Adapting an Ebi for Children with ASD for Community Implementation with Latino Families: Therapist and Parent Recommendations for Adaptations

Background: Disparities exist in identification, diagnosis, and treatment for Latino children with ASD. There is increased focus on the use of evidence based interventions (EBI) in mental health treatment and the need for culturally responsive EBIs has been identified (APA, 2006). Identifying culturally appropriate ways to adapt EBIs using input from stakeholders is critical.

Objectives: This qualitative study used focus groups and interviews to gather parent and therapist perceptions of implementation of a structured EBI for children with ASD (An Individualized Mental Health Intervention for ASD (AIM HI)) when utilized with Latino families with the goal of identifying potential training and EBI adaptations.

Methods: Data collection occurred from focus groups with therapists (n=17) and semi-structured interviews with Latino parents (n=29) who participated in the AIM HI community effectiveness trial. Of the therapists, 35% self-identified as Hispanic/Latino and 47% reported speaking Spanish. All parents self-identified as Hispanic/Latino; 86% spoke Spanish and 66% preferred Spanish. Focus groups and interviews were transcribed and coded to identify relevant themes.

Results: The following themes were identified using rapid assessment analysis process (RAP) of focus groups and consensus coding of interviews. Three salient themes emerged regarding potential adaptations.

Theme 1 Adapting training: The most frequent themes for training adaptations were related to helping therapists deliver AIM HI with Latino, or non-English speaking families. A clear need was identified for increased training in using a culturally-informed approach to intervention delivery and individualizing AIM HI for diverse families. The need for training when working with an interpreter was another identified theme.

Theme 2 Adapting AIM HI: Salient themes regarding adapting AIM HI focused on making the intervention more accessible to parents by simplifying behavioral terminology and adding a parent workbook. Increasing the accessibility of AIM HI to Spanish speaking families was a salient theme with therapists identifying the need for additional translated AIM HI materials to provide information and context to non-English speaking families. Adaptations to increase the utility of AIM HI included adding a parent module with psychoeducation about ASD (in both English and Spanish).

Theme 3 Adapting AIM HI delivery: Themes regarding adapting intervention delivery differed by stakeholder group. Therapists advocated using technology (text messages, phone based app) to communicate with parents during treatment; however, no parents endorsed wanting to be sent treatment information weekly via electronic method. The majority of parents (61%) reported that they preferred information from their therapist to be delivered in both verbal and printed format (e.g., resources and handouts); 64% reported that they preferred their therapist to provide treatment forms and materials to them incrementally week by week as opposed to receiving a complete workbook at the beginning of treatment (an option preferred by 32% of parents).

Conclusions: These findings highlight the need to adapt EBI training and intervention delivery for Latino families, with a focus on understanding the needs of stakeholder groups. Based on these findings, future study in our research program will involve developing and piloting testing a toolkit specifically addressing the recommendations generated from this qualitative data.