated programs in both satisfaction and outcomes. This proposed study would greatly inform future directions for the field of culturally diverse DD research as a whole.</p> <hd id="AN0169767967-31">Conclusion</hd> <p>In sum, the present study adds data on the extent to which child behavioral and caregiver mental health services delivered in their preferred language are feasible and acceptable to an often underserved population of families of young children with DD. Findings suggest that Spanish-speaking Hispanic caregivers may prefer psychoeducation and peer supports over MBSR. Thus, the data gathered from this study are an important first step for better understanding how to best adapt these types of interventions to support these families, recognizing that there may be differing needs within this community.</p> <p> <emph>Eunice Kennedy Shriver National Institute of Child Health and Human Development (grant number R01 HD093661) awarded to Dr. Laura Lee McIntyre at the University of Oregon and Dr. Cameron Neece at Loma Linda University</emph>.</p> <p> <emph>International Society for Autism Research (INSAR) Summer Research Internship in Autism Spectrum Disorder and Cultural Diversity awarded to Jonathan Safer-Lichtenstein at the University of Oregon and Dr. Cameron Neece at Loma Linda University</emph>.</p> <ref id="AN0169767967-32"> <title> References </title> <blist> <bibl id="bib1" idref="ref40" type="bt">1</bibl> <bibtext> Abidin, R.R. (2012). Parenting Stress Index–Fourth edition (PSI-4). Psychological Assessment Resources.</bibtext> </blist> <blist> <bibl id="bib2" idref="ref41" type="bt">2</bibl> <bibtext> Achenbach, T., & Rescorla, L. (2000). Manual for the ASEBA Preschool Forms and Profiles. University of Vermont, Research Center for Children, Youth, and Families.</bibtext> </blist> <blist> <bibl id="bib3" idref="ref7" type="bt">3</bibl> <bibtext> Baker, B.L., McIntyre, L.L., Blacher, J., Crnic, K.A., Edelbrock, C., & Low, C. (2003). Preschool children with and without developmental delay: Behavior problems and parenting stress over time. Journal of Intellectual Disability Research, 47, 217–230. https://doi.org/10.1046/j.1365-2788.2003.00484.x</bibtext> </blist> <blist> <bibl id="bib4" idref="ref49" type="bt">4</bibl> <bibtext> Bearss, K., Burrell, T.L., Challa, S.A., Postorino, V., Gillespie, S.E., Crooks, C., & Scahill, L. (2018). Feasibility of parent training via telehealth for children with autism spectrum disorder and disruptive behavior: A demonstration pilot. Journal of Autism and Developmental Disorders, 48, 1020–1030. https://doi.org/10.1007/s10803-017-3363-2</bibtext> </blist> <blist> <bibl id="bib5" idref="ref10" type="bt">5</bibl> <bibtext> Bitsika, V., & Sharpley, C. (2000). Development and testing of the effects of support groups on the well-being of parents of children with autism. Journal of Applied Health Behavior, 2, 8–15.</bibtext> </blist> <blist> <bibl id="bib6" idref="ref42" type="bt">6</bibl> <bibtext> Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101.</bibtext> </blist> <blist> <bibl id="bib7" idref="ref52" type="bt">7</bibl> <bibtext> Calzada, E.J., Basil, S., & Fernández, Y. (2013). What Latina mothers think of evidence-based parenting practices: A qualitative study of treatment acceptability. Cognitive and Behavioral Practice, 20, 362–374. https://doi.org/10.1016/j.cbpra.2012.08.004</bibtext> </blist> <blist> <bibl id="bib8" idref="ref16" type="bt">8</bibl> <bibtext> Cappe, E., Downes, N., Albert-Benaroya, S., Ech-Chouikh, J.A., De Gaulmyn, A., Luperto, L., Caron, V., Roussel, E., Taton, R., & Sankey, C. (2021). Preliminary