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Program Profile: Criando con Amor: Promoviendo Armonía y Superación (CAPAS)

Evidence Rating: Effective - More than one study Effective - More than one study

Date: This profile was posted on May 20, 2019

Program Summary

This program includes two versions of a culturally adapted parenting intervention for immigrant Latino populations. The program is rated Effective. Both versions of the intervention were found to have a statistically significant impact on improving parenting practices, compared with the control group. Only the enhanced intervention had a positive, statistically significant effect on child internalizing behaviors. Neither had a statistically significant effect on externalizing behavior.

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

Program Description

Program Goals/Target Population
Criando con Amor: Promoviendo Armonía y Superación (CAPAS), a culturally adapted version of GenerationPMTO (Parent Management Training Oregon), is a parent-training program for Latino immigrant parents whose children exhibit mild-to- moderate behavioral problems. The five primary goals of the program are to 1) promote parent–child positive involvement, 2) help children develop prosocial skills, 3) decrease children’s deviant behavior with effective discipline, 4) enhance parental supervision, and 5) help family members negotiate agreements (i.e., problem solving).

The first version of the program, CAPAS-Original (CA), is designed to incorporate two salient cultural values: 1) superación (increasing educational attainment and achievement beyond the parents’ levels), and 2) educación (raising children to be competent and respectful adults) with the specific parenting practices of Latino immigrants (Domenech Rodríguez et al. 2011; Baumann et al. 2014). The second version, CAPAS-Enhanced (CE), is designed to increase the program’s focus on cultural and contextual issues such as the impact of immigration challenges and biculturalism on the parenting experiences of immigrant Latino families.

Program Components
The CA intervention closely adheres to the GenerationPMTO program, which includes five core components: 1) skill encouragement, 2) problem-solving, 3) positive involvement, 4) limit setting, and 5) monitoring. The skill encouragement component involves encouraging positive behavior that promote prosocial skills and cooperation while preventing and reducing the development of mild, moderate, or severe conduct problems. The problem-solving component consists of collaboratively identifying solutions for unmet family needs and problems. The positive involvement component involves promoting close relationships between parents and youth. The limit setting component involves effectively disciplining children through use of mild, short, and consistent consequences for misbehavior. The monitoring component consists of regularly scheduled check-ins with children.

The CA intervention also includes the following supporting skills:
  1. Effective communication: Parents listen to and respect each family member’s opinions and allow for compromise.
  2. Emotional regulation: Parents control their emotions when interacting with their children.
  3. Clear directions: Parents provide clear instructions, so their children know what is expected of them.
  4. School success: Parents promote and support their children’s academic performance.
  5. Mindfulness: Parents are attentive, nonreactive, and nonjudgmental in interactions with their children.
Consistent with GenerationPMTO, CA is delivered in 12 sessions over a 12-week period in both individual and group formats. However, cultural experts, translators, and other consultants examined the GenerationPMTO program manual and supportive materials and modified the program for linguistic appropriateness and cultural relevance in language and content. Culturally relevant expressions were also included in the adaption of role-play scripts (Parra-Cardona et al. 2016).

The CE intervention included all the sessions of CA intervention as well as two additional culture-specific sessions that related to immigration and biculturalism. During these training sessions, parents discuss immigration-related challenges and benefits and strategies for coping with discrimination related to immigration status. Parents also discuss the “culture gap” that exists between generations, with the promotion of biculturalism as a useful solution to addressing these issues (Parra-Cardona et al. 2011).

Because two culture-specific components were added to the CE intervention, two additional parenting skills sessions (motivational behavior modeling and problem-solving specific challenges) were added to the CA curriculum to ensure that the two interventions were equal in length and amount of training provided.

Key Personnel
Both versions of CAPAS are led by both a cultural adaption specialist, who is Latino/a, fully bilingual, and a resident of the target community and a GenerationPMTO trained expert with direct knowledge of the target population and 6 years of experience delivering the intervention to Latino/a families with young children (Parra-Cardona et al. 2018).

Additional Information
CAPAS is a culturally adapted version of GenerationPMTO, which can also be found on CrimeSolutions.gov: https://www.crimesolutions.gov/ProgramDetails.aspx?ID=596

Evaluation Outcomes

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Outcomes of the Criando con Amor: Promoviendo Armonía y Superación (CAPAS)-Original (CA) intervention are discussed under Study 1, while outcomes of the CAPAS-Enhanced (CE) intervention are discussed under Study 2.

Overall, for the CA intervention, Parra-Cardona and colleagues (2017a) found no statistically significant effect favoring the CA intervention group on the Internalizing and Externalizing Subscales of the Child Behavior Checklist (CBCL). However, there were statistically significant effects on parental outcomes favoring the CA group. For the CE intervention, Parra-Cardona and colleagues (2017b) found a statistically significant effect favoring the CE intervention group on the CBCL Internalizing Subscale, but no difference on the Externalizing Subscale. There were also statistically significant effects favoring the CE group on parental outcomes.

Study 1
CBCL Internalizing Subscale
Parra-Cardona and colleagues (2017a) did not find any statistically significant differences between the CA intervention group and the control group on the CBCL Internalizing Subscale at the 6-month follow up.

CBCL Externalizing Subscale
There were no statistically significant differences between the CA group and the control group on the CBCL Externalizing Subscale at the 6-month follow up.

Skill Encouragement
There was a statistically significant increase in parents’ reports of skills encouragement for children in the CA group, compared with the control group parents at the 6-month follow up.

Supervision
There was a statistically significant increase in measures of parental supervision for the CA group, compared with the control group at the 6-month follow up.

Problem Solving
There was a statistically significant increase in parents’ reports of positive family problem-solving behaviors for the CA group, compared with the control group parents at the 6-month follow up.

Positive Involvement
There was a statistically significant increase in parents’ reports of positive involvement with children for the CA group, compared with the control group parents at the 6-month follow up.

Limit Setting
There was a statistically significant increase in parents’ reports of limit-setting strategies in response to misbehaving children for the CA group, compared with the control group parents at the 6-month follow up.

Study 2
CBCL Internalizing Subscale
Parra-Cardona and colleagues (2017b) found a statistically significant difference favoring the CE intervention group, compared with the control group on the CBCL Internalizing Subscale at the 6-month follow up.

CBCL Externalizing Subscale
There was no statistically significant difference between the CE group and the control group on the CBCL Externalizing Subscale at the 6-month follow up.

Skill Encouragement
There was a statistically significant increase in parents’ reports of skills encouragement of children for the CE group, compared with the control group parents at the 6-month follow up.

Supervision
There was a statistically significant increase in measures of parental supervision for the CE group, compared with the control group at the 6-month follow up.

Problem Solving
There was a statistically significant increase in parents’ reports of positive family problem-solving behaviors for the CE group, compared with the control group parents at the 6-month follow up.

Positive Involvement
There was a statistically significant increase in parents’ reports of positive involvement with children for the CE group, compared with the control group parents at the 6-month follow up.

Limit Setting
There was a statistically significant increase in parents’ reports of limit-setting strategies in response to misbehaving children for the CE group, compared with the control group parents at the 6-month follow up.
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Evaluation Methodology

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Study 1
Parra-Cardona and colleagues (2017a) used a randomized control design to evaluate the effectiveness of the two culturally adapted versions of GenerationPMTO: Criando con Amor: Promoviendo Armonía y Superación (CAPAS)-Original (CA) and CAPAS-Enhanced (CE). The sample comprised 103 families randomly assigned to one of the culturally adapted interventions, or to a control group. The intervention included 12 sessions over 12 weeks.

Recruitment strategies targeted key community settings with high Latino presence such as faith-based organizations, health care settings, and mental health offices. Families were required to meet the following criteria to be eligible for the study: 1) live in single or two-parent families at the time of the study, 2) identify themselves as first generation Latina/o or Hispanic, 3) be Spanish-speaking, 4) be 18 years of age or older, and 5) report financial adversity as confirmed by a family income not higher than 40 percent of the U.S. Department of Health and Human Services (HHS) poverty guidelines. Eight parenting groups were recruited to participate in four cohorts. Enrolled participants were randomly assigned to one of the three conditions. Computer-generated randomization involved blocking on one of the four recruitment cohorts and age of the target child—younger (5–8) versus older (9 and above).

