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Community-based therapists are frequently faced with the complex task of applying existing research knowledge to clients who may differ markedly from those enrolled in controlled outcome studies. The current paper examines the utility of modular psychotherapy design as one method of facilitating the flexible delivery of evidence-based mental health services to ethnically and culturally diverse children and families. Modularity complements existing approaches to the provision of culturally-sensitive, empirically-informed treatment through its ability to balance the prioritization of research evidence and local practitioner cultural knowledge. Specific applications of modular principles to clinical work with diverse youth are highlighted. Special considerations and limitations relevant to modular psychotherapy and the overall mental health services research literature are discussed, as well as the continued importance of individual clinicians' cultural competence and use of treatment progress monitoring, both of which should be combined with identified treatment modules to support the delivery of high-quality care.

We studied the efficacy and implementation outcomes of a culturally responsive parent training (PT) program. Fifty-four Chinese American parents participated in a wait-list controlled group randomized trial (32 immediate treatment, 22 delayed treatment) of a 14-week intervention designed to address the needs of high-risk immigrant families. Parents were eligible for intervention if they were Chinese-speaking immigrants referred from schools, community clinics, or child protective services with concerns about parenting or child behavior problems. Retention and engagement were high with 83% of families attending 10 or more sessions. Results revealed that the treatment was efficacious in reducing negative discipline, increasing positive parenting, and decreasing child externalizing and internalizing problems. Treatment effects were larger among families with higher levels of baseline behavior problems and lower levels of parenting stress. Further augmentation of PT to address immigrant parent stress may be warranted. Qualitative impressions from group leaders suggested that slower pacing and increased rehearsal of skills may improve efficacy for immigrant parents unfamiliar with skills introduced in PT. (Contains 4 tables and 3 figures.)

Social support networks may encourage or dissuade help-seeking for youth behavior problems in ways that contribute to racial/ethnic disparities in mental health services. The authors examined how parental social network characteristics were related to the use of mental health services in a diverse sample of families in contact with Child Welfare. Data from 1,519 families of White (n = 812), African American (n = 418), and Latino (n = 289) origin were drawn from the National Survey of Child and Adolescent Well-Being. Data were collected prospectively after the initiation of a Child Welfare investigation for alleged maltreatment. Results revealed that parental perceptions of support were negatively associated with service use across racial/ethnic groups, and this association was explained by better subsequent mental health status enjoyed by children of parents with stronger social support. Moderator analyses suggested that larger social networks were associated with a decreased use of services among Whites and more highly educated families. (Contains 4 tables and 3 figures.)

Latino youth in a low-income urban community are at high risk of exposure to violence. Given an accumulation of factors before, during, and after migration, immigrant youth might be at increased risk of exposure to violence and other relevant stressors (e.g., acculturation stress, language proficiency, acculturation/enculturation, and parental separations). Utilizing a short-term longitudinal design, we assessed exposure to violence and immigrant stressors and examined their relative impact on psychopathology in a sample of 164 Latino youth. Immigrant youth reported greater exposure to immigrant stressors relative to native-born peers, but few differences in rates of exposure to violence emerged. When considered alongside relevant immigration stressors, exposure to violence emerged as the strongest predictor of youth psychopathology. Results suggest that some types of stressors have more consistently deleterious effects on mental health and understanding resilient outcomes might entail considering the meaning attributed to stressors and the resources available to cope with stressors. (Contains 5 tables.)

This study examined associations between parental cultural orientation, childhood shyness, and anxiety symptoms in a sample of Hispanic American children (N = 127). Parents completed measures of their level of acculturation, collectivism, and socialization goals, while children provided self-reports of anxiety symptoms and both parents and children provided reports of children's shyness. Results provided some support for the relationship between parental cultural orientation and expressed shyness in children. Additionally, results suggested that although increasing levels of parental collectivism are associated with more consistent levels of child shyness across social contexts; shyness with peers is uniquely associated with anxiety symptoms. Implications of these results for future research on social development and internalizing problems in Hispanic children are discussed. (Contains 1 figure and 3 tables.)

We examined familial and cultural factors predicting parent-child (dis)agreement on child behavior and parenting problems. Immigrant Chinese parents (89.7% mothers; M age = 44.24 years) and their children (62 boys; 57.9%) between the ages of 9 and 17 years (M = 11.9 years, SD = 2.9) completed measures of parent punitive behavior and child problems. Concordance in item profiles and discrepancies in overall problem levels were assessed. Overall, immigrant parents reported fewer child and parenting problems than did their children. Relationship closeness predicted less disagreement in ratings of child internalizing symptoms and punitive parenting. Parental acculturative stress and parent-child acculturation dissonance predicted more disagreement regarding internalizing problems. The findings highlight potential under-identification of internalizing problems among immigrant Chinese families that may be driven by acculturation processes. (Contains 4 tables and 3 figures.)