results of the effects of a psychoeducational program on stress and quality of life among French parents of a child with autism. Focus on Autism and Other Developmental Disabilities, 36(3), 176–186. https://doi.org/10.1177/1088357620986946</bibtext> </blist> <blist> <bibl id="bib9" idref="ref14" type="bt">9</bibl> <bibtext> Castellanos, R., Yildiz Spinel, M., Phan, V., Orengo-Aguayo, R., Humphreys, K.L., & Flory, K. (2020). A systematic review and meta-analysis of cultural adaptations of mindfulness-based interventions for Hispanic populations. Mindfulness 11, 317–332. https://doi.org/10.1007/s12671-019-01210-x</bibtext> </blist> <blist> <bibtext> Chacko, A., Jensen, S., Lowry, L., Cornwell, M., Chimklis, A., Chan, E., Lee, D., & Pulgarin, B. (2016). Engagement in behavioral parent training: Review of the literature and implications for practice. Clinical Child and Family Psychology Review, 19(3), 204–215. <ulink href="http://dx.doi.org/10.1007/s10567-016-0205-2">http://dx.doi.org/10.1007/s10567-016-0205-2</ulink></bibtext> </blist> <blist> <bibtext> Chlebowski, C., Magaña, S., Wright, B., & Brookman-Frazee, L. (2018). Implementing an intervention to address challenging behaviors for autism spectrum disorder in publicly-funded mental health services: Therapist and parent perceptions of delivery with Latinx families. Cultural Diversity & Ethnic Minority Psychology, 24(4), 552–563. https://doi.org/10.1037/cdp0000215</bibtext> </blist> <blist> <bibtext> Corralejo, S., & Domenech Rodríguez, M. (2018). Technology in parenting programs: A systematic review of existing interventions. Journal of Child and Family Studies, 27(9), 2717–2731. https://doi.org/10.1007/s10826-018-1117-1</bibtext> </blist> <blist> <bibtext> DuBay, M., Watson, L.R., & Zhang, W. (2018). In search of culturally appropriate autism interventions: Perspectives of Latino caregivers. Journal of Autism and Developmental Disorders, 48(5), 1623–1639. https://doi.org/10.1007/s10803-017-3394-8</bibtext> </blist> <blist> <bibtext> Dykens, E.M., Fisher, M.H., Taylor, J.L., Lambert, W., & Miodrag, N. (2014). Reducing distress in mothers of children with autism and other disabilities: A randomized trial. Pediatrics, 134(2), e454–e463. <ulink href="http://dx.doi.org/10.1542/peds.2013-3164">http://dx.doi.org/10.1542/peds.2013-3164</ulink></bibtext> </blist> <blist> <bibtext> Estrada, L., & Deris, A.R. (2014). A phenomenological examination of the influence of culture on treating and caring for Hispanic children with autism. International Journal of Special Education, 29(3), 4–15.</bibtext> </blist> <blist> <bibtext> Forehand R.L. & McMahon R.J. (1981). Helping the noncompliant child: A clinician's guide to parent training. Guilford Press.</bibtext> </blist> <blist> <bibtext> Gadke, D.L., Kratochwill, T.R., & Gettinger, M. (2021). Incorporating feasibility protocols in intervention research. Journal of School Psychology, 84, 1–18. https://doi.org/10.1016/j.jsp.2020.11.004</bibtext> </blist> <blist> <bibtext> Grossman, P., Niemann, L., Schmidt, S., & Walach, H. (2004). Mindfulness-Based Stress Reduction and health benefits: A meta-analysis. Journal of Psychosomatic Research, 57(1), 35–43. https://doi.org/10.1016/S0022-3999(03)00573-7</bibtext> </blist> <blist> <bibtext> Jasis, P., & Ordóñez-Jasis, R. (2004). Convivencia to empowerment: Latino parent organizing at La Familia. The High School Journal, 88(2), 32–42. https://doi.org/10.1353/hsj.2004.0023</bibtext> </blist> <blist> <bibtext> Kuhn, J.L., Vanegas, S.B., Salgado, R., Borjas, S.K., Magaña, S., & Smith DaWalt, L. (2020). The cultural