CURRENT PROJECTS

TREATMENT ACCEPTABILITY

Using both quantitative and quality methods we are investigating treatment acceptability of empirically supported treatments among Latinxs.

USING SPANISH LANGUAGE INTERPRETERS PSYCHOTHERAPY

The proposed study will evaluate client outcomes when an interpreter is used for the delivery of behavioral health services (for clients who present with anxiety) as compared to outcomes for clients who receive services from a bilingual therapist who speaks their native language. It addresses a significant public health concern as 1) Latinxs are substantially impacted by behavioral health problems, 2) Latinxs have low service utilization rates, and 3) there is a massive treatment-provider gap for Spanish-speakers. Data collection is currently underway.

TRAINING COMMUNITY HEALTH WORKERS TO DELIVER BEHAVIORAL ACTIVATION TO DEPRESSED LATINXS

Latinxsare substantially impacted by depression and underutilize behavioral health services. This is problematic as depression impacts quality of life and may Latinxs at an increased risk of death by suicide. Moreover, in the case of Spanish-speaking Latinxs (SSL), theimplications in the disparity between the growing number of Spanish-speakers in the U.S. and the limited availability of bilingual quality behavioral health services are substantial. Community Health Workers (CHWs) are trusted and respected community leaders who share cultures, languages, and social concerns, and represent one mechanism for reducing the treatment provider gap. The broad aim of this grant proposal is to reduce the gap of behavioral health disparities by providing a novel and potentially sustainable pathway to deliver BA to treat symptoms of depression among primary care SSL patients: 1) Explore the feasibility of training CHWs to deliver BA with (SSL) primary care patients. 2) Conduct a pilot study to explore the extent to which the delivery of BA by CHWs reduces depression symptoms as compared to a control condition (BA delivered by a master’s level therapist). 3) Examine SSL primary care patients’ treatment acceptability of BA as delivered by CHWs.

EVALUATING THE FEASIBILITY AND ACCEPTABILITY OF SPOKEN IMAGINAL EXPOSURE FOLLOWING THE WET PROTOCOL DEVELOPED FOR THE TREATMENT OF POST-TRAUMATIC STRESS DISORDER.

Exposure therapy is not accessible or effective for everyone. A minority of individuals do not respond to this treatment and continue to experience symptoms and some individuals fail to engage in treatment due to a host of barriers (Gutner, 2016; Imel, Laska, Jakupcak, & Simpson, 2013; Keefe, Wiltsey Stirman, Cohen, DeRubeis, Smith, & Resick, 2017; Tripp et al., 2019).
In response to these criticisms, researchers developed Written Exposure Therapy (WET), a treatment for PTSD hypothesized to bolster the efficiency of treatment delivery and increase patient satisfaction (Sloan & Marx, 2019). Pilot and efficacy studies have indicated that WET produces long-term reductions in PTSD symptomology, fewer treatment dropouts, and high rates of patient satisfaction with the treatment (Sloan et al., 2013; Sloan et al., 2012).
Although WET appears to be an excellent alternative to lengthier exposure-based trauma focused treatments for PTSD, it is not without limitations. One glaring limitation, is the acceptability and effectiveness of WET for individuals with low educational backgrounds or low literacy levels. A close examination of WET studies’ sample characteristics revealed that only a minority of individuals had low educational levels (~ 20-31%: Sloan et al., 2012; Sloan et al., 2018) Additionally, literacy levels did not appear to be examined. Thus, the extent to which a therapy that is requires writing can be effective for clients with low education or low literacy levels is unknown. Thus, the current study aims to capitalize on the benefits of both treatments and limiting their consequences by delivering the spoken imaginal exposure element of PET following the WET protocol.

THE INTERPLAY OF IMMIGRANT IDENTITY, PERCEIVED SUPPORT FROM HIGHER EDUCATION INSTITUTIONS, AND MENTAL HEALTH OUTCOMES IN DACA RECIPIENTS

Although DACA provides short-term benefits, there are still many barriers these students face in regard to education and employment2. Furthermore, immigration and DACA statuses are influential in shaping a young person’s identity2, and those with a strong immigrant identity cope better with stressful events, perform better in school and social settings compared to those with weak identities9. In addition, the way that others perceive undocumented youth can have a deleterious impact on them and their aspirations as well as residing in a mixed-status community (i.e., undocumented vs. documented) can deprive these students of support and encouragement for future goals10. However, it should be noted that collective contribution, or civic engagement and social support, has been identified as a component for resiliency in DACA youth that is important in their development, well-being, academic success, and are necessary in institutions of higher education11.

Research Objective: Does social/financial support moderate the relationship between immigrant identity and psychological well-being among DACA recipients? In order to answer this question, a non-experimental quantitative study will be conducted through a series of measures and questionnaires among DACA recipients in a university setting.