Associations among neighborhood disadvantage, maternal acculturation, parenting and conduct problems were investigated in a sample of 444 Chinese American adolescents. Adolescents (54% female, 46% male) ranged from 12 to 15 years of age (mean age = 13.0 years). Multilevel modeling was employed to test the hypothesis that the association between maternal acculturation and adolescents' conduct problems could be explained by differences in mothers' reliance on monitoring and harsh discipline. In addition, guided by segmented assimilation theory, measures of neighborhood disadvantage were expected not only to be related to differences in parenting, but also to moderate the effects of maternal acculturation on parenting. Results indicated that increased maternal acculturation was related to higher levels of maternal monitoring and lower levels of harsh discipline, which, in turn, were related to lower levels of adolescents' conduct problems. Hierarchical linear modeling results revealed that neighborhood disadvantage was related to lower levels of maternal monitoring. However, neighborhood disadvantage did not moderate the link between maternal acculturation and parenting practices.

This study examined the role of adolescents' and mothers' self-reports of English and heritage language proficiency in youth's academic and emotional adjustment among 444 Chinese American families. Adolescents who were proficient in English tended to exhibit higher reading achievement scores, math achievement scores, and overall GPA. Mothers who were English proficient tended to have children with higher academic achievement and fewer depressive symptoms. Results also indicated that adolescents' heritage language maintenance was associated with positive adjustment, particularly amongst foreign-born youth and for youth whose parents were highly proficient in the heritage language. Mother-adolescent match in heritage language proficiency was related to higher math achievement scores and overall GPA. Additionally, higher heritage language proficiency was associated with fewer depressive symptoms for foreign-born but not U.S.-born youth. Overall, the findings suggest that proficiency in both the English and heritage language may confer advantages to Chinese American youth.

The authors examined racial/ethnic disparities in mental health service use based on problem type (internalizing/externalizing). A diverse sample of youth in contact with public sectors of care and their families provided reports of youth's symptoms and functional impairment during an initial interview. Specialty and school-based mental health service use during the subsequent 2 years was assessed prospectively. Greater disparities in mental health service receipt were evident for internalizing problems, with non-Hispanic White youth more likely to receive services in response to internalizing symptoms than minority youth. Fewer disparities in rates of unmet need emerged for externalizing problems, but minority youth were more likely to have need for externalizing problems met and African American youth were particularly likely to receive services in response to such problems. Findings highlight the importance of considering problem type when examining racial disparities in mental health services and underscore concerns about the responsiveness of mental health services for minority youth with internalizing disorders. (Contains 4 tables and 2 figures.)

In a sample of 107 Chinese immigrant families we examined whether cultural child-rearing beliefs moderated the association between parents' use of punitive discipline and children's behavioral adjustment. Immigrant parents and their children aged 7 to 17 years completed measures of parental discipline and child behavior problems. Parents also reported on indigenous Chinese child-rearing ideologies regarding shaming and training as strategies for raising competent and moral children. Results of hierarchical regression models conducted with parent-reported data indicated that the negative effects of punitive discipline on child behavior problems were not apparent when parents adhered to training and shaming ideologies. However, the buffering effects of training ideologies were more robust and consistent than shaming. The findings provide some evidence that the discipline-behavior problem link may be moderated by cultural context of caregiver psychology which shapes the meaning and implications of parental behavior. (Contains 4 figures and 4 tables.)

This study examined youth mental health service (MHS) use as a function of family immigrant status and type of mental health need (internalizing vs. externalizing). A sample of Hispanic and Asian/Pacific Islander families (youth ages 11-18; N = 457) involved with public sectors of care provided reports of youth mental health need during an initial interview and MHS use was examined prospectively over 2 years. While externalizing need predicted specialty and school-based MHS use in the overall sample, family immigrant status moderated the association between youth need and specialty MHS use such that immigrant youth were more likely to receive services for externalizing need and less likely to receive services for internalizing need relative to non-immigrant youth.

We examined correlates of lifetime parent-to-child aggression in a representative sample of 1,293 Asian American parents. Correlates examined included nativity, indicators of acculturation, socioeconomic status, family climate, and stressors associated with minority status. Results revealed that Asian Americans of Chinese descent and those who immigrated as youth were more likely to report minor parental aggression; ethnicity and nativity were not associated with severe aggression. Indices of acculturation did not predict risk, but minority status stressors (perceived discrimination, low social standing) predicted risk of both minor and severe aggression. Affective climate differed markedly in families with minor versus severe aggression. Parental aggression in Asian American families may not be cultural per se, but stress associated with immigrant family context may heighten vulnerability.

Purpose: We evaluated the hypothesis that abusive parents' reports may exaggerate rates of child behavior problems in a clinical sample. Method: The association between parental ratings of behavior problems and independent observations of child behaviors was examined in a sample of 205 clinic-referred families, 58 of which had a reported history of physical abuse. Results: Relative to the comparison group, parents in the abuse group reported more externalizing problems in their children after controlling for parental psychopathology, and displayed more emotionally controlling and less supportive behavior during parent-child interactions. However, there was no association between abuse history and observed child behaviors during the interaction tasks. Abuse status significantly moderated the association between parent-reported externalizing behaviors and observed demanding behavior by the child; the association was significant among comparison families, but not in the abuse group families. Conclusions: Results indicate that abusive parents may over-report externalizing behavior problems in their children.