adaptation of a transition program for Latino families of youth with autism spectrum disorder. Family Process, 59, 477–491. https://doi.org/10.1111/famp.12439</bibtext> </blist> <blist> <bibtext> Lopez, K., Magaña, S., Morales, M., & Iland, E. (2019). Parents Taking Action: Reducing disparities through a culturally informed intervention for Latinx parents of children with autism. Journal of Ethnic & Cultural Diversity in Social Work, 28(1), 31–49. https://doi.org/10.1080/15313204.2019.1570890</bibtext> </blist> <blist> <bibtext> Maenner, M., Shaw, K., Baio, J., Washington, A., Patrick, M., DiRienzo, M., Christensen, D., Wiggins, L., Pettygrove, S., Andrews, J., Lopez, M., Hudson, A., Baroud, T., Schwenk, Y., White, T., Robinson Rosenberg, C., Lee, L., Harrington, R., Huston, M., ... Dietz, P. (2020). Prevalence and characteristics of autism spectrum disorder among children aged 8 years—autism and developmental disabilities monitoring network, 11 sites United States, 2016. MMWR Surveillance Summaries, 69(4), 1–12. <ulink href="http://dx.doi.org/10.15585/mmwr.ss6904a1">http://dx.doi.org/10.15585/mmwr.ss6904a1</ulink></bibtext> </blist> <blist> <bibtext> Magaña, S., Lopez, K., & Machalicek, W. (2017). Parents Taking Action: A psycho-educational intervention for Hispanic parents of children with ASD. Family Process, 56(1), 59–74. https://doi.org/10.1111/famp.12169</bibtext> </blist> <blist> <bibtext> Matson, J.L., & Nebel-Schwalm, M. (2007). Assessing challenging behaviors in children with autism spectrum disorders: A review. Research in Developmental Disabilities, 28(6), 567–579. https://doi.org/10.1016/j.rdd.2006.08.001</bibtext> </blist> <blist> <bibtext> McCabe, K., & Yeh, M. (2009). Parent–child interaction therapy for Mexican Americans: A randomized clinical trial. Journal of Clinical Child & Adolescent Psychology, 38, 753–759. https://doi.org/10.1080/15374410903103544</bibtext> </blist> <blist> <bibtext> McIntyre, L.L. (2008a). Adapting Webster-Stratton's incredible years parent training for children with developmental delay: findings from a treatment group only study. Journal of Intellectual Disability Research, 52, 1176–1192. https://doi.org/10.1111/j.1365-2788.2008.01108</bibtext> </blist> <blist> <bibtext> McIntyre, L.L. (2008b). Parent training in young children with developmental disabilities: a randomized controlled trial. American Journal on Mental Retardation, 113, 356–368. https://doi.org/10.1352/2008.113:356-368</bibtext> </blist> <blist> <bibtext> McIntyre, L. (2013). Parent training interventions to reduce challenging behavior in children with Intellectual and Developmental Disabilities. International Review of Research in Developmental Disabilities, 44, 245–279. https://doi.org/10.1016/B978-0-12-401662-0.00008-7</bibtext> </blist> <blist> <bibtext> McIntyre, L.L., & Neece, C.L. (2018). Testing the efficacy of Mindfulness-Based Stress Reduction combined with behavioral parent training in families with preschoolers with developmental delay [Grant number R01 HD093661; Funding dates 9/10/18 – 5/31/23]. Eunice Kennedy Shriver National Institute of Child Health and Human Development.