FEASIBILITY AND ACCEPTABILITY OF PARENTING INTERVENTIONS 
DELIVERED IN SPANISH TO CAREGIVERS OF CHILDREN WITH AUTISM AND 
OTHER DEVELOPMENTAL DELAYS: A MIXED-METHODS DESIGN 
by 
JONATHAN SAFER-LICHTENSTEIN 
A DISSERTATION 
Presented to the Department of Special Education and Clinical Sciences and the 
Division of Graduate Studies of the University of Oregon 
in partial fulfillment of the requirements 
for the degree of 
Doctor of Philosophy  
June 2022 
                                        DISSERTATION APPROVAL PAGE 
Student: Jonathan Safer-Lichtenstein 
Title: Feasibility and Acceptability of Parenting Interventions Delivered in Spanish to 
Caregivers of Children with Autism and Other Developmental Delays: A Mixed-methods 
Design 
This dissertation has been accepted and approved in partial fulfillment of the 
requirements for the Doctor of Philosophy degree in the Department of Special Education 
and Clinical Sciences by: 
Laura Lee McIntyre, PhD  Chairperson 
Geovanna Rodriguez, PhD Core Member 
Wendy Machalicek, PhD  Core Member 
Benedict McWhirter, PhD Institutional Representative 
and 
Andy Karduna Interim Vice Provost for Graduate Studies 
Original approval signatures are on file with the University of Oregon Division of 
Graduate Studies. 
Degree awarded June 2022 
ii 
© 2022 Jonathan Safer-Lichtenstein 
iii 
DISSERTATION ABSTRACT 
Jonathan Safer-Lichtenstein 
Doctor of Philosophy  
Department of Special Education and Clinical Sciences 
June 2022 
Title: Feasibility and Acceptability of Parenting Interventions Delivered in Spanish to 
Caregivers of Children with Autism and Other Developmental Delays: A Mixed-methods 
Design 
Parents of children with autism spectrum disorder (ASD) or developmental delay 
(DD) experience increased stress due to raising a child with a disability, particularly if the
child also presents with challenging behaviors. As such, there is benefit to developing 
evidence-based interventions that: 1) help parents cope with stress, and 2) manage the 
challenging behaviors of their children. This is particularly true for underserved groups, 
including Spanish-speaking Hispanic/Latinx populations, who are often underrepresented 
in intervention research. Two promising interventions in reducing caregiver stress are 
psychoeducation/support groups and mindfulness-based stress reduction (MBSR); an 
intervention effective in reducing child challenging behaviors is Behavioral Parent 
Training (BPT).  This study piloted these three interventions for 60 Spanish-speaking 
Hispanic caregivers of children with ASD or DD as part of a larger, randomized-
controlled trial.  We sought to examine the feasibility and acceptability of these 
interventions both within this Spanish-speaking cohort, and compared to previously run 
English-speaking cohorts.  Additionally, due to unforeseen circumstances of COVID-19, 
the BPT intervention was modified for telehealth delivery, allowing for initial exploration 
of the modality for this population.  Results from attendance and satisfaction data, as well 
iv 
as participant focus groups, showed that Spanish-speaking participants attended sessions 
at similar rates and demonstrated preference for psychoeducation/support groups over 
MBSR compared to English-speaking participants, while finding BPT strategies 
generally acceptable.  Participants reported appreciating the knowledge gained and sense 
of community established in the psychoeducation/support groups.  Implications and 
future directions, including potential cultural adaptation of materials to maximize 
participant engagement and buy-in, are discussed. 
v 
CURRICULUM VITAE 
NAME OF AUTHOR:  Jonathan Safer-Lichtenstein 
GRADUATE AND UNDERGRADUATE SCHOOLS ATTENDED: 
University of Oregon, Eugene, OR 
Ursinus College, Collegeville, PA 
DEGREES AWARDED: 
Doctor of Philosophy in School Psychology, 2022, University of Oregon 
Bachelor of Arts in Psychology and Spanish, 2012, Ursinus College 
AREAS OF SPECIAL INTEREST: 
Culturally appropriate parent training for caregivers of children with autism 
Parenting interventions for Spanish-speaking families  
PROFESSIONAL EXPERIENCE: 
Graduate Employee, University of Oregon, 2018-2021 
Assessment Extern, HEDCO Comprehensive Diagnostic Assessment Clinic, 
University of Oregon, 2019-2020  
Bilingual Practicum Therapist, Child and Family Center, University of Oregon, 
2019-2021 
School Psychology Practicum Intern, Yolanda Elementary School, Springfield 
School District, 2017-2018 
Research Coordinator, Georgetown University, 2014-2017 
GRANTS, AWARDS, AND HONORS: 
UO College of Education Dissertation Research Fellowship, 2020-2021 
UO Sandra Morgen Public Impact Fellowship, 2020-2021 
INSAR Summer Research Internship in Autism and Cultural Diversity, 2019 
AAIDD Student/Early Career Professional Scholarship, 2019 
UO Wes Becker Scholarship Award, 2018-2019 
UO First Year Fellow, 2017-2018 
PUBLICATIONS: 
vi 
McIntyre, L. L., Neece, C. L., Sanner, C. M., Rodriguez, G., & Safer-Lichtenstein, J. 
