Longitudinal Findings of a U.S. Preventive Family Intervention Tested Among Youth in Ecuador: Familias Unidas

• In Event: Parent and Family Interventions: Applying pre-existing knowledge and experience in new and global contexts

Abstract

Introduction: Interventions that address adolescent conduct problems are essential for decreasing negative risk behaviors and promoting positive protective factors among youth. Although interventions have been developed and tested in the United States, preventive evidence-based interventions (EBIs) are less available in Latin American countries such as Ecuador (Huedo-Medina, et al., 2008). Therefore, the purpose of this study was to evaluate the efficacy of an evidence-based, parent-centered intervention, Familias Unidas, in preventing/reducing conduct problems, across time, among youth in Guayaquil, Ecuador. While the efficacy of Familias Unidas has been demonstrated in the U.S. (e.g., Prado et al., 2022; Estrada et al., 2017), it is unknown whether this intervention works similarly in Hispanic populations outside of the United States. Methods: Ecuadorian families (N=239) were recruited from two public schools in Guayaquil and randomized to either Familias Unidas (n=129) or Community Practice (n=110). A series of latent growth models were run to test for differences between Familias Unidas and Community Practice on conduct disorder symptoms across three timepoints covering 6 months. Ecuadorian mental health professionals were trained to deliver the evidence-based intervention. Further, intervention fidelity was also measured and assessed. Intervention fidelity ratings were conducted via observations of recorded parent group and family sessions. Ratings were also conducted to assess inter-rater fidelity reliability. Results: Findings indicate no direct relationship between condition and average change in conduct problems at 6 months post baseline (standardized beta = -0.11, 95% CI = -0.304, 0.067, p = 0.173; CFI / TLI = 0.96 / 0.93). However, indirect effects favoring Familias Unidas over Community Practice were found through improvements in family functioning. Results indicate that, after adjusting for the effects of family functioning at baseline, the intervention increased family functioning at 3-months post-baseline (b = 0.21, 95% CI = 0.070, 0.352, p < 0.01). In addition, family functioning at 3-months post-baseline reduced conduct problems at 6-months post-baseline (b = -0.52, 95% CI = -0.88, -0.18, p < 0.001). This mediation effect was statistically significant (b = -0.11, 95% CI = -0.21, -0.01, p < 0.05). In terms of intervention fidelity, the average session quality was 4.5 (SD = .91) out of a 0 to 6 range. Kappa scores were acceptable (k = .87). Conclusions: Familias Unidas intervention effects were indirect, reducing adolescent conduct problems by first impacting family functioning. Findings highlight that Familias Unidas was efficacious in an international setting and indicate the viability of successfully delivering preventive EBIs in Ecuador. EBIs from the U.S. can be proven efficacious in countries such as Ecuador, where there is a critical need for prevention and emerging infrastructure to test and sustain interventions.

Authors

• Yannine Estrada, University of Miami
  Presenting Author

• Alyssa Lozano, University of Miami

• Ana Quevedo Terán

• Daphne Eckembrecher

• Lourdes M. Rojas

• Cecilia Condo Tamayo

• Tae Kyoung Lee, Sungkyunkwan University

• Maria Rosa Velazquez

• Maria I Tapia

• Julio Martin

• Guillermo Prado, University of Miami