</bibtext> </blist> <blist> <bibtext> McIntyre, L.L., Neece, C.L., Sanner, C.M., Rodriguez, G., & Safer-Lichtenstein, J. (2021). Examining the feasibility of delivering a behavioral parent training program via telehealth to Spanish-speaking Latinx parents of young children with developmental delay. School Psychology Review. https://doi.org/10.1080/2372966X.2021.1902749</bibtext> </blist> <blist> <bibtext> Neece, C.L. (2014). Mindfulness-based stress reduction for parents of young children with developmental delays: Implications for parental mental health and child behavior problems. Journal of Applied Research in Intellectual Disabilities, 27(2), 174–186. https://doi.org/10.1111/jar.12064</bibtext> </blist> <blist> <bibtext> Neece, C. L., Chan, N., Klein, K., & Fenning, R. (2019). Mindfulness-based stress reduction for parents of children with developmental delays: Understanding the experiences of Latino families. Mindfulness, 10, 1017–1030. https://doi.org/10.1007/s12671-018-1011-3</bibtext> </blist> <blist> <bibtext> Neece, C.L., McIntyre, L.L., & Fenning, R. (2020). Examining the impact of COVID-19 in ethnically diverse families with young children with developmental delays. Journal of Intellectual Disability Research, 64(10), 739–749. https://doi.org/10.1111/jir.12769</bibtext> </blist> <blist> <bibtext> Nguyen, C., Krakowiak, P., Hansen, R., Hertz-Picciotto, I., & Angkustsiri, K. (2016). Sociodemographic disparities in intervention service utilization in families of children with autism spectrum disorder. Journal of Autism and Developmental Disorders 46(12), 3729–3738. https://doi.org/10.1007/s10803-016-2913-3</bibtext> </blist> <blist> <bibtext> Nock, M.K., & Kazdin, A.E. (2005). Randomized controlled trial of a brief intervention for increasing participation in parent management training. Journal of Consulting and Clinical Psychology, 73, 872–879. <ulink href="http://dx.doi.org/10.1037/0022-006X.73.5.872">http://dx.doi.org/10.1037/0022-006X.73.5.872</ulink></bibtext> </blist> <blist> <bibtext> Noe-Bustamanate, L., Mora, L., & Lopez, M.H. (2020, August 11). About one-in-four U.S. Hispanics have heard of Latinx, but just 3% use it. Pew Research Center. https://<ulink href="http://www.pewresearch.org/hispanic/2020/08/11/about-one-in-four-u-s-hispanics-have-heard-of-latinx-but-just-3-use-it/">www.pewresearch.org/hispanic/2020/08/11/about-one-in-four-u-s-hispanics-have-heard-of-latinx-but-just-3-use-it/</ulink></bibtext> </blist> <blist> <bibtext> Ogg, J., Shaffer-Hudkins, E., Childres, J., Feldman, M., Agazzi, H., & Armstrong, K. (2014). Attendance and implementation of strategies in a behavioral parent training program: Comparisons between English and Español Programs. Infant Mental Health Journal, 35(6), 555–564. https://doi.org/10.1002/imhj.21470</bibtext> </blist> <blist> <bibtext> Ortiz C., & Del Vecchio, T. (2013). Cultural diversity: Do we need a new wake-up call for parent training? Behavioral Therapy, 44(3), 443–458. https://doi.org/10.1016/j.beth.2013.03.009</bibtext> </blist> <blist> <bibtext> Parra Cardona, J.R., Domenech-Rodriguez, M., Forgatch, M., Sullivan, C., Bybee, D., Holtrop, K., Escobar-Chew, A.R., Tams, L., Dates, B., & Bernal, G. (2012). Culturally adapting an evidence-based parenting intervention for Latino immigrants: The need to integrate fidelity and cultural relevance. Family Process, 51(1), 56–72. https://doi.org/10.1111/j.1545-5300.2012.01386.x</bibtext> </blist> <blist> <bibtext> Ramos, G., Blizzard, A., Barroso, N., & Bagner, D. (2018). Parent training and skill acquisition and utilization among Spanish- and English-speaking Hispanic families. Journal of Child and Family Studies, 27(1), 268–279. https://doi.org/10.1007/s10826-017-0881-7</bibtext> </blist> <blist> <bibtext> Ratto, A., Anthony, B., Mendez, R., Safer-Lichtenstein, J., Dudley, K., Kahn, N., Pugliese, C., Kenworthy, L., Biel, M., Martucci, J., & Anthony, L.G. (2017). Lessons learned: Engaging culturally diverse families in neurodevelopmental disorders intervention research. Autism, 21(5), 622–634. https://doi.org/10.1177/1362361316650394</bibtext> </blist> <blist> <bibtext> Reid, J.M., Webster-Stratton, C., & Beauchaine, T.P. (2001). Parent training in Head Start: A comparison of program response among African American, Asian American, Caucasian, and Hispanic mothers. Prevention Science, 2, 209–227. https://doi.org/10.1023/A:1013618309070</bibtext> </blist> <blist> <bibtext> Resnicow, K., Baranowski, T., Ahluwalia, J.S., & Braithwaite, R.L. (1999). Cultural sensitivity in public health: Defined and demystified. Ethnicity & Disease, 9(1), 10–21.