A Community‐Responsive Adaptation to Reach and Engage Latino Families Affected by Maternal Depression

• Author: Elizabeth Martinez,Thomas Chavez,Stephanie D'Costa,Carmen R. Valdez,Alyssa Ramirez Stege
• Published date: 01 June 2018
• Date: 01 June 2018
• DOI: http://doi.org/10.1111/famp.12310

A Community-Responsive Adaptation to Reach and

Engage Latino Families Affected by Maternal

Depression

CARMEN R. VALDEZ*

ALYSSA RAMIREZ STEGE*

ELIZABETH MARTINEZ*

STEPHANIE D’COSTA

†

THOMAS CHAVEZ

‡

As family researchers and practitioners seek to improve the quality and accessibility

of mental health services for immigrant families, they have turned to culturally adapted

interventions. Although many advancements have been made in adapting interventions

for such families, we have yet to understand how the adaptation can ensure that the

intervention is reaching families identified to be in greatest need within a local system

of care and community. We argue that reaching, engaging, and understanding the needs

of families entails a collaborative approach with multiple community partners to ensure

that adaptations to intervention content and delivery are responsive to the sociocultural

trajectory of families within a community. We describe a cultural adaptation framework

that is responsive to the unique opportunities and challenges of identifying and recruit-

ing vulnerable families through community partnerships, and of addressing the needs of

families by incorporating multiple community perspectives. Specifically, we apply these

principles to the cultural adaptation of an intervention originally developed for low-

income African American and White families facing maternal depression. The new inter-

vention, Fortalezas Familiares (Family Strengths), was targeted to Latino immigrant

families whose mothers were in treatment for depression in mental health and primar y

care clinics. We conclude with key recommendations and directions for how family

researchers and practitioners can design the cultural adaptation of interventions to be

responsive to the practices, preferences, and needs of underserved communities, includ-

ing families and service providers.

Keywords: Latino Families; Cultural Adaptation; Intervention; Maternal Depression

Fam Proc 57:539–556, 2018

*Department of Counseling Psychology, University of Wisconsin-Madison, Madison, WI.

†

Department of Educational Psychology, University of Wisconsin-Madison, Madison, WI.

‡

Counselor Education Program, College of Education, University of New Mexico, Albuquerque, NM.

Correspondence concerning this article should be addressed to Carmen R. Valdez, PhD, Department of

Counseling Psychology, University of Wisconsin, Madison, 301 Education Building, 1000 Bascom Mall,

Madison, WI 53706. E-mail: cvaldez@wisc.edu

The project described was supported by the University of Wisconsin Morgridge Center for Public Ser-

vice, and the Clinical and Translational Science Award Program, previously through the National Center

for Research Resources grant 1UL1RR025011, and now by the National Center for Advancing Transla-

tional Sciences, grant 9U54TR000021. Many thanks to Martica Bacallao, Sandra Maga~

na, and Luis Zayas

for their contributions to the Fortalezas Familiares project, and to the community members involved in

the adaptation.

539

Family Process, Vol. 57, No. 2, 2018 ©2017 Family Process Institute

doi: 10.1111/famp.12310

CONTEXT OF LATINO IMMIGRANT MENTAL HEALTH

For family focused interventions to reach, engage, and address the mental health needs

of Latino immigrant families in the United States, the interventions must be respon-

sive to the families’ life trajectories and contexts (Castro, Barrera, & Steiker, 2010).

Although many immigrants come to this country with much hope and enthusiasm, the

stressors associated with immigration, settlement, and acculturation, coupled with

absence of familiar supports, have contributed to increasing vulnerability for depression

(Valdez, Abegglen, & Hauser, 2013). Depression is prevalent among women in the gene ral

population, but Latinas have been shown to have an earlier and more persistent course of

depressive illness than their non-Latina counterparts (Breslau, Kendler, Su, Gaxiola-

Aguilar, & Kessler, 2005). This tendency is especially so among Latinas who are less edu-

cated, of immigrant status, and primarily Spanish speaking (Myers et al., 2002).

Latinas’ high vulnerability to depression poses serious consequences for children

because of the potential for children to experience long-standing impairment associated

with their mother’s depression (Goodman et al., 2011; Timko et al., 2009). Yet, the major-

ity of evidence based family focused interventions for maternal depression have been

developed for the general population and have not been widely disseminated to Latinos

(Cardemil, Kim, Pinedo, & Miller, 2005). Latinos are the largest minority group in the

United States, yet they continue to be one of the most underrepresented ethnic groups in

mental health services and intervention research (Stacciarini, 2009). Some reasons for

Latino families’ low levels of mental health service utilization include practical barriers,

such as lack of insurance, as well as cultural barriers, such as stigma of mental health

(Valdez, Dvorscek, Budge, & Esmond, 2011).Moreover, mental health interventions have

failed to be grounded in the linguistic and cultural experience of Latinos (Bernal & S

aez-

Santiago, 2006; Cardemil et al., 2005). This failure is alarming because clients’ worldview

of illness, client-therapist characteristics and relationship, and organizational factors,

such as cost and availability of culturally grounded mental health services, appear to

improve mental health outcomes (Benish, Quintana, & Wampold, 2011; Bernal & S 

aez-

Santiago, 2006).

As family practitioners and researchers are becoming increasingly interested in

addressing the mental health of minority populations, adaptations must be developed to

improve the cultural and linguistic relevance of interventions. We propose that a cultural

adaptation needs to be responsive to the local community context, including an under-

standing of which families need the intervention the most, and how and where to reach

them to maximize the potential impact of the intervention. This step is particularly impor-

tant for families experiencing clinical distress because they may be more difficult to reach

through conventional recruitment methods. Reaching families is followed by engaging

them and other community stakeholders to inform the adaptation, and addressing family

needs via a culturally grounded intervention.

In this article, we describe the process of culturally adapting an intervention originally

developed for low-income White and African-American women with depression and their

families into an intervention that can be used with Latino immigrant families. We begin

by briefly presenting the original intervention, Keeping Families Strong, by describing its

theoretical foundation, format, and content to illustrate our starting point. We then pro-

vide a rationale for culturally adapting this intervention for Latino families. Next, we pro-

vide the cultural adaptation models that guided our work along with the unique processes

we used to respond to our local context. We also address concerns raised in the literature

about the utility and justification of cultural adaptations. Moreover, we describe in detail

the systematic approach we took to adapting the intervention as a Latino family-based

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