(2021). Telehealth delivery of a behavioral parent training program to Spanish-
speaking Latinx parents of young children with developmental delay: Applying an 
implementation framework approach. School Psychology Review. 
https://doi.org/10.1080/2372966X.2021.1902749  
Safer-Lichtenstein, J., Reardon, K., & McIntyre, L. L. (2020). Does location matter? A 
single state case study examining geographic differences in school-based ASD 
identification practices. Journal of Applied School Psychology, 37(2), 1–12. doi: 
https://doi.org/10.1080/15377903.2020.1821270  
Safer-Lichtenstein, J., Hamilton, J., & McIntyre, L. L. (2020). School-based autism 
rates by state: An analysis of demographics, DSM alignment, and differential 
diagnoses. Journal of Autism and Developmental Disorders. Advance online 
publication. https://doi.org/10.1007/s10803-020-04700-3  
Safer-Lichtenstein, J., & McIntyre, L. L. (2020). Comparing autism symptom severity 
between children with a medical autism diagnosis and an autism special education 
eligibility. Focus on Autism and Other Developmental Disabilities, 35(3), 186–
192. https://doi.org/10.1177/1088357620922162
Kunze, M., Drew, C., Machalicek, W., Safer-Lichtenstein, J., & Crowe, B. (2019). A 
systematic examination of the influence of interventionist language on mands 
using a speech generating device. Behavior Analysis in Practice, 12, 777-781. 
https://doi.org/10.1007/s40617-019-00379-w  
Safer-Lichtenstein, J., Hamilton, J., & McIntyre, L. L. (2019). Examining demographics 
in randomized controlled trials of group-based social skills interventions for 
individuals with autism spectrum disorder. Journal of Autism and Developmental 
Disorders, 49(8), 3453-3461. https://doi.org/10.1007/s10803-019-04063-4  
Ratto, A.B., Anthony, B.J., Mendez, R., Safer-Lichtenstein, J., Dudley, K., Kahn, N., 
Pugliese, C., Kenworthy, L., Biel, M., Martucci, J., & Anthony, L.G. (2017). 
Lessons learned: Engaging culturally diverse families in neurodevelopmental 
disorders intervention research. Autism, 21(5), 622–634. 
https://doi.org/10.1177/1362361316650394 
vii 
ACKNOWLEDGMENTS 
I want to acknowledge and thank my dissertation committee, Drs. Laura Lee 
McIntyre, Geovanna Rodriguez, Wendy Machalicek, and Benedict McWhirter, for their 
support throughout the dissertation process. To my advisor, Dr. Laura Lee McIntyre, 
thank you for your continued support of my graduate education and research. To Dr. 
Cameron Neece, thank you for your help coordinating with the Loma Linda University 
arm of this project. To Doug Gomez, thank you for your consultation around qualitative 
methodology and analysis. To Stephanie Puerta, thank you for your help coding 
qualitative data. To Charlotte Winter, thank you for your organization of the data. Thank 
you to everyone who was involved in the PRO-Parenting Study and who made this study 
possible. Finally, thank you to my wife, Jessica, and to my parents, family, and friends 
for supporting me throughout this process. 
This research was made possible through grants provided by the Eunice Kennedy 
Shriver National Institute of Child Health and Human Development (grant number R01 
HD093661) awarded to Dr. Laura Lee McIntyre at the University of Oregon and Dr. 
