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Objective: Latino families raising children with mental health needs report greater dissatisfaction with care compared with other families. Activation is a promising strategy to eliminate disparities. This study examined the comparative effectiveness of MePrEPA, an activation intervention for Latino parents whose children receive mental health services. Methods: A randomized controlled trial (N=172) was conducted in a Spanish-language mental health clinic to assess the effectiveness of MePrEPA, a four-week group psychoeducational intervention to enhance parent activation among Latino parents. Inclusion criteria were raising a child who receives services for mental health needs and ability to attend weekly sessions. Outcomes were parent activation, education activation, quality of school interaction, and parent mental health. Effectiveness of the intervention was tested with a difference-in-difference approach for estimating linear mixed models. Heterogeneity of treatment effect was examined. Results: MePrEPA enhanced parent activation (ß=5.98, 95% confidence interval [CI]=1.42–10.53), education activation (ß=7.98, CI=3.01–12.94), and quality of school interaction (ß=1.83, CI=.14–3.52) to a greater degree than did a parent-support control group. The intervention’s impact on parent activation and education outcomes was greater for participants whose children were covered by Medicaid and were novices to therapy and those with low activation at baseline. No statistically significant effects were observed in parent mental health. Conclusions: Activation among Latino parents was improved with MePrEPA, which can be readily incorporated in current practices by mental health clinics. Future work should replicate findings in a large number of sites, adding behavioral measures and distal impacts while examining MePrEPA’s effects across settings and populations.

Background: Comparative effectiveness research (CER) is supported by policymakers as a way to provide service providers and patients with evidence-based information to make better health-care decisions and ultimately improve services for patients. However, Latina/o patients are rarely involved as study advisors, and there is a lack of documentation on how their voices contribute to the research process when they are included as collaborators. Objectives: The purpose of this article was to contribute to the literature by presenting concrete contributions of Latina/o parent involvement to study design, implementation and outcomes in the context of a CER study called Padres Efectivos (Parent Activation). Methods: Researchers facilitated a collaborative relationship with parents by establishing a mentor parent group. The contributions of parent involvement in the following stages of the research process are described: (i) proposal development, (ii) implementation of protocols, (iii) analysis plan and (iv) dissemination of results. Results: Mentor parents’ contributions helped tailor the content of the intervention to their needs during proposal, increased recruitment, validated the main outcome measure and added two important outcome measures, emphasized the importance of controlling for novice treatment status and developed innovative dissemination strategies. Conclusions: Mentor parents’ guidance to the researchers has contributed to reaching recruitment goals, strengthened the study protocol, expanded findings, supported broad ownership of study implications and enriched the overall study data collection efforts. These findings can inform future research efforts seeking an active Latino parent collaboration and the timely incorporation of parent voices in each phase of the research process.

Individuals with mental illness experience poor health and may die prematurely from chronic illness. Understanding whether the presence of co-occurring chronic physical health conditions complicates mental health treatment is important, particularly among patients seeking treatment in primary care settings.Examine (1) whether the presence of chronic physical conditions is associated with mental health service use for individuals with depression who visit a primary care physician, and (2) whether race modifies this relationship.Secondary analysis of the National Ambulatory Medical Care Survey, a survey of patient-visits collected annually from a random sample of 3000 physicians in office-based settings.Office visits from 2007 to 2010 were pooled for adults aged 35-85 with a depression diagnosis at the time of visit (N=3659 visits).Mental health services were measured using a dichotomous variable indicating whether mental health services were provided during the office visit or a referral made for: (1) counseling, including psychotherapy and other mental health counseling and/or (2) prescribing of psychotropic medications.Most patient office visits (70%) where a depression diagnosis was recorded also had co-occurring chronic physical conditions recorded. The presence of at least 1 physical chronic condition was associated with a 6% decrease in the probability of receiving any mental health services (P0.05). There were no differences in service use by race/ethnicity after controlling for other factors.Additional research is needed on medical care delivery among patients with co-occurring health conditions, particularly as the health care system moves toward an integrated care model.

Background. Many families in contact with child protective service agencies do not receive needed health services. Agencies have used community and family participatory practices as a way to improve services for families. We lack a better understanding of variation in these practices and on whether they improve health service use among caregivers and children. Conceptual Framework. The socio-technical systems framework underscores agency characteristics of the work environment as factors associated with variation in agency practices and agencies' ability to reach their goals. Research Objective. This research is divided into three studies: The first examines the association between agency characteristics related to quality-oriented culture, flexibility in procedures and caseworker strain on agency use of community review boards, and formerly served caregiver participation in planning/policy groups. The second study tests whether caregivers from an agency with these boards and/or planning/policy groups are more likely to be served through a participatory decision-making service practice. Finally, study three compares caregiver and child physical and mental health service use between caregivers served through a participatory practice and those who did not experience it. Methods. All study analyses are drawn from the National Survey of Child and Adolescent Well-Being (NSCAW). Multivariate logistic regressions incorporating weights and the complex survey design of the data as well as the implementation of propensity scores to address selection bias in study three are used to test the proposed associations. Findings. In the first study, agency characteristics did not explain variation in agency use of community review boards or caregiver-based planning/policy groups. In the second study, caregiver participation in planning/policy groups was surprisingly negatively associated with caregiver inclusion in decision-making during service planning. In the last study, caregiver inclusion in participatory decision-making did not predict child health service use. Implications. Caregiver and family member inclusion in the discussions leading to decision-making during service planning meetings is a promising strategy for increasing health service use among children in contact with a CPS agency.