Catherine DeCarlo Santiago

Poverty and Mental Health: How Do Low-Income Adults and Children Fare in Psychotherapy?

Poverty is associated with an increased risk for psychological problems. Even with this increased risk for mental health problems and need for care, many low-income adults and families do not receive treatment because of logistical, attitudinal, and systemic barriers. Despite significant barriers to obtaining care, research suggests that low-income individuals show significant benefit from evidence-based mental healthcare. In this article, we review the link between poverty and mental health, common barriers to obtaining mental health services, and treatment studies that have been conducted with low-income groups. Finally, we discuss the implications of the research reviewed and offer recommendations for clinicians working with low-income children or adults, highlighting the importance of evidence-based care, extensive outreach, and empathic respect.

Preliminary Efficacy of an Intervention to Reduce Psychosocial Stress and Improve Coping in Low-Income Families

This article reports pre–post intervention results from a randomized controlled trial evaluating the initial efficacy of a couples-based intervention aimed at teaching skills for coping with stress and improving relationship skills in a sample of 173 ethnically diverse low-income co-resident mothers and fathers who were raising at least one child together. Couples were randomly assigned to one of three interventions or to an assessment-only control condition. The Fatherhood, Relationship, and Marriage Education (FRAME) intervention is a 14-h psychoeducation intervention developed specifically to strengthen the ability of low-income mothers and fathers to reduce conflict, cope with stress, and co-parent effectively. Three versions of FRAME were assessed: a men-only group, a women-only group, and a couple’s group. The pre-post intervention analyses revealed reductions in financial stress, disengagement coping, and involuntary disengagement responses, as well as improvements in problem solving. These pre–post changes on stress and coping variables were both statistically significant and reliable as assessed by the Reliable Change Index (Jacobson and Truax 1991). Results were particularly strong for the couples’ and women’s groups. In addition, positive pre-post changes on stress and coping variables were associated with pre-post reductions on symptoms of depression for participants assigned to an intervention. The results demonstrate that participants in FRAME acquire some of the key skills taught in the intervention, and skills acquisition appears to translate into symptom reduction. In addition, this study highlights the value of an intervention aiming to improve the capacity of parents with economic hardship to cope effectively with stress.

Testing the Adaptation to Poverty-Related Stress Model: Predicting Psychopathology Symptoms in Families Facing Economic Hardship

This study tested the Adaptation to Poverty-related Stress Model and its proposed relations between poverty-related stress, effortful and involuntary stress responses, and symptoms of psychopathology in an ethnically diverse sample of low-income children and their parents. Prospective Hierarchical Linear Modeling analyses conducted with 98 families (300 family members: 136 adults, 82 adolescents and preadolescents, 82 school-age children) revealed that, consistent with the model, primary and secondary control coping were protective against poverty-related stress primarily for internalizing symptoms. Conversely, disengagement coping exacerbated externalizing symptoms over time. In addition, involuntary engagement stress responses exacerbated the effects of poverty-related stress for internalizing symptoms, whereas involuntary disengagement responses exacerbated externalizing symptoms. Age and gender effects were found in most models, reflecting more symptoms of both types for parents than children and higher levels of internalizing symptoms for girls.

Predictors of responses to stress among families coping with poverty-related stress

Abstract This study tested how poverty-related stress (PRS), psychological distress, and responses to stress predicted future effortful coping and involuntary stress responses one year later. In addition, we explored age, sex, ethnicity, and parental influences on responses to stress over time. Hierarchical linear modeling analyses conducted with 98 low-income families (300 family members: 136 adults, 82 school-aged children, 82 adolescents) revealed that primary control coping, secondary control coping, disengagement, involuntary engagement, and involuntary disengagement each significantly predicted future use of that response. Primary and secondary control coping also predicted less maladaptive future responses to stress, while involuntary responses to stress undermined the development of adaptive responding. Age, sex, and interactions among PRS and prior coping were also found to predict certain responses to stress. In addition, child subgroup analyses demonstrate the importance of parental modeling of coping and involuntary stress responses, and warmth/nurturance and monitoring practices. Results are discussed with regard to the implications for preventive interventions with families in poverty.

Family and cultural influences on low-income latino children's adjustment.

This study examined family and cultural influences on adjustment among 90 low-income Latino middle school children (46% girls; average age = 11.38, SD = .66) and their primary caregivers (93% female; average age = 36.12, SD = 6.13). All participants identified as Hispanic/Latino, with 75% of families identifying as Mexican-origin Latino, and 77% of parents and 32% of children identifying as immigrants. Hierarchical linear modeling analyses revealed that family reframing interacted with familism, with high levels of both associated with fewer psychological symptoms, whereas passive appraisal is linked to worse functioning. Results are discussed with regard to the implications of this research for preventive interventions with families in poverty.

Preliminary Evaluation of a Family Treatment Component to Augment a School-Based Intervention Serving Low-Income Families.