Cameron Neece at Loma Linda University. This study was also supported by the 
International Society for Autism Research (INSAR) Summer Research Internship in 
Autism Spectrum Disorder and Cultural Diversity awarded to Jonathan Safer-
Lichtenstein at the University of Oregon and Dr. Cameron Neece at Loma Linda 
University. 
viii 
TABLE OF CONTENTS 
Chapter Page 
I. INTRODUCTION .................................................................................................... 1 
Representation in Research .................................................................................... 2 
Mindfulness-Based Stress Reduction .................................................................... 3 
Psychoeducation and Support Groups ................................................................... 4 
Behavioral Parent Training .................................................................................... 6 
Telehealth ............................................................................................................... 9 
Literature Gap ........................................................................................................ 11 
Present Study and Research Questions .................................................................. 12 
II. METHOD ................................................................................................................ 16 
Interventions .......................................................................................................... 16 
Participants ............................................................................................................. 18 
Procedure ............................................................................................................... 19 
Measures ................................................................................................................ 22 
Analysis Plan ......................................................................................................... 26 
III. RESULTS .............................................................................................................. 30 
Quantitative ............................................................................................................ 30 
Qualitative .............................................................................................................. 34 
IV. DISCUSSION ........................................................................................................ 45 
Limitations ............................................................................................................. 51 
Future Directions ................................................................................................... 53 
Conclusion ............................................................................................................. 55 
ix 
Chapter Page 
APPENDIX A .............................................................................................................. 56 
APPENDIX B .............................................................................................................. 65 
REFERENCES CITED ................................................................................................ 68 
x 
LIST OF FIGURES 
Figure Page 
1. CONSORT diagram. .............................................................................................. 61 
2. Attendance at Spanish-speaking Cohort ................................................................ 62 
3. Attendance Across Cohorts.................................................................................... 63 
4. Treatment Satisfaction ........................................................................................... 64 
xi 
LIST OF TABLES 
Table Page 
1. Demographics for Spanish-speaking Cohort. .......................................................... 56 
2. Demographics Across Cohorts. ............................................................................... 57 
3. ANCOVA Results for Attendance, Part One. .......................................................... 58 
4. ANCOVA Results for Attendance, Part Two. ......................................................... 59 
5. ANCOVA Results for Satisfaction. ......................................................................... 60 
xii 
I. INTRODUCTION
Recent prevalence estimates suggest that Hispanic/Latinx individuals represent 
the fastest growing population in autism spectrum disorder (ASD; Maenner et al., 2020).  
As such, there is an increasing need to identify and provide appropriate intervention 
services for Hispanic youth with ASD and other intellectual and developmental 
disabilities (IDDs).  Unfortunately, research suggests that existing service systems often 
fail to meet the treatment needs of Hispanics with IDD (Liptak et al., 2008; Nguyen et al., 
2016; Zuckerman et al., 2017).  Non-English speaking families experience additional 
challenges including fewer intervention hours and more unmet intervention needs, with 
some studies showing language proficiency being the single most important factor in 
predicting access to services (Stahmer et al., 2019; Zuckerman et al., 2017).  One way 
that such disparities could be attenuated is through research to test whether widely 
utilized, evidence-based, IDD intervention practices are feasible and acceptable when 
delivered in Spanish to Hispanic populations. 
Interventions targeting parent mental health and well-being, including particularly 
stress reduction, are often the focus of interventions due to the heightened levels of 
psychological distress associated with parenting a child with a disability (Baker et al., 
2003).  Two interventions that target stress reduction and positive coping are 
mindfulness-based stress reduction (MBSR; Dykens et al., 2014; Neece et al., 2014) and 
psychoeducation/support groups (Bitsika & Sharpley, 2000).  Although these 
interventions vary significantly in scope, philosophy, and approach, they both have 
promising outcomes for caregivers of children with IDD.  
Additionally, children with IDD often have heightened behavioral challenges, 
1 
with some studies suggesting that, relative to children who are typically developing, 
children with IDD have three to four times the number of behavioral challenges (e.g., 
Baker et al., 2003).  Given that child challenging behavior is a frequent concern of 
parents of children with IDD (Matson & Nebel-Schwalm, 2007), interventions targeting 
reducing behavior problems in children with IDD are common.  An intervention that has 
shown promise in this area, and is considered relatively cost-effective and easy-to-
implement is Behavior Parent Training (BPT) modified to meet the specific needs of 
children with IDD (McIntyre, 2013).  Finally, there is a need to test the most cost-
effective and feasible manner for delivering these types of interventions, with recent 
evidence supporting telehealth, or interventions delivered online (Corralejo & Rodriguez, 
2018).   
Representation of diverse populations in developmental disabilities research 
On the whole, individuals from diverse backgrounds have been underrepresented 
in IDD treatment research (e.g., Safer-Lichtenstein et al., 2019).  This limits the 
generalizability of findings from intervention research studies that are considered 
“evidence-based.”  Pierce and colleagues (2014) found that only 28% of published 
articles in prominent IDD journals reported on the ethnic background of their 
participants.  Furthermore, fewer than half of these studies included race or ethnicity in 
their analyses.  West et al. (2016) conducted a meta-analysis and found that the ethnicity 
was only provided for 31% of the 2,489 participants who took part in foundational ASD 
intervention research studies.  Additionally, of those participants for whom ethnicity was 
provided, approximately 85% were considered White or multiracial, with Hispanics 
specifically comprising only 2.5% of the combined sample.  This study also highlighted 
2 
that parent-led implementation studies had a particularly high concentration of White 
participants.  Of the 279 caregivers who took part in parent-implemented ASD 
interventions, 51.6% identified as White and 48% identified as multiracial (West et al., 
2016).  These findings indicate the limited extent to which most ASD intervention 
research can be generalized to diverse, and particularly Hispanic, populations in the 
United States. 
Mindfulness-Based Stress Reduction (MBSR) 
MBSR is an empirically supported stress-reduction intervention that utilizes a 
combination of mindfulness meditation, body awareness, and exploration of thoughts and 
actions.  The intervention aims to increase awareness that arises from paying attention, on 
purpose, in the present moment and without judgment (Kabat-Zinn, 2009).  The 
intervention is typically delivered in a group format over eight weeks.  There is a lot of 
evidence to document the efficacy of MBSR in reducing stress, anxiety, and depression 
in a wide variety of people (Grossman et al., 2004).  There is also a growing body of 
research that MBSR interventions may be particularly beneficial for parents of children 
with ASD and other developmental delays (DD), as these individuals are at heightened 
risk for stress based on the additional caregiving challenges (Dykens et al., 2014; Neece, 
2014).  Neece (2014) randomly assigned 46 parents of children with DD to either an 
eight-week MBSR program or a waitlist control group.  Neece (2014) found that those 
who participated in the MBSR intervention had significant improvements in terms of 
stress, depression, and overall life satisfaction compared to those in the control group.  In 
another study, Dykens and colleagues (2014) utilized a randomized trial involving 243 
mothers of children with ASD or other disabilities to compare MBSR with a control 
3 
 
condition of positive psychology practices.  This study utilized six-week group-based 
interventions, and found that while participants in both interventions experienced 
reductions in stress, depression, and anxiety, those in the MBSR group had even greater 
improvements.   
The above studies exemplify the potential benefits of MBSR for stress reduction, 
however the majority of MBSR research has been done with higher SES, primarily 
White, participants.  There has been some MBSR research that has utilized more diverse 
samples and provided intervention in both English and Spanish (Kabat-Zinn et al., 2016; 
Roth & Robbins, 2004).  These studies targeted medical patients seen for treatment at 
health centers, and found that positive effects of intervention were comparable across 
racial/ethnic and language groups.  Castellanos and colleagues (2020) conducted a meta-
analysis specifically looking at MBSR interventions that have been culturally adapted for 
Hispanic populations.  They found similar impact for this population, with moderate to 
large effect sizes for reduced psychiatric distress compared to no-treatment controls.  The 
studies in this meta-analysis varied greatly in the degree to which cultural adaptations 
were made.   
In terms of MBSR research with diverse caregivers of children with DD, only two 
studies have attempted to incorporate more diverse participants into MBSR research 
(Bazzano et al., 2015; Neece et al., 2019).  Both Bazzano et al. (2015) and Neece et al. 
(2019) delivered MBSR interventions in English but used live interpretation services 
during MBSR intervention sessions.  The Bazzano and colleagues (2015) study included 
66 diverse participants, with one-third of participants preferring Spanish. Findings 
suggest that regardless of demographic factors, participants experienced decreased stress 
4 
and increased mindfulness practices.  Similarly, Neece and colleagues (2019) ran an 
MBSR intervention for 80 caregivers of children with DD, about half of whom identified 
as Hispanic.  This study indicated that MBSR is similarly efficacious for Hispanic and 
non-Hispanic families in reducing stress, depression, and even parent-reported child 
problem behaviors.  Qualitative analyses done in this study to assess acceptability found 
that many Hispanic families indicated the intervention could be further improved if it 
were to be offered directly in Spanish, rather than via interpreters (Neece et al., 2019). 
Psychoeducation support groups 
Psychoeducation is a practice that is used to teach parents knowledge-based 
content around the characteristics of a disorder or mental health condition.  This content 
is generally broader (i.e., what defines the disorder and how to attain services) than more 
specific skills-based training (i.e. how to implement a behavior plan), and is often 
combined with support group elements, such as sharing of common experiences between 
parents (Steiner et al., 2012).  There have been studies indicating that parents of children 
with IDD appreciate and benefit from group-based psychoeducation.  McAleese and 
colleagues (2014) found that parents of children with ASD demonstrated improvements 
in knowledge about the presentation of the disorder and in reported parenting self-
efficacy following participation in such a group.  Additionally, other studies have shown 
that psychoeducation may improve parent well-being and mental health, including by 
reducing depressive symptoms (Bristol et al., 1993) and stress (Bitsika & Sharpley, 2000; 
Patra et al., 2015).  There is also evidence of the utility of this type of intervention in 
different cultures (e.g., Mukhtar et al., 2018; Patra et al., 2015), although less work has 
been done with culturally diverse participants in the United States.  Chlebowski and 
5 
colleagues (2018) ran focus groups with Hispanic parents of children with ASD about 
their perceptions of and needs for services.  This study found that Hispanic parents 
expressed having limited overall knowledge about developmental disabilities prior to 
beginning services with their children, and felt that psychoeducation could be of great 
benefit.  
One example of a psychoeducation program that has been developed for Hispanic 
parents of children with ASD is called Parents Taking Action (Lopez et al., 2019; 
Magaña et al., 2017).  The researchers in these studies worked with a group of 
community-based partners and advisors to develop an intervention using a Community 
Health Worker Model, in which a Hispanic mother of a child with ASD worked as part of 
the research team to provide support and encourage uptake of strategies to participants 
(Magaña et al., 2017).  Other strategies focused on fitting the program to the context of 
the family by including familiar, culturally meaningful, sayings and stories into lessons.  
Findings from initial studies on this program showed improved outcomes in several 
important domains compared to waitlist controls, including child behaviors and parent 
knowledge of rights, but not maternal depression (Lopez et al., 2019; Magaña et al., 
2017).  To date, there have not been any studies testing group-based psychoeducation 
methods with this population. 
Behavioral Parent Training (BPT) 
One important type of intervention that can be utilized to address the needs of 
underserved families through relatively cost- and time-efficient, easy-to-learn, and 
parent-friendly strategies is Behavioral Parent Training (BPT).  Within the IDD research 
community, there is often an overall goal of improving child outcomes by reducing 
6 
“challenging behaviors,” a heterogeneous class of behaviors that includes self-injury, 
aggression, and noncompliance (Matson & Nebel-Schwalm, 2007).  Research indicates 
that early intervention implemented prior to kindergarten entry is critical in helping 
reduce these types of behaviors across the lifespan (National Research Council, 2001).  
Although there are many child-focused, clinician-led, interventions with strong evidence 
bases for reducing these behaviors (e.g., Applied Behavior Analysis, Early Start Denver 
Model, Pivotal Response Treatment, etc.), there is a lot of variability in the degree and 
nature to which parents are involved (Stahmer, 2007).   
While it is impossible for any single intervention to target all possible skill 
deficits and behavioral excesses often associated with IDD, BPT has proven effective in 
reducing a wide range of challenging behaviors.  BPT is derived from principles of 
behaviorism, and targets child problem behaviors by teaching strategies to parents for 
increasing positive interactions with their children and decreasing negative or coercive 
behaviors (McIntyre, 2013).  Bagner and colleagues (2016) specifically recommend BPT 
in infancy for high-risk, ethnic minority, families, as this represents a critical window for 
maximizing long term outcomes.  Techniques of BPT, including praise, sensitivity, and 
limit setting are associated with a wealth of positive child outcomes in typically 
developing children, and have been utilized in numerous manualized interventions, often 
as group-based programs.  Some examples include the Incredible Years Parent Training 
(IYPT), Positive Parenting Program (Triple P), and Parent Child Interaction Therapy 
(PCIT). 
There is also increasing evidence that these programs can be adapted and utilized 
specifically for children with IDD (McIntyre, 2013; Matson et al., 2009).  McIntyre 
7 
 
(2013) identified 19 studies representing 11 different parent training programs that 
specifically looked at the effect of parent training, without other components, on children 
with IDD.  The vast majority of these studies demonstrated reductions in child problem 
behaviors and increases in observed positive parenting behaviors.  In one example of 
modifying a BPT program to meet the needs of these families, McIntyre (2008a, 2008b) 
adapted the IYPT intervention by incorporating aspects of the IDD literature into the 
standard curriculum.  IYPT is a 12-session, 2.5 hour per session, BPT curriculum that 
was originally developed for parents of typically developing children.  Adaptations made 
to meet the needs of families with IDD and ASD included modifying video vignettes to 
be more appropriate to children with delays, removing content around “time out” that has 
proven less effective with children with developmental disabilities, and adding additional 
content on predicting and responding to challenging behaviors (McIntyre, 2008b).  These 
studies found that the children with IDD and their parents improved similarly to parents 
in studies of typically developing children, and that the parents were satisfied and 
engaged in the modified program. 
