Program Profile: eHealth Familias Unidas

The goals of the online mental health program for Hispanic families are to prevent and reduce depressive and anxious symptoms, suicide ideation/behaviors, and drug use in Hispanic youth. The program is rated No Effects. The program did not have a statistically significant impact on past-90-day alcohol use and family functioning. The treatment group had a statistically significant reduction in past-90-day drug use, prescription drug use, and cigarette use, compared with the control group.

A No Effects rating implies that implementing the program is unlikely to result in the intended outcome(s) and may result in a negative outcome(s).

This program's rating is based on evidence that includes at least one high-quality randomized controlled trial.

Program Goals

The eHealth Familias Unidas program is an internet adaptation of Familias Unidas, an evidence-based family intervention for Hispanic immigrant families. The goals of the eHealth Familias Unidas program are to prevent and reduce internalizing symptoms (such as depressive and anxious symptoms), suicide ideation/behaviors, and drug use in Hispanic youth by improving family communication.

Program Components

eHealth Familias Unidas consists of eight online, recorded, e-parent group sessions that can be accessed over the Internet and four parent–adolescent family sessions delivered by a facilitator using web-based video conferencing software. The eight e-parent group video sessions last approximately 30 minutes each, are prerecorded, and can be watched at the convenience of parents on a website specifically designed for the study. The sessions consist of three components: 1) simulated parent group discussions, 2) a culturally syntonic telenovela series (that is, a soap opera), and 3) interactive exercises. The simulated parent group discussions feature a group of Hispanic parent actors who role-play the intervention. During the simulated discussions, the actors discuss personal struggles associated with their adolescent child, offer support, role-play new skills, and provide suggestions on how to prevent adolescent risk behaviors. The interactive exercises included in the telenovela are used to reinforce intervention material, to adapt the participatory learning strategy used in the face-to-face intervention, and to tailor the intervention to the specific needs of each participating family.

Family sessions are conducted with a Health Insurance Portability and Accountability Act–compliant online video-conferencing software. Each family session is approximately 45 minutes long and involves the adolescent with at least one primary caregiver. The content of family sessions is tailored based on the goals and needs of each individual family. While there is a given set of information that needs to be covered in each session (for example, communication skills, behavior management), this information is couched within the context, goals, and specific situation of each family.

Program Theory

The intervention is guided by Ecodevelopmental Theory and Entertainment Education Theory (Estrada et al. 2017). Ecodevelopmental theory suggests that, for an intervention to be maximally successful, it should intervene in multiple domains and levels of the social ecology. Familias Unidas targets risk and protective factors for youth drug use and sexual risk behaviors operating in different ecological domains (family, school, and peers) that influence adolescent health and behavior (Coatsworth, Pantin, and Szapocznik, 2002). Entertainment Education Theory provides a contextual framework for the medium by which the intervention is delivered. The theory suggests that, to engage individuals with online content, the receiver (the person watching) needs to identify with the characters and become absorbed in the story (a process called transportation). The medium used in the intervention is designed to make the intervention culturally relevant.

Study

Estrada and colleagues (2019) conducted a randomized controlled trial to evaluate the impact of eHealth Familias Unidas on a sample of Hispanic eighth graders with behavioral problems. Participant recruitment, intervention delivery, and assessment follow-up took place from April 2014 to October 2016. Adolescents and their primary caregivers were recruited from 18 middle schools in the Miami–Dade County Public School (MDCPS) district. To be eligible for participation in the study, participants had to meet the following requirements: a) the adolescent was of Hispanic origin; b) the adolescent was in the eighth grade at enrollment; c) the adolescent was living with a primary caregiver who was willing to participate in the study; d) the family was living within the catchment area of a MDCPS school at baseline; e) the family had access to the internet (for example, at home, school, or library); and f) the adolescent exhibited a level 1, 2, or 3 behavior problem as defined by MDCPS. Level 1 behaviors included acts that disrupt the orderly operation of the classroom, school function, and extracurricular activities or approved transportation; level 2 behaviors included destruction of property or confrontation with school staff; and level 3 behaviors included harmful and/or offensive behaviors such as physically harming others or endangering safety.

The total sample was comprised of 230 Hispanic eighth graders. The treatment group consisted of 113 adolescents who participated in the intervention and received prevention as usual. The control group consisted of 117 adolescents who received prevention as usual. Prevention as usual included an HIV–prevention curriculum provided by MDCPS during health and science classes. The curriculum consisted of six lessons delivered in a classroom setting that aimed to provide information about HIV/AIDS and other sexually transmitted infections.

On average, adolescents in the study were 13.6 years old and males made up the majority of the sample (63 percent). Most adolescents (56.5 percent) were born in the United States; those who were born outside the United States were from Cuba (20 percent), Honduras (6 percent), and Colombia (3 percent). The majority of families (55.7 percent) had an annual household income below $20,000. There were no statistically significant differences between the treatment and control groups at baseline in regard to demographic characteristics, adolescent risky behaviors, or family functioning variables except for parent-reported parent–adolescent communication. Specifically, parent-reported parent–adolescent communication was higher for eHealth Familias Unidas treatment group participants, compared with prevention-as-usual control group participants. These baseline differences were controlled for within the analyses.

This study assessed the impact of eHealth Familias Unidas on the following outcomes: past-90-day drug use, prescription drug use, cigarette use, alcohol use, and family functioning. Drug (marijuana, cocaine, inhalants, and other drugs), prescription drug, cigarette, and alcohol use were measured using items from Monitoring the Future, a population-based epidemiologic survey. Specifically, adolescents were asked whether and how many times they had used a particular substance during the 90 days before each assessment. Family functioning was measured using parent reports of three indicators: a) parent–adolescent communication, b) parental monitoring of peers, and c) positive parenting. The Parent–Adolescent Communication Scale was used to measure parent–adolescent communication. Items were measured on a five-point scale. The Parent Relationship With Peer Group Scale was used to measure parental monitoring of peers and to obtain parental reports of actively supervising their adolescent and knowing their adolescent’s friends. The Parenting Practices Scale was used to measure positive parenting. The instrument included questions about positive parenting, rewards, and acknowledgments provided to adolescents in response to positive behaviors. Participant families were assessed at baseline and at 3- and 12-months post baseline. Assessments were completed at the adolescent’s school and were administered by the Audio Computer-Assisted Self-Interview (ACASI) software. ACASI programming included an audio option for participants with reading difficulty and was conducted in English or Spanish, depending on the participant’s language preference. Assessments were conducted in separate rooms for parents and adolescents.

The past-90-day drug use, prescription drug use, cigarette use, and alcohol use variables were count variables. Zero-inflated Poisson growth models were used to estimate longitudinal changes across these outcomes, including the effect of the intervention on the frequency of use as well as the likelihood of use. The authors used structural equation modeling to examine the impact of the treatment on a latent family functioning variable. As a post hoc test, the latent family functioning variable was decomposed to examine intervention effects on each family functioning indicator. The authors did not conduct subgroup analyses.

The facilitator team consisted of 16 paid mental health professionals, all with master’s-level degrees in their fields (for example, mental health counseling, social work). The research team’s clinical supervisor delivered facilitator training over a span of 3 days. Training included didactic instruction, role-plays, and group discussion of recorded sessions. Facilitators were also trained in technical components of the intervention such as how to track attendance and monitor attendance through the website. Facilitators received four 2-hour supervision sessions delivered throughout the course of the intervention by both the first author and the clinical supervisor (Estrada et al. 2019).

These sources were used in the development of the program profile:

These sources were used in the development of the program profile: