College of Psychology Theses and Dissertations

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Date of Award

1-1-2013

Document Type

Dissertation - NSU Access Only

Degree Name

Doctor of Psychology (PhD)

Department

Center for Psychological Studies

First Advisor

Diana Formoso

Second Advisor

Christian DeLucia

Third Advisor

Stephen Campbell

Keywords

barriers, engagement, immigration, minorities, social support, stress

Abstract

Failure to engage and retain low-income, ethnic minority and immigrant families in treatment is a problem that plagues many intervention initiatives. Often, those most in need of services also experience significant barriers to treatment (e.g., logistical barriers, stress), resulting in low attendance rates. This study employed an ecological framework to examine the relationship between parents' report of stress, social support, and their engagement in a culturally sensitive, school-based intervention. Stress related to low income, minority and/or immigrant status is presented as a specific barrier that impacts treatment engagement. Additionally, social support is conceptualized as having a "buffering effect" on the potential negative impact of stress on engagement. Archival data was examined for families who participated in Connections intervention, a family focused intervention intended to strengthen family relationships, coping skills, and social support and to prevent child mental health problems. Thirty-five mothers of 3rd to 5th grade children were included in this study. Of this sample, 43% identified as Haitian, 31% as Hispanic, 14% as African American, 6 as "other," 3% as English-Speaking Caribbean, and 3% as European-American. Results indicated that maternal stress was negatively related to attendance, and satisfaction with social support was positively related to attendance. In addition, a stress by need for support interaction emerged, suggesting that attendance is most negatively impacted for mothers reporting high levels of stress and high levels of need for support. Among mothers with high stress, those indicating low need for support were able to attend almost twice as many sessions as those with high need for support. Attendance rates were also related to maternal acculturation: mothers identified as "enculturated" had the highest attendance rates (74%), followed by "assimilated" mothers(67%), "bicultural" mothers (50%), and marginalized mothers (20%). Treatment engagement is frequently conceptualized as an individual-level factor (e.g., motivation, readiness for change), but results suggest engagement also is shaped by contextual factors such as stress and social support. Future directions in research and clinical implications are discussed.

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