 Additionally, research indicates that Hispanic parents may benefit similarly from 
parent training interventions as do non-Hispanic White parents (Ramos et al., 2018).  
Calzada and colleagues (2013) conducted focus groups with Hispanic mothers around 
how they viewed different parenting strategies considered evidence based.  These authors 
found that Hispanic mothers found some such strategies acceptable, including 
specifically the use of praise and social rewards.  These mothers found some strategies 
(i.e. elimination of spanking) less acceptable, and were divided on others (i.e. time-out).  
Much of the implementation research with this population has been done utilizing Parent 
8 
Child Interaction Therapy (PCIT), which uses more individualized and tailored strategies 
than does IYPT or other group-based interventions, while still targeting very similar 
parenting behaviors and child outcomes (Zisser & Eyberg, 2010).  Results have been 
promising, with multiple RCTs showing PCIT to be similarly effective in Spanish, 
although parents needed additional opportunities for practice to master certain skills, 
compared to when the intervention has been delivered in English (McCabe & Yeh, 2009; 
Ramos et al., 2018).  Ogg and colleagues (2014) looked specifically at implementation 
and attendance with this population, and found no differences in attendance between 
those who received BPT groups in English and Spanish.  To date, research with this 
population has only been done with parents of typically developing children, and has not 
been tested with Spanish-speaking parents of children with IDD.  This is despite the fact 
that some research has indicated that certain parenting practices, such as improved 
scaffolding and sensitivity to child’s cues, might be even more critical for Hispanic 
caregivers in reducing challenging behaviors of children with developmental delays 
(Marquis & Baker, 2014). 
Telehealth 
Although all of the above interventions are typically delivered via live, in-person, 
sessions, there have been increased attempts in recent years to test online delivery 
modalities, or telehealth.  A recent review study identified 31 technology-based behavior 
parent training interventions, and found that they generally had positive effects in 
improving outcomes such as parent knowledge, behavior, and self-efficacy (Corralejo & 
Rodriguez, 2018).   These interventions primarily consisted of websites, DVDs, or other 
technology-based sources of information, often accompanied with individual coaching, 
9 
rather than live online groups.  Significant pre-post differences in reports of parenting 
behavior were found for the majority of these studies.  One study did deliver a BPT 
intervention in an online group format, and found comparable effect sizes to groups 
delivered in person (Reese et al., 2015).  However, the authors acknowledge a limitation 
of these studies being that they were validated with primarily higher SES, White 
caregivers, and may not be accessible to underserved populations (Corralejo & 
Rodriguez, 2018).   
There is also some evidence supporting online BPT interventions for parents of 
children with development disabilities.  A number of studies have found positive effects 
of different forms of internet-delivered BPT for children with ASD, including treatment 
acceptability, parent knowledge, and child behavior (Ingersoll et al., 2016; Vismara et al., 
2013; Wainer & Ingersoll, 2015).  These results have been replicated for parents of 
children with other disorders known to cause challenging behaviors, including ADHD 
(DuPaul, 2018; Xie et al., 2013).  However, similar to the interventions used for typically 
developing children, these online BPT interventions have primarily been conducted in a 
format where caregivers access a website or other source of technology-based materials, 
and are either self-guided and self-paced, or individualized and include the assistance of a 
coach.   
Finally, my literature search uncovered no attempts to deliver BPT or other 
parenting interventions in a telehealth format to Spanish-speaking Hispanic caregivers.  
One study described an exploratory process of developing a culturally adapted website of 
ASD-related information in Spanish (Buzhardt et al., 2015).  This website, the Online and 
Applied System for Intervention Skills (OASIS) is a training program for parents 
10 
designed to increase their ability to teach new skills and manage challenging behaviors 
for their child with ASD.  The authors of this study discussed their cultural adaptations to 
the English OASIS website based on recommendations developed through input from 
focus groups and an advisory board. Although the website was culturally adapted with 
information presented in Spanish, it does not appear that any studies have been conducted 
thus far to test the accessibility and efficacy of the program with Spanish-speaking 
Hispanic populations.  There also do not appear to be any examples in the literature of 
online group-based parenting interventions delivered in Spanish. 
Literature gap 
While the aforementioned interventions (psychoeducation, MBSR, BPT) have 
been shown to be generally effective with White middle- to upper-socioeconomic status 
(SES) families, there is much less evidence of their effectiveness when delivered in 
Spanish to lower- SES Hispanic caregivers of children with IDD.  Furthermore, no 
studies have looked at the efficacy of utilizing telehealth methodologies for any type of 
intervention with these families.  In order to begin developing the evidence base for 
treatments with this population, an important first step is to examine acceptability and 
feasibility of intervention content, study design, and procedures (Gadke et al., 2021).  