USING A TELENOVELA STYLE E-HEALTH INTERVENTION TO TREAT DEPRESSION AMONG LATINXS.

Depression is a primary behavioral health concern among Latinxs in the U.S. Unfortunately, Latinxs have low behavioral health service utilization rates which exacerbate the negative consequences associated with depression. Internal barriers (stigma, education, beliefs, etc.) and external barriers (cost, language, time, transportation, etc.) account for this observed disparity. Traditional approaches to ameliorating the existing disparities typically target either internal orexternal barriers. The proposed project seeks to test an intervention for Latinxs who have depression using a culturally specific internet-based intervention modeled after a Behavior Activation (BA) protocol that targets bothinternal and external barriers. Internal barriers (i.e., stigma, attitudes, low behavioral health literacy) will be addressed by educating viewers on what depression is, how it is treated, and clarifying common misconceptions among this population. Additionally, because this intervention can be completed at home, the stigma associated with attending behavioral health services will be eliminated. Given the method of delivery (a mobile application available anywhere at no cost), external barriers to treatment (e.g., cost, language, time and transportation) will be significantly reduced. The specific aims to the proposed project are to examine:1)client outcomes when an e-health intervention is used for the delivery of BA therapy for mild to moderately depressed clients, as compared to outcomes for clients who receive traditional in-person BA therapy; and 2) treatment acceptability and feasibility of the intervention.The measures to be used for this study are: Patient Health Questionnaire-9 and a customer satisfaction/feasibility measure. Overall, the purpose the development and implementation of this culturally tailored intervention is to electronically provide brief BA therapy to Latinxs who may otherwise not have access to treatment due to external and internal barriers.

DBT FOR IPV: USING VIDEO ADJUNCTS TO IMPROVE TREATMENT OUTCOMES FOR SURVIVORS OF DV

Intimate partner violence (IPV) is a common occurrence in the U.S. Victims of IPV are at an elevated risk of experiencing an array of physical and mental health consequences, which frequently co-occur and act synergistically, placing victims at a higher risk for revictimization. One transdiagnostic treatment, Dialectical Behavior Therapy (DBT), focused on helping individuals gain more balanced emotions and behaviors, has shown success in treating victims of IPV. However, the DBT for IPV treatment protocol is not without its limitations. Specifically, clients may need additional exposure to the skills and concepts taught in the treatment. Yet, additional exposure to the skills facilitated though a therapist is difficult to do given the limited budgets for services for victims of IPV and the client provider gap. In order to address these issues, video intervention adjuncts (VIAs) were developed to serve as treatment adjuncts. A Stage One Pilot Trial was conducted to examine the preliminary efficacy, feasibility, and participant acceptability of the two-day DBT for IPV skills group paired with the VIAs versus treatment as usual (the two-day DBT for IPV skills group without the VIAs). Twenty-four women were randomly assigned to the experimental VIA or control condition and completed a one-month follow-up. The data suggests that the VIAs were viewed as acceptable and feasible to implement. Further those in the VIA condition reported greater skill use (with one skill, mindfulness, being significantly greater) and superior outcomes on clinical measures (with one outcome measure, interpersonal sensitivity, being significantly improved). The results of this Stage One Pilot Study provides preliminary evidence that the VIAs are a useful addition to the DBT for IPV skills group and warrant further research.

USING AN ENTERTAINMENT EDUCATION MEDIA CAMPAIGN TO REDUCE STIGMA AND INCREASE MENTAL HEALTH AMONG LATINAS

There are about 55 million Latinxs in the United States and a significant portion of this population experience some type of mental health problem throughout their lifetime. Although there are services available for this population, Latinxs have low rates of service utilization. Internal barriers, such as lack of knowledge and negative attitudes towards mental health services, have been linked to low utilization of services. Media campaigns, such as entertainment-education (E-E) videos, have been an effective intervention used to increase literacy and reduce stigma across different health domains but have been limitedly researched for mental health among Latinxs. The current study was conducted to develop an E-E video that would be accepted among the Latinx community and the see if the video would increase mental health literacy and decrease stigma. The current study was divided into three studies. The first study focused on the development of the video using qualitative methods, study two focused on assessing the acceptability of the video among Latinxs using qualitative and quantitative methods, and study three was a randomized control trial (RCT) to assess if those who watched the video would report increased mental health literacy and decreased stigma compared to those in the control group that did not watch the video. An E-E video was developed and well received among the Latinxs community. Results from study 3 indicated group mean differences for mental health literacy, with those who watched the video reporting an increase in scores compared to those in the control group. Differences in stigma were not noted but could be due to its complexity. Future research should focus on assessing the longitudinal effects of the E-E video on mental health literacy and stigma using a larger RCT study.