This pilot feasibility study provided a preliminary test of a community-partnered intervention that targeted engaging parents and improving parent functioning. This intervention was combined with the Cognitive-Behavioral Intervention for Trauma in Schools (CBITS), allowing for a comparison of the CBITS-as-usual (CBITS) with the CBITS-plus-family treatment component (CBITS + Family). This study used a quasi-experimental design, capitalizing on ongoing CBITS implementation within a school system. A total of 19 parent–student dyads participated in CBITS groups and 21 parent–student dyads participated in CBITS + Family groups. Parents and students under both conditions completed pre- and posttreatment measures. Participants were from low-income, predominantly Latino families. Children were 59% female with an average age of 11.83 years. Parents who received the family treatment component reported higher satisfaction and attended a greater proportion of sessions than parents who received CBITS. In addition, parents who received the family treatment component reported improvements in primary control coping, secondary control coping, family loyalty and closeness, as well as decreases in involuntary engagement and family passive appraisal. Parents who received the family component also showed more warmth, monitoring, and less inconsistency at post-intervention. Results suggest that the family component may contribute to improved parent functioning that could benefit children in the long term.

Examining the impact of a family treatment component for CBITS: When and for whom is it helpful?

This study compared the Cognitive Behavioral Intervention for Trauma in Schools (CBITS), as it is typically delivered, to CBITS-plus-family treatment component (CBITS + Family), developed through a community partnership. This study used a quasi-experimental design, capitalizing on ongoing CBITS implementation within a school system. In total, 32 parent/student dyads were recruited in CBITS groups and 32 parent/student dyads were recruited in CBITS + Family groups. Parents and students in both conditions completed pre- and posttreatment measures, in addition to a 6-month posttreatment follow-up assessing symptoms. Families were low-income and predominately Latino. Children were 59% female with an average age of 11.70. Participating parents were 84% female with an average age of 38.18. The majority of parents (80%) were immigrants and 70% reported not finishing high school. Parents who received CBITS + Family showed significant improvements in attitudes toward mental health, school involvement, and primary control coping, while demonstrating significant reductions in involuntary engagement and inconsistent discipline. CBITS + Family appears to be most beneficial for children with high symptom severity in terms of reducing posttraumatic stress disorder symptoms and disengagement coping. Finally, greater improvements in parent variables predicted larger symptom reductions among children within the CBITS + Family group. This study suggests that CBITS + Family is beneficial for parents of children exposed to trauma and may be especially helpful for children with high initial symptom severity. Children in CBITS + Family appear to benefit most when their parents show larger improvements in school involvement and greater reductions in parental inconsistency and involuntary engagement.

Improving Implementation of Mental Health Services for Trauma in Multicultural Elementary Schools: Stakeholder Perspectives on Parent and Educator Engagement

Although more schools are offering mental health programs, few studies have involved the school community in research to improve their successful implementation. In this community-partnered study, focus groups were conducted with school staff and parents to explore issues related to community engagement and feasibility of a mental health intervention for elementary school students exposed to trauma. Four educator focus groups, including 23 participants, and 2 parent focus groups, consisting of 9 Spanish-speaking and 7 English-speaking parents were conducted. Participants discussed facilitators and barriers to successful implementation of the program. Participants identified the importance of pre-implementation parent education, raising awareness of the impact of student mental health among educators, maintaining ongoing communication during the intervention, and addressing logistical concerns. Participants described clear considerations for parent and educator engagement, both at the pre-implementation phase and during implementation of the program. Implications for next steps of this community-partnered approach are described.

Engaging parents in evidence-based treatments in schools: Community perspectives from implementing CBITS

This study explored parent engagement in an evidence-based treatment, the Cognitive Behavioral Intervention for Trauma in Schools (CBITS), which was delivered in a school setting. To examine the successes and challenges related to engaging parents in this school-based program, we conducted qualitative interviews by phone to obtain data from clinicians, parents, and other school personnel across eleven schools from 3 different regions of the United States. Almost all of these schools served low-income and ethnically diverse communities. We describe general impressions of parent engagement, parent reactions and preferences with regard to CBITS, barriers to parent engagement, and how to overcome barriers from multiple perspectives. Parent engagement across schools varied, with extensive outreach and relatively good parent engagement in CBITS described in some schools, while in other schools, efforts to engage parents were not as consistent. Implications for future efforts to engage parents in school-based treatments are discussed.

Culture and Educational Stress and Internalizing Symptoms Among Latino Adolescents: The Role of Ethnic Identity

ABSTRACT Discrimination experienced by Latino youth in school has been explored in past research although the interrelatedness of culture and educational stress—the stress due to Hispanic culture not being acknowledged in school and racial tensions in school—has been less studied. The current study examines the effect of this stress on internalizing symptoms among 58 low-income Latino adolescents (Mage =13.31, 53% male) and tests whether ethnic identity moderates this association. Results show that culture and educational stress is associated with worse mental health. Further, a significant ethnic identity X stress interaction was found for somatic problems showing that youth high in ethnic identity exploration reported more somatic problems in the face of high culture and educational stress. Hence, youth who are more actively exploring their identity may be more vulnerable to the damaging context of culture and educational stress. Implications for multicultural consultation are discussed.