Establishing initial acceptability and feasibility through investigating attendance, 
satisfaction, and alignment with cultural and familial values and norms, is essential to 
informing the next steps of this program of research.  Once preliminary evidence of 
satisfaction and feasibility is established, efficacy of intervention on child and parent 
outcomes can be investigated.  In this study the feasibility and acceptability of the 
psychoeducation, MBSR, and BPT interventions, as well as the telehealth delivery 
11 
 
modality, are investigated with Spanish-speaking Hispanic caregivers of children with 
IDD.  The data gathered from this process can address the dearth of studies examining 
parenting interventions for Spanish-speaking caregivers of young children with IDD and 
inform the field about the types of interventions that can be feasibly delivered with this 
often underserved population. 
Current study 
 The present study is part of a larger NIH-funded longitudinal, randomized control 
trial (RCT) examining differences in the efficacy between two interventions aimed at 
helping parents of young children with developmental delays cope with stress and 
manage child challenging behavior (McIntyre & Neece, 2018).  This RCT is ongoing and 
is being conducted in the greater Portland metro area of Oregon and in Southern 
California in the Inland Empire region surrounding Loma Linda, California.  The two 
interventions being compared in the larger RCT are BPT combined with MBSR (BPT-M) 
and BPT combined with psychoeducation/support (BPT-E).  Participants are enrolled and 
randomized to either the BPT-M or BPT-E condition and receive their intervention in a 
group-delivered format.  In BPT-M, participants receive six weeks of group-based MBSR 
intervention, followed by 10 weeks of group-based BPT.  In BPT-E, participants receive 
six weeks of group-based psychoeducation, again followed by 10 weeks of the same 
group-based BPT intervention.  Although BPT is delivered to both conditions, 
participants remain in their original group assignment.  The reason for this treatment 
order in the larger RCT is to test the additive effects of a stress reduction component prior 
to BPT, with MBSR directly targeting stress and psychoeducation serving as an active 
control.  The core BPT intervention for both groups was the IYPT program for children 
12 
with IDD (McIntyre, 2008b) described above.  See the Method section for further 
description of all three interventions.  Also of note, the content of all three of the above 
programs was directly translated to Spanish but was not further adapted or modified.  
Video examples that accompany the BPT curriculum were provided dubbed in Spanish 
by the Incredible Years publishing company. 
By way of context, for the larger RCT study, 230 families will be recruited by the 
end of the full trial in 2023.  The larger RCT to date includes two completed English-
speaking cohorts (English N = 80) and one monolingual Spanish-speaking cohort 
(Spanish N = 60) in Loma Linda, California.  The present study focused primarily on the 
Spanish-speaking cohort, with some comparisons made with the English-speaking 
cohorts.  Additionally, because the English-speaking cohort at Loma Linda had a large 
proportion of Hispanic participants (based on self-reported ethnicity on a demographics 
form), the English-speaking group was analyzed as English-speaking Hispanic and 
English-speaking non-Hispanic participants.  This allowed us to parse out differences 
brought on by participant ethnicity as opposed to just language of intervention delivery.  
Questions of feasibility and acceptability are especially relevant among these different 
groups given the relative dearth of intervention research, particularly for interventions 
delivered in Spanish.  Specifically, there are three primary research questions:  
1) Do attendance and ratings of intervention satisfaction differ between parents who
participated in the psychoeducation intervention versus the MBSR intervention
groups in Spanish?
2) Do attendance and ratings of intervention satisfaction differ between parents who
participated in the psychoeducation intervention and MBSR intervention groups
13 
in Spanish versus those who participated in English, and do those differences hold 
regardless of demographic factors? 
3) Do attendance and ratings of intervention satisfaction differ between parents who
participated in the BPT groups in Spanish versus those who participated in
English, and do those differences hold regardless of demographic factors?
Although there are no studies explicitly focusing on the feasibility and 
acceptability of these types of interventions with Spanish-speaking Hispanic caregivers of 
children with IDD, there are studies that have examined outcomes of similar types of 
interventions that were either individualized (Lopez et al., 2019), run in English with 
interpreters (Neece et al., 2019), or completed with parents of typically developing 
children (McCabe & Yeh, 2009; Ogg et al., 2014; Ramos et al., 2018).  Based on the 
generally promising results of these studies with Hispanic caregivers, several hypotheses 
were made about the outcomes of the research questions.  Overall, it was hypothesized 
that the MBSR, psychoeducation, and BPT interventions would be perceived as equally 
as acceptable by Spanish-speaking participants as by English-speaking participants, with 
some potential for differences within the Spanish cohort specifically.  This would provide 
support for the generalizability of these interventions, and further justification of their use 
with this population. 