</bibtext> </blist> <blist> <bibtext> Rothschild, L.B., Ratto, A.B., Haaga, D.A.F., Kenworthy, L., Hardy, K., Verbalis, A., Pugliese, C., Strang, J., Safer-Lichtenstein, J., Anthony, B.J., & Anthony, L.G. (2021). Parents matter: Parent acceptance of school-based executive functions interventions relates to child outcomes. Journal of Clinical Psychology. Advance online publication. https://doi.org/10.1002/jclp.23309</bibtext> </blist> <blist> <bibtext> Ryder, A. G., Alden, L., & Paulhus, D. L. (2000). Is acculturation unidimensional or bidimensional?: A head-to-head comparison in the prediction of demographics, personality, self-identity, and adjustment. Journal of Personality and Social Psychology, 79, 49–65. https://doi.org/10.1037/0022-3514.79.1.49</bibtext> </blist> <blist> <bibtext> Safer-Lichtenstein, J., Hamilton, J., & McIntyre, L. (2019). Examining demographics in randomized controlled trials of group-based social skills interventions for individuals with autism spectrum disorder. Journal of Autism and Developmental Disorders, 49(8), 3453–3461. https://doi.org/10.1007/s10803-019-04063-4</bibtext> </blist> <blist> <bibtext> Steiner, A. M., Koegel, L. K., Koegel, R.L., & Ence, W.A. (2012). Issues and theoretical constructs regarding parent education for autism spectrum disorders. Journal of Autism and Developmental Disorders, 42, 1218–1227. https://doi.org/10.1007/s10803-011-1194-0</bibtext> </blist> <blist> <bibtext> van Mourik, K., Crone, M.R., de Wolff, M.S., & Reis, R. (2017). Parent training programs for ethnic minorities: A meta-analysis of adaptations and effect. Prevention Science, 18(1), 95–105. https://doi.org/10.1007/s11121-016-0733-5</bibtext> </blist> <blist> <bibtext> Webster-Stratton, C. (1994). Advancing videotape parent training: A comparison study. Journal of Consulting and Clinical Psychology, 62, 583–593. https://doi.org/10.1542/peds.2016-3010</bibtext> </blist> <blist> <bibtext> Webster-Stratton, C. (2013). Incredible years parent training: A user's guide. Incredible Years.</bibtext> </blist> <blist> <bibtext> West, E., Travers, J., Kemper, T., Liberty, L., Cote, D., McCollow, M., & Stansberry Brusnahan, L. (2016). Racial and ethnic diversity of participants in research supporting evidence-based practices for learners with autism spectrum disorder. The Journal of Special Education, 50(3), 151–163. https://doi.org/10.1177/0022466916632495</bibtext> </blist> <blist> <bibtext> Wolfe, K., & Duran, L. (2013). Culturally and linguistically diverse parents' perceptions of the IEP process: A review of current research. Multiple Voices for Ethnically Diverse Exceptional Learners, 13(2), 4–18. https://doi.org/10.5555/muvo.13.2.y452140732mlg231</bibtext> </blist> <blist> <bibtext> Zuckerman, K., Lindly, O., Reyes, N., Chavez, A., Macias, K., Smith, K., & Reynolds, A. (2017). Disparities in diagnosis and treatment of Autism in Hispanic and non-Hispanic White families. Pediatrics, 139(5), E20163010-3010v1.