Coping Together: Reducing Mental Health Disparities for Latinx Families (2022-2023)

Background

The COVID-19 pandemic amplified existing disparities and disproportionately affected the mental health of Latinx groups who experience worse mental health status and treatment outcomes compared to white individuals. Beyond the pandemic's direct health impacts, 13.7 million Latinx families in the U.S. have aggravated economic hardship leading to increased incidents of family conflict and domestic violence. These disparities are maintained by decades of systemic oppression that give rise to poor social drivers of health. 

While high quality, evidence-based mental health interventions exist to manage a range of stressors that Latinx immigrant/refugee families encounter, this vulnerable population has lower access to culturally-appropriate mental health services. This team’s research has shown that family stress is a key driver of mental health decline in Latinx immigrant families, especially during and after the immigration process. With the development of Coping Together, a family-based intervention deployed in global settings, this project aims to support the mental health of vulnerable communities. 

Project Description

This project team will conduct a systematic and comprehensive adaptation of the evidence-based family therapy intervention, Coping Together, for distressed Latinx immigrant/refugee families. Because Coping Together focuses on helping families develop skills to manage conflict, violence and other relationship issues that impact overall mental health and well-being, this team will explore whether the intervention demonstrates high fit and appropriateness for Latinx families.

Specific goals of this project are to:

  • Determine key targets for intervention in distressed families through observations and interviews with community partners. The team will leverage prior quantitative research aimed at identifying distinct sources of stress and resilience in this population to inform interview guides.  
  • Present the standard, unadapted Coping Together intervention to families to obtain their perceptions of core versus modifiable components, and compile families’ preferences for dose, delivery, format, interventionists and setting for an adapted version of Coping Together.
  • Manualize the adapted Coping Together intervention for delivery and use.

To carry out the adaptation, team members will use methods and principles from complementary fields, including human-centered design, health disparities research, community-engaged research and implementation science. The team will adopt Double Diamond (D2), a community-centric model of human-centered design that emphasizes creating collaborative partnerships, building coalitions, developing relationships and planning/re-planning to understand current community knowledge.

This project will be carried out in two phases:

Phase 1: Needs Assessment

  • Discover: Team members will review prior work to identify targets for intervention in Latinx immigrant/refugee families; conduct a review of existing interventions and adaptations designed for Latinx immigrants/refugees; conduct key informant group and individual interviews pertaining to dose, delivery, format, interventionists and setting; complete observations at community partner sites.  
  • Define: Team members will conduct a parallel mixed-methods, multi-informant analysis to synthesize findings and map potential adaptations of Coping Together. 

Phase 2: Delivery and Dissemination

  • Develop: Team members will iteratively present the prototype of the adapted intervention to stakeholders for feedback on relevance and cultural fit. Team members will also use stakeholder feedback to reformulate and target problem areas. 
  • Deliver: The team will manualize Coping Together for Latinx families with linguistic and conceptual equivalence to the culture and context and develop a method for testing in a subsequent trial.

Anticipated Outputs

Intervention manual; white paper; academic manuscripts; conference and community stakeholder presentations

Student Opportunities

Ideally, this team will be comprised of 3-4 graduate students and 5 undergraduate students. Prospective graduate students will be recruited from master’s and doctoral programs in global health, clinical psychology, nursing, public policy and population health. Undergraduate students will likely be enrolled in programs focused on improving population mental health, reducing disparities in vulnerable communities and informing policy. All applicants should have deep interest or prior experience in mental health and development of psychosocial interventions; working with the Latinx community and health disparities; community-engaged research; implementation science; qualitative or mixed-methods research; and/or fluency in Spanish.

All undergraduate students will have opportunities to participate in all aspects of this applied mental health research relying on human centered design, community-engaged methods and implementation science. Students will receive training in data collection and management, parallel mixed-methods analysis, monitoring and evaluation, cultural adaptations to interventions and dissemination of findings.

Graduate students will have opportunities to mentor undergraduate students at earlier training stages, and will lead data analysis and co-author manuscripts and policy white papers with support from other team members. The team will have weekly meetings (virtual and/or in-person) focused on developing group cohesion, didactic instruction and planning and debriefing different aspects of the project. Team leaders will provide oversight and necessary connections and training to team members in CT and the cultural considerations of adaptation processes.

Srishti Sardana will serve as the project manager.

In the optional summer component, undergraduate students will likely work 8 hours/week from April-June 2022.

Timing

Summer 2022 – Summer 2023

  • Summer 2022 (optional): Submit IRB; contact partner agencies; complete desk review
  • Fall 2022: Interviews with community partners; mixed methods analyses of quantitative and qualitative data
  • Spring 2023: Manualize CT adaptation; revise and submit CT manual
  • Summer 2023 (optional): Dissemination of scholarly products; submit peer-reviewed manuscripts and white paper; present research at academic conference.

Crediting

Academic credit available for fall and spring semesters

See earlier related team, Coping with COVID-19: Using Behavioral Science and Digital Health to Promote Healthy Families (2020-2021).

 

Image: Slide from Coping Together presentation by Eve Puffer, Amber Rieder and Wanda Boone, October 27, 2021

Tree with roots.

Team Leaders

  • Gabriela Nagy Carrasquel, School of Medicine-Psychiatry and Behavioral Sciences
  • Eve Puffer, Arts & Sciences-Psychology and Neuroscience
  • Srishti Sardana, Johns Hopkins University

/yfaculty/staff Team Members

  • Rushina Cholera, School of Medicine-Pediatrics: Primary Care Pediatrics
  • Andrea Diaz Stransky, School of Medicine-Psychiatry: Child and Adolescent Psychiatry
  • Irene Felsman, School of Nursing
  • Rosa Gonzalez-Guarda, School of Nursing
  • Jennifer Plumb Vilardaga, School of Medicine-Population Health Sciences
  • Allison Stafford, School of Nursing