Asians recently surpassed Hispanics as the largest group of new immigrants to the United States. Among Asians, Filipinos are the largest subgroup in California and the second largest subgroup in the U.S. Los Angeles County is home to the largest concentration of Filipinos in the country. Despite their size, they have been described as an “invisible minority” because they are one of the least understood and researched groups related to health status and needs. Filipinos are exposed to multiple adversities, including immigration stress, loss of social status, and lower self-esteem due to discrimination, placing young children at risk for future behavioral and mental health problems. In contrast to the “model minority myth” ascribed to Asians in general, recent studies showcase an increased need for mental health and social services among Filipinos, in part because of higher rates of problem behaviors such as substance use, high school dropout, and teen births compared to other Asian subgroups. Filipino adolescents were also found to have increased reports of depressive symptoms and alarmingly high rates of suicidal ideation (38.9%) and suicide attempts (27%).
Despite these behavioral health challenges, Filipino adults and children have low rates of mental health care and preventive care utilization. Barriers to accessing mental health care include: stigma, cultural factors (hiya or shame to the family), lack of knowledge about mental health and services, and conflicting messages about mental health received by professionals and other community leaders.
Wicked Problem Description:
“Mental health crises and distress are viewed differently because of ignorance, poor knowledge, stigma and discrimination. This cannot continue to be allowed to happen, especially as we know that there can be no health without mental health.” – Professor Gabriel Ivbijaro, President of the World Federation for Mental Health
Mental health disorders among children in the U.S. are a wicked problem with an estimated cost of $247 billion per year. One out of five children in the U.S. have a mental, emotional, or behavioral health diagnosis, placing them at risk for poorer health and shorter lives. Evidence-based parenting interventions provided in childhood have proven to be effective in preventing the onset and escalation of child behavioral and mental health problems. Yet, few parents participate in such programs, especially hard-to-reach, underserved minority and immigrant populations like Filipinos.
Our project is designed to reflect the first two phases of a three-phase community-partnered participatory research (CPPR) initiative. Phase 1 involved a series of meetings to address barriers and needs in the community in order to develop a shared understanding of mental health that will inform the implementation of a culturally-congruent educational campaign to improve mental health awareness in our community. We formed a steering committee of 5-10 members to meet monthly to plan activities and identify at least 25 community members and leaders to 12 quarterly coalition meetings. We finalized our educational campaign strategy and planned a conference that combined science and the arts to engage the community in a dialogue about mental health. Phase 2 involves training providers and parent peers to act as mental health promoters who conduct outreach using this shared understanding of mental health with a focus on engaging parents to participate in the Incredible Years® Parent Program. This curriculum will incorporate, kapwa, a core Filipino value defined as community, togetherness, or a sense of shared identity. We will offer the Incredible Years® Parent program in community-based settings across Los Angeles County over two years. We are currently approaching at least 400 Filipino families about participating in these groups, and plan to enroll 180 parents.
There are two intended outcomes for this project:
- A significant reduction in mental health stigma in our target community
- A significant increase in the participation rate in the Incredible Years® Parent Program offered as a prevention service
- Steering Committee – Our committee, called Team KAPWA formed. We held 24 steering committee meetings (2 per month) and obtained IRB approval to evaluate process outcomes of our project. Members include all clinical scholars, Ana Jayme, MFT Intern (community partner), and project staff.
- Focus group analysis – We have completed data analysis for five focus groups aimed at creating a shared definition of childhood mental health in the Filipino community. We obtained IRB approval for these groups. We are now working on manuscript preparation for a peer-reviewed journal.
- Community Dialogue Evaluation – During Year 1, we hosted a community dialogue on Filipino youth mental health issues. We have completed data analysis of an evaluation of the conference. A summary of our findings has been accepted as an oral presentation at the APHA Annual meeting this fall 2018.
- Filipino Well-Being Training Summit – Team Kapwa members Joyce Javier and Jed David were on the Planning Committee for this first summit sponsored by the Los Angeles County Department of Mental Health (LAC-DMH). We held a workshop on family communication at this event. Over 200 community members attended the summit, which will take place again in February 2019.
- Identification of sustainable funding source for offering Incredible Years in the community after grant funding ends. We helped advocate for IY to be added to DMH’s listed of approved Prevention and Early Intervention programs that therapists can bill for.
- Approval of protocol for randomized controlled trial evaluating the Incredible Years School Age program in the Filipino community: We obtained IRB approval in June 2018 from CHLA/USC, and have several community partners for this study including: primary care clinics, schools, churches, and community based organizations.
- We have formed a new community advisory board of parent champions and community leaders who will inform ways to use social media to retain Filipino parents in IY and hosted reunion for all IY parent alumni on 8/25/18.
Phase 1 took place during Year 1. Phase 2 started in Year 2 and will continue in Year 3.
- Kayamanan Ng Lahi Philippine Folk Arts (KNL)
- Search to Involve Pilipino Americans (SIPA)
- Special Service for Groups Asian Pacific Counseling and Treatment Centers (APCTC)
- Filipino Cultural School (FCS)-Filipino American Services Group, Inc. (FASGI)
- Precious Blood School/Parish-Immaculate Heart of Mary School-Calvary Presbyterian Church
During Phase 1, steering committee members took a survey indicating their level of mental health stigma, knowledge about mental health disparities among Filipino youth, mental health service systems in the community, and their feelings around their level of engagement with the group. The steering this survey to measure new partnerships, knowledge gained, and level of engagement during Year 2 and will continue in Year 3. During Phase 2, we will implement the Incredible Years® School Age Parent Program, an evidence-based preventive parenting intervention and measure parenting practices, parenting stress, child behavior (parent and teacher report), as well as enrollment and participation rates.