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Using an Evidence-Based Parenting Program to Engage a Community

January 20, 2020
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Given the similar size and distribution of Asian and Hispanic populations in central Ohio, Michael Flores, PhD, clinical team coordinator in the Big Lots Behavioral Health Services at Nationwide Children’s Hospital, was puzzled about why significantly fewer Asian families were seeking mental and behavioral health services at Nationwide Children’s.

Roughly 4.9% of the Columbus population is Asian, according to 2010 census data, and about 5.5% is Hispanic.

“I saw maybe one or two Asian children in my first few years here,” he says. “But I saw dozens of Hispanic children. I knew that this was an indication that we were not reaching the Asian community in central Ohio.”

So when Chang Liu, PhD, MSW, LSW, a Chinese-speaking behavioral health therapist at Nationwide Children’s, discussed some of her professional goals for the next year with him, which included improving awareness and access to care to the local Asian American population, Dr. Flores presented an idea to provide the Incredible Years® (IY) parenting program in Mandarin Chinese to meet Dr. Liu’s goals and reach out to an underrepresented population in behavioral health.

IY is a series of evidence-based programs for parents, children and teachers. The IY program is used by schools and mental health centers across the country. At Nationwide Children’s the IY program is available for parents or guardians of children ages 3 to 8 years old who are interested in learning skills to better manage their child’s (or children’s) disruptive behaviors. The program is facilitated by trained behavioral health specialists.

“Our main objective was to engage more with the Asian community,” Dr. Flores adds. “We wanted to get to know these families so that we could start breaking stigmas about mental health services and educate them about available services.”

The stigmas about mental health in the Asian community are not new. They are among the same stigmas that plague communities across the United States.

“People think that there is shame to needing mental health services, or that it is something the family should be able to handle on their own,” says Minghuizi Yi, MSW, LSW, behavioral health community-based therapist on the Integrative Family and Systems Treatment (I-FAST) team at Nationwide Children’s. “There’s a stigma against talking about problems within the community. Which means they might not know of or think about prevention services or getting help early.”

Dr. Liu and Yi translated all of the program materials into Chinese. Translating the concepts in a culturally competent way was important to the success of the program.

“For example, there’s no word for ‘time-out’ in Chinese – we have to explain the concept, even though there’s not an exact parallel term,” says Dr. Liu. “And at first, we didn’t plan to paraphrase or translate many of the transcripts of the videos. But doing so seemed to connect the behavioral strategies being taught to the families, such that they stated that this was one of their most liked and beneficial aspects of the group.”

Concepts taught in the program include:

  • child focused play
  • social and emotional coaching
  • praise and reward
  • limit setting
  • ignoring
  • time out

According to Dr. Flores, there were a few other differences between the Chinese class and the classes offered in English – not in the content but in the delivery.

“We learned a lot about making culturally appropriate adjustments,” says Dr. Flores. “For example, early on, we discussed the most appropriate food options after someone suggested we order Chinese food instead of pizza during our classes.”

Another difference was retention. The class had 14 participants, and all but one stayed the full 14 weeks – and that one made up the missed coursework for the weeks missed. According to Dr. Flores, it’s not uncommon for the English IY classes to experience up to a 50% drop out rate.

As they were preparing the class, Liu and Yi worked with the American Asian Community Services to present information about behavioral health services and promote the classes.

“The American Asian community is tightly knit. Participants in the lectures and the parenting program became a source of information for the community – both in person and online. This is an important way for us to get high-quality mental health information to the community.”

“This was just an idea a year ago. It’s been exciting to watch Dr. Liu and Ms. Yi work hard to make this class a reality. They went above and beyond to make it something where the families could be supported, engaged and excited about learning new parenting techniques,” says Dr. Flores.

“This is the first IY class to be offered here in a language other than English,” adds Dr. Flores. “In fact, it’s the first IY group in the United States run in Chinese by Chinese-speaking therapists.”

To say that the class was a success might be an understatement.

“The class was full, with a waitlist, and there’s interest in doing another session in 2020,” says Dr. Flores. “Now we’re looking at how we can expand to other languages, such as Spanish.”

The participants echoed the sentiment.

As part of the ‘graduation ceremony’ on the last night of class, participants stood up and shared what they learned and found valuable about the class as they received their certificate. Among the comments (translated and lightly edited for clarity):

  • I hope more people can benefit from these types of groups.
  • This was a wonderful program, I learned a lot of surprising things.
  • I wish I could have attended this earlier.
  • I am really glad that I attended this group. I learned a lot. I am also happy to meet the other parents.
  • It is good to have a framework that I can use. It helps to stay positive.

For more information about how families can be involved in future IY classes at Nationwide Children’s, providers and families can contact the Behavioral Health Intake Department.

“We start with a 60-minute, in-person session to assess behavioral needs,” says Dr. Flores. “Then we can help get the right pieces in place, including IY classes.”  

 

Class participants with instructors and members of Behavioral Health leadership
Class in session
Giving feedback about the class to Behavioral Health leadership