We examined contextual factors that may affect the impact of physical discipline on later child behavior problems among high-risk Black and White families. We examined race, parental warmth, and early child problems as potential moderators of the discipline-behavior problem link. The sample included 442 White and Black children and their caregivers interviewed at ages 4, 6, and 8 years. Results indicated that physical discipline operated similarly across the groups, leading to increased externalizing problems only when children demonstrated behavioral problems early on. However, while warm parental attitudes protected against later problems among White children, these attitudes exacerbated early problems in Black children. These findings suggest both racial variability and generalizability in the effects of parenting on child adjustment. (Contains 1 table, 2 figures, and 1 footnote.)

Youth psychiatric emergencies have increased at alarming rates, and disproportionately so for youth of color. Outpatient follow-up care is critical for positive youth outcomes, but rates of follow-up remain low, especially for racial/ethnic minoritized youth. Mobile crisis response can initiate care connection. The current study (1) describes the population who received mobile crisis response (MCR) within the nation's largest county public mental health system, (2) assesses rates of follow-up outpatient services after MCR, and (3) examines racial/ethnic disparities in outpatient services and correlates of receipt of therapy dose (≥8 sessions). Administrative claims for MCR and outpatient services for youth ages 0 to 18 were abstracted from the Los Angeles County Department of Mental Health. From October 2016–2019, 20,782 youth received a MCR, 52.5% of youth were female, and youth mean age was 13.41 years. The majority of youth (91.8%) received some outpatient services after their first MCR. However, only 56.7% of youth received ≥1 therapy session. In a logistic regression, youth age, gender, race/ethnicity, primary language, primary diagnosis, insurance status, MCR call location, and MCR disposition significantly predicted receipt of ≥8 therapy sessions. Findings highlight disparities in therapy receipt for Asian American Pacific Islander, Black, and White youth (relative to Latinx youth), older youth, youth whose MCR was initiated from a police station call, and youth whose MCR did not result in hospitalization. We discuss priorities for quality improvement for MCR processes and strategies to promote linkage to care to achieve mental health equity. [ABSTRACT FROM AUTHOR]

This study evaluated the effects of Safe Alternatives for Teens and Youths–Acute (SAFETY-A), a brief strengths-based, cognitive-behavioral family intervention, on racial-ethnic minority youths receiving emergency department (ED) treatment for suicidal episodes. Participants were 105 racial-ethnic minority youths enrolled in a randomized controlled trial evaluating SAFETY-A versus enhanced usual care for youths receiving ED treatment for suicidal episodes. Analyses examined group effects on care linkage after discharge and adequate treatment dose. A sample of 55 White youths was included for comparison. Racial-ethnic minority youths who received SAFETY-A had higher treatment linkage rates than those receiving usual care. Adequate treatment dose rates did not differ by group. Racial-ethnic minority youths receiving SAFETY-A had higher treatment linkage rates after discharge than those receiving usual care. SAFETY-A is a promising approach to enhance care continuity and mental health equity for racial-ethnic minority youths at risk for suicide. [ABSTRACT FROM AUTHOR]

The authors examined the influence of race/ethnicity on patterns of ratings of adolescent psychopathology completed by adolescents, parents, and teachers in a sample of 600 adolescents. Robust racial/ethnic differences in behavior problems emerged with parent and teacher reports, but not with adolescent self-reports. Discrepancy scores revealed that minority parents reported fewer behavior problems than did youth. Such findings have important implications for treatment seeking, as parents are often the initiators of service use for youth. Compared to other informants, teachers reported fewer internalizing problems among minority adolescents in general, fewer externalizing problems in Asian/Pacific Islanders, and more externalizing problems for African Americans. These findings are consistent with a number of explanations, including cultural differences in adult distress thresholds, racial/ethnic bias among teachers, and cultural differences in symptom expression.

Expressed emotion measures, encompassing dimensions of criticism (CRIT), and emotional over-involvement (EOI) are increasingly being used to assess the parent-child relationship in child clinical populations, despite the lack of studies assessing their validity. We examined the correspondence between CRIT, EOI, and parent-child interactions as observed by neutral coders in a sample of 252 clinic-referred children and adolescents, ages 7-17 years. We found support for the validity of the CRIT code, with high critical parents showing more antagonism, negativity, disgust, harshness, and less responsiveness, compared to parents who scored in the low or borderline ranges. In contrast, none of the observed behaviors were found to correspond with parental EOI, suggesting either that this construct lacks validity with juvenile samples or that behaviors that correspond to EOI are difficult to observe. We conclude that high parental CRIT can be used as an index of problematic parent-child interactions.