Thirty-six families (66 participants) were assigned to the CAPAS-Original (CA) intervention. Of these 66, 36 were mothers, and 30 were fathers. Across the 36 families, there were 14 girls and 22 boys. The average number of target children per household was 2.69, and the average age was 9.44. On average, the parents were 35.97 years old, had 9.38 years of education, and had been living in the United States for an average of 15.04 years. Most of the parents (59) were originally from Mexico. The annual family income was below $20,000 for 41.7 percent of the families, and 25 percent had an income between $21,000 and $30,000.

The control group included 32 families with 59 participants, 32 mothers and 27 fathers and 17 girls and 15 boys. The average number of target children per household was 3.10, and the average age was 9.16. On average, parents were 36.52 years old, had 7.87 years of education, and had been living in the United States for average of 14.80 years. Most of the parents (55) were originally from Mexico. The annual family income was below $20,000 for 25 percent, and 37.5 percent had an income between $21,000 and $30,000. There were no statistically significant differences in average parent age, parents’ years living in the United States, average age or gender of target children, or number of children per household across the CA, CE, and control conditions.

Data was collected from assessments that were administered preintervention, postintervention, and at a 6-month follow up. Assessments were completed either at home or at a local site chosen by the participant (e.g., at church). Participants were given the choice to complete measures in Spanish or English. All participants elected to complete measures in Spanish. One child per family was identified as the focal child. Child outcomes included the focal child’s internalizing and externalizing behaviors, measured by the Child Behavior Checklist (CBCL; Achenbach 1991). Parenting outcomes were measured using scales adapted from Martinez and Eddy (2005) through collaboration between bilingual and bicultural PMTO-trained researchers (Domenech Rodriguez et al. 2013). Parenting outcomes included skills encouragement, limit-setting, supervision, problem solving, and positive involvement. The researchers used multilevel growth modeling to examine the effects of the three intervention conditions on changes in outcomes. The researchers did not conduct subgroup analyses.

Study 2
Parra-Cardona and colleagues (2017b) also evaluated the CAPAS Enhanced intervention. This evaluation used the same methods and measured the same outcomes as Study 1 (Parra-Cardona et al. 2017a). The CAPAS-Enhanced (CE) group comprised 35 families with 64 participants. Of these 64, 35 were mothers, and 29 were fathers. Across the 35 families, there were 18 girls and 17 boys. The average number of target children per household was 2.63, and the average age was 8.66. On average, the parents were 36.97 years old, had 8.72 years of education, and had been living in the United States for an average of 14.11 years. Most of the parents (57) were originally from Mexico. The annual family income was below $20,000 for 22.9 percent of participating families, and 34.3 percent had an income of between $21,000 and $30,000. The control group from Study 1 served as the control group for Study 2. All assessments, outcome measures, and statistical analyses used in Study 1 were also used in Study 2. The researchers did not conduct subgroup analyses.
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Cost

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There is no cost information available for this program.
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Implementation Information

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The original GenerationPMTO certification process can take up to 2 years to complete. However, for the Criando con Amor: Promoviendo Armonía y Superación (CAPAS) program, interventionists were trained in the core components during two, 5-day intensive trainings. Thus, the study authors only consider the culturally adapted CAPAS intervention to be GenerationPMTO-informed. To aid in community buy-in, the CAPAS-Original and CAPAS-Enhanced programs were delivered in the building of a local religious organization widely recognized and trusted by the Latino community (Parra Cardona et al. 2012).
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Evidence-Base (Studies Reviewed)

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

Study 1
Parra-Cardona, J. Rubén, Deborah Bybee, Cris M. Sullivan, Melanie M. Domenech Rodríguez, Brian Dates, Lisa Tams, Guillermo Bernal, and Joanne Davila. 2017a. “Examining the Impact of Differential Cultural Adaptation with Latina/o Immigrants Exposed to Adapted Parent Training Interventions.” Journal of Consulting and Clinical Psychology 85(1):58–71.