</bibtext> </blist> </ref> <aug> <p>By Jonathan Safer-Lichtenstein; Laura Lee McIntyre; Geovanna Rodriguez; Douglas Gomez; Stephanie Puerta and Cameron L. Neece</p> <p>Reported by Author; Author; Author; Author; Author; Author</p> </aug> <nolink nlid="nl1" bibid="bib22" firstref="ref1"></nolink> <nolink nlid="nl2" bibid="bib34" firstref="ref2"></nolink> <nolink nlid="nl3" bibid="bib53" firstref="ref3"></nolink> <nolink nlid="nl4" bibid="bib46" firstref="ref4"></nolink> <nolink nlid="nl5" bibid="bib51" firstref="ref5"></nolink> <nolink nlid="nl6" bibid="bib41" firstref="ref6"></nolink> <nolink nlid="nl7" bibid="bib14" firstref="ref8"></nolink> <nolink nlid="nl8" bibid="bib31" firstref="ref9"></nolink> <nolink nlid="nl9" bibid="bib18" firstref="ref11"></nolink> <nolink nlid="nl10" bibid="bib47" firstref="ref15"></nolink> <nolink nlid="nl11" bibid="bib23" firstref="ref17"></nolink> <nolink nlid="nl12" bibid="bib21" firstref="ref18"></nolink> <nolink nlid="nl13" bibid="bib24" firstref="ref20"></nolink> <nolink nlid="nl14" bibid="bib28" firstref="ref21"></nolink> <nolink nlid="nl15" bibid="bib40" firstref="ref22"></nolink> <nolink nlid="nl16" bibid="bib17" firstref="ref23"></nolink> <nolink nlid="nl17" bibid="bib44" firstref="ref24"></nolink> <nolink nlid="nl18" bibid="bib29" firstref="ref25"></nolink> <nolink nlid="nl19" bibid="bib26" firstref="ref26"></nolink> <nolink nlid="nl20" bibid="bib27" firstref="ref27"></nolink> <nolink nlid="nl21" bibid="bib50" firstref="ref28"></nolink> <nolink nlid="nl22" bibid="bib32" firstref="ref29"></nolink> <nolink nlid="nl23" bibid="bib30" firstref="ref30"></nolink> <nolink nlid="nl24" bibid="bib35" firstref="ref31"></nolink> <nolink nlid="nl25" bibid="bib16" firstref="ref34"></nolink> <nolink nlid="nl26" bibid="bib49" firstref="ref36"></nolink> <nolink nlid="nl27" bibid="bib42" firstref="ref37"></nolink> <nolink nlid="nl28" bibid="bib45" firstref="ref39"></nolink> <nolink nlid="nl29" bibid="bib25" firstref="ref43"></nolink> <nolink nlid="nl30" bibid="bib58" firstref="ref44"></nolink> <nolink nlid="nl31" bibid="bib33" firstref="ref54"></nolink> <nolink nlid="nl32" bibid="bib10" firstref="ref55"></nolink> <nolink nlid="nl33" bibid="bib11" firstref="ref59"></nolink> <nolink nlid="nl34" bibid="bib52" firstref="ref60"></nolink> <nolink nlid="nl35" bibid="bib15" firstref="ref65"></nolink> <nolink nlid="nl36" bibid="bib48" firstref="ref66"></nolink> <nolink nlid="nl37" bibid="bib20" firstref="ref72"></nolink> <nolink nlid="nl38" bibid="bib43" firstref="ref73"></nolink> <nolink nlid="nl39" bibid="bib38" firstref="ref74"></nolink>
Header DbId: eric
DbLabel: ERIC
An: EJ1400098
AccessLevel: 3
PubType: Academic Journal
PubTypeId: academicJournal
PreciseRelevancyScore: 0
IllustrationInfo
Items – Name: Title
  Label: Title
  Group: Ti
  Data: Feasibility and Acceptability of Spanish-Language Parenting Interventions for Young Children with Developmental Delays
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Safer-Lichtenstein%2C+Jonathan%22">Safer-Lichtenstein, Jonathan</searchLink><br /><searchLink fieldCode="AR" term="%22McIntyre%2C+Laura+Lee%22">McIntyre, Laura Lee</searchLink><br /><searchLink fieldCode="AR" term="%22Rodriguez%2C+Geovanna%22">Rodriguez, Geovanna</searchLink><br /><searchLink fieldCode="AR" term="%22Gomez%2C+Douglas%22">Gomez, Douglas</searchLink><br /><searchLink fieldCode="AR" term="%22Puerta%2C+Stephanie%22">Puerta, Stephanie</searchLink><br /><searchLink fieldCode="AR" term="%22Neece%2C+Cameron+L%2E%22">Neece, Cameron L.</searchLink>
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Intellectual+and+Developmental+Disabilities%22"><i>Intellectual and Developmental Disabilities</i></searchLink>. 2023 61(4):307-325.
