The Puente Project: Use of Parents Taking Action to Promote Service Utilization Among Latinx Families

Background: Access to effective, evidence-based services for youth with developmental disabilities in the community is limited, especially for ethnic minorities populations where significant disparities in identification, service entry and utilization are documented (Mandell et al., 2002, 2005, 2007). There are a growing number of system-driven efforts to address service disparities. In 2016, the State of California Department of Developmental Services launched an initiative to address disparities in care for Latinx clients. To best inform this effort, the San Diego Regional Center (SDRC) prioritized the identification and tracking of disparities in current service expenditures and authorizations by ethnicity and race. This examination informed the design of a targeted intervention effort to promote service utilization among Latinx families through the use of a Promotora (lay health worker) home-visiting model, entitled the PUENTE Project. The goal of the intervention is to promote psychoeducation and empowerment for parents of Latinx children with developmental disabilities.

Objectives: The aim of the current study is to examine the development, implementation and outcomes for the PUENTE Project.

Methods: Service utilization data from 27.343 SDRC clients were examined to identify the appropriate target population for intervention. Five parents/family members of individuals with developmental disabilities were hired as Promotoras. After receiving 25 hours of training on the content and delivery of Parents Taking Action, Promotoras began home visits with families of children with autism spectrum disorders (ASD) and/or intellectual disability (ID). Case managers at SDRC identified Latinx families who were underutilizing services for referral to the program. Promotoras visited families weekly for 12 weeks to discuss Parents Taking Action content and share personal experiences. An independent assessor visited families prior to intervention and immediately following the end of sessions to gather relevant evaluation measures.

Results: Analyses indicated significantly lower SDRC spending for Latinx clients that first emerges between the ages of 14-16 for individuals with ID and ASD. To date, families of 24 children from this group have been referred to PUENTE. Promotoras have conducted over 85 home visits with families. Participating children have a mean age of 13.04 years (SD=1.87, range – 10-16) and 52% (n=12) are male. Diagnoses include ID (n=8; 38%) or ASD (n=5, 24%), ASD+ID (n=4, 19%), and ID+ CP/EP (n=4, 19%). Preliminary data indicate that parents demonstrate moderate levels of strain (M=61.81, score range = 21-105) as well as intermediate disability knowledge (M=31.78, score range = 14-56) and use of effective strategies (M=40.22, score range = 14-56) for addressing children’s needs. A total of 55.5% of families received scores in the clinical range on the CES-D. Families were utilizing an average of 1.79 services (SD=1.36, range = 1-4) within schools and 3.35 services (SD=2.9, range = 0-10) outside the school context. Formal and informal feedback from Promotoras, Regional Center case managers, and families is positive regarding the intervention and service model.

Conclusions: These results demonstrate the feasibility and appropriateness of the PUENTE Project to reach Latinx families with children with developmental disabilities. Effectiveness and impact of the intervention will be discussed.