Study 2
Parra-Cardona, J. Rubén, Deborah Bybee, Cris M. Sullivan, Melanie M. Domenech Rodríguez, Brian Dates, Lisa Tams, Guillermo Bernal, and Joanne Davila. 2017b. “Examining the Impact of Differential Cultural Adaptation with Latina/o Immigrants Exposed to Adapted Parent Training Interventions.” Journal of Consulting and Clinical Psychology 85(1):58–71.
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Additional References

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

Achenbach, T. M. 1991. Manual for the Child Behavior Checklist:4–18. Burlington, Vt.: University of Vermont.

Bernal, G., J. Bonilla, and C. Bellido. 1995. “Ecological Validity and Cultural Sensitivity for Outcome Research: Issues for the Cultural Adaptation and Development of Psychosocial Treatments with Hispanics.” Journal of Abnormal Child Psychology 23:67.

Domenech Rodriguez, M. M., A. A. Baumann, and A. L. Schwartz. 2011. “Cultural Adaptation of an Evidence-Based Intervention: From Theory to Practice in a Latino/a Community Context.” American Journal of Community Psychology 47: 170–86.

Forgatch, M.S., and G.R. Patterson. 2010. “The Oregon Model of Parent Management Training (PMTO): An Intervention for Antisocial Behavior in Children and Adolescents.” In J Weisz, and A. Kazdin (eds.). Evidence-Based Psychotherapies for Children and Adolescents, 2nd Edition. New York, N.Y.: Guilford Press:159–78.

Martinez, C. R. Jr., and J. M. Eddy. 2005. “Effects of Culturally Adapted Parent Management Training on Latino Youth Behavioral Health Outcomes.” Journal of Consulting and Clinical Psychology 73:841–51.

Parra-Cardona, Jose Ruben, Melanie Domenech-Rodriguez, Marion Forgatch, Cris Sullivan, Deborah Bybee, Kendal Holtrop, Ana Rocio Escobar-Chew, Lisa Tams, Brian Dates, and Guillermo Bernal. 2012. “Culturally Adapting an Evidence-Based Parenting Intervention for Latino Immigrants: The Need to Integrate Fidelity and Cultural Relevance.” Family Process 51(1):56–72.

Parra-Cardona, J.R., G. Lopez Zeron, M. Domenech Rodriguez, A.R. Escobar-Chew, M. Whitehead, C. Sullivan, and G. Bernal. 2016. “A Balancing Act: Integrating Evidence-Based Knowledge and Cultural Relevance in a Program of Prevention Parenting Research with Latino/a Immigrants.” Family Process 55:321–37.

Parra-Cardona, J. Ruben, Gabriela Lopez-Zeron, Silvia Gisela Leija, Megan K. Maas, Monica Villa, Efrain Zamudio, Melecia Affredondo, Hsueh-Han Yeh, and Melanie M. Domench Rodriguez. 2018. “A Culturally Adapted Intervention for Mexican-Origin Parents of Adolescents: The Need to Overtly Address Culture and Discrimination in Evidence-Based Practice.” Family Process, doi:10.1111/famp.12381

Patterson, G.R., M.S. Forgatch, and D.S. DeGarmo. 2010. “Cascading Effects Following Intervention.” Development and Psychopathology 22(4):949–70.
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Program Snapshot

Age: 4 - 12, 30 - 40

Gender: Both

Race/Ethnicity: Hispanic

Geography: Urban

Setting (Delivery): Other Community Setting

Program Type: Conflict Resolution/Interpersonal Skills, Family Therapy, Group Therapy, Parent Training

Targeted Population: Families

Current Program Status: Active

Listed by Other Directories: Model Programs Guide, National Registry of Evidence-based Programs and Practices, Blueprints for Healthy Youth Development (formerly Blueprints for Violence Prevention)

Researcher:
Jose Ruben Parra-Cardona
Steve Hicks School of Social Work, The University of Texas at Austin
1925 San Jacinto Blvd., Room 3.130F
Austin TX 78712
Phone: 512.232.9215
Fax: 512.471.9600
Website
Email