– Name: Avail
  Label: Availability
  Group: Avail
  Data: American Association on Intellectual and Developmental Disabilities. P.O. Box 1897, Lawrence, KS 66044-1897. Tel: 785-843-1235; Fax: 785-843-1274; e-mail: AJMR@allenpress.com; Web site: https://meridian.allenpress.com/aaidd
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 19
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2023
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
– Name: Audience
  Label: Education Level
  Group: Audnce
  Data: <searchLink fieldCode="EL" term="%22Adult+Education%22">Adult Education</searchLink>
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Young+Children%22">Young Children</searchLink><br /><searchLink fieldCode="DE" term="%22Developmental+Delays%22">Developmental Delays</searchLink><br /><searchLink fieldCode="DE" term="%22Parents%22">Parents</searchLink><br /><searchLink fieldCode="DE" term="%22Intervention%22">Intervention</searchLink><br /><searchLink fieldCode="DE" term="%22Spanish+Speaking%22">Spanish Speaking</searchLink><br /><searchLink fieldCode="DE" term="%22Hispanic+Americans%22">Hispanic Americans</searchLink><br /><searchLink fieldCode="DE" term="%22Latin+Americans%22">Latin Americans</searchLink><br /><searchLink fieldCode="DE" term="%22Stress+Management%22">Stress Management</searchLink><br /><searchLink fieldCode="DE" term="%22Parent+Education%22">Parent Education</searchLink><br /><searchLink fieldCode="DE" term="%22Metacognition%22">Metacognition</searchLink><br /><searchLink fieldCode="DE" term="%22Attendance%22">Attendance</searchLink><br /><searchLink fieldCode="DE" term="%22Satisfaction%22">Satisfaction</searchLink><br /><searchLink fieldCode="DE" term="%22Social+Support+Groups%22">Social Support Groups</searchLink><br /><searchLink fieldCode="DE" term="%22Psychoeducational+Methods%22">Psychoeducational Methods</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1352/1934-9556-61.4.307
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 1934-9491<br />1934-9556
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Hispanic/Latinx parents of children with developmental delays/disabilities (DD) face disparities in service access and research participation. In the present study, 60 Spanish-speaking caregivers of young children with DD participated in randomly assigned stress reduction interventions (psychoeducation/support groups or Mindfulness-Based Stress Reduction [MBSR]), followed by behavioral parent training (BPT). Caregiver attendance and satisfaction ratings were measured, and focus groups gathered additional information on caregivers' takeaways from the interventions. Caregivers demonstrated high satisfaction across interventions, with slightly greater preference for psychoeducation/support groups, and qualitative data indicated that the relevance of the information and style of delivery may be responsible. Researchers and clinicians may attain greater engagement with this population by focusing on intervention services that include psychoeducation and peer support elements.
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: As Provided
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2023
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1400098
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1400098
RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1352/1934-9556-61.4.307
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 19
        StartPage: 307
    Subjects:
      – SubjectFull: Young Children
        Type: general
      – SubjectFull: Developmental Delays
        Type: general
      – SubjectFull: Parents
        Type: general
      – SubjectFull: Intervention
        Type: general
      – SubjectFull: Spanish Speaking
        Type: general
      – SubjectFull: Hispanic Americans
        Type: general
      – SubjectFull: Latin Americans
        Type: general
      – SubjectFull: Stress Management
        Type: general
      – SubjectFull: Parent Education
        Type: general
      – SubjectFull: Metacognition
        Type: general
      – SubjectFull: Attendance
        Type: general
      – SubjectFull: Satisfaction
        Type: general
      – SubjectFull: Social Support Groups
        Type: general
      – SubjectFull: Psychoeducational Methods
        Type: general
    Titles:
      – TitleFull: Feasibility and Acceptability of Spanish-Language Parenting Interventions for Young Children with Developmental Delays
        Type: main
  BibRelationships:
    HasContributorRelationships:
      – PersonEntity:
          Name:
            NameFull: Safer-Lichtenstein, Jonathan
      – PersonEntity:
          Name:
            NameFull: McIntyre, Laura Lee
      – PersonEntity:
          Name:
            NameFull: Rodriguez, Geovanna
      – PersonEntity:
          Name:
            NameFull: Gomez, Douglas
      – PersonEntity:
          Name:
            NameFull: Puerta, Stephanie
      – PersonEntity:
          Name:
            NameFull: Neece, Cameron L.
    IsPartOfRelationships:
      – BibEntity:
          Dates:
            – D: 01
              M: 01
              Type: published
              Y: 2023
          Identifiers:
            – Type: issn-print
              Value: 1934-9491
            – Type: issn-electronic
              Value: 1934-9556
          Numbering:
            – Type: volume
              Value: 61
            – Type: issue
              Value: 4
          Titles:
            – TitleFull: Intellectual and Developmental Disabilities
              Type: main
ResultId 1