First, it is hypothesized that parents in both the MBSR and psychoeducation 
conditions in Spanish will express high acceptability (i.e., mean of 6 or higher on 7-point 
Likert scale) with those interventions, with the psychoeducation group potentially 
displaying even higher ratings as it may fill a specific knowledge gap for this population 
(Chlebowski et al., 2018) and may be less culturally dependent than MBSR.  Second, it is 
14 
hypothesized that participants who complete the MBSR and psychoeducation groups in 
Spanish will have comparable acceptability to those who complete these groups in 
English, with non-significant overall differences of language group by intervention.  
Third, it is hypothesized that participants who complete the BPT groups in Spanish will 
have comparable acceptability to those who complete the groups in English.   
15 
II: METHOD 
Interventions 
Mindfulness-Based Stress Reduction (MBSR) 
The MBSR intervention consisted of a combination of didactic training, practice 
exercises, and discussions about mindfulness delivered by a certified MBSR instructor.  
Specifically, the MBSR program included six weekly 2-hour group sessions, 30–45 
minutes of daily home practice guided by instructional audio CDs, and an MBSR parent 
workbook.  Participants were taught formal mindfulness exercises designed to increase 
mindful practices (i.e., nonjudgmental awareness of the present moment), including body 
scans, mindful yoga, and sitting meditation.  The MBSR instructor also taught ways to 
informally practice mindfulness in daily life, and how to use the strategies specifically to 
combat stress.  During intervention sessions, participants practiced formal mindfulness 
exercises and asked questions relating to the practice of mindfulness in everyday life.  
The MBSR component of BPT-M is pared down somewhat from standard MBSR 
intervention in that it includes six, rather than eight, sessions and does not include a 
daylong meditation retreat at the end.  Abbreviated MBSR interventions are becoming 
increasingly common in both clinical and research settings to increase feasibility for 
participants, with research suggesting that similar gains can be made with less class time 
(Carmody & Baer, 2009). 
Psychoeducation and support 
The psychoeducation intervention was designed as a support group in which 
parents were provided with information and encouraged to discuss with one another 
relevant supports and resources for their children related to their development, disability, 
16 
education, therapies, and other services.  The psychoeducation intervention similarly 
consisted of six weekly 2-hour sessions, daily homework that included monitoring 
progress on session goals, and a workbook for parents of children with special needs that 
provides information on child development, disability, and associated considerations.  
Each of the psychoeducation sessions centered around a specific topic/theme considered 
relevant and important for participants.  These topics were: Preparing for Individualized 
Education Plan (IEP) meetings, Navigating Developmental Service Agencies, 
Communicating with Teachers, Advocacy, Sibling Issues, and Community Resources.  
Each psychoeducation session began with group leaders providing some didactic 
information on the topic, then breaking parents up into pairs for small-group discussion, 
and finishing with a larger group discussion based on what parents shared amongst one 
another. 
Behavioral Parent Training (BPT) 
As mentioned in the introduction, the 10-week BPT intervention that all 
participants received was the Incredible Years Parent Training modified for children with 
developmental delays (IYPT-DD).  IYPT-DD sessions were led by a team of two group 
leaders/ co-therapists and were built around videotape vignettes (using Webster-
Stratton’s original content; see Webster-Stratton, 2006).  Sessions included discussions, 
role-plays, modeling, and feedback techniques to achieve engagement with and mastery 
of the content.  Parents were given weekly homework assignments that involved thinking 
about and practicing session content.  In IYPT-DD, much of Webster-Stratton’s original 
content is retained, including lessons on play, praise, rewards, limit setting, and handling 
challenging behaviors.  Modifications in the adapted version included 
17 
expanding/adapting discussion questions and key points to those that best generalize for 
children with DD, having parents identify positives and challenges of raising a child with 
DD (Session 1), excluding content about time out, teaching parents how to predict and 
avoid problem behavior by tracking antecedents and consequences (Sessions 6-7), and 
providing informational handouts to parents about disability-related supports and 
kindergarten transition (Session 10; McIntyre, 2008a, 2008b). 
Participants 
Primary caregivers of preschool-aged children (3-5 years) with IDD were 
recruited to participate in this study.  To be eligible, caregivers needed to report that they 
were their child’s primary caregiver; their child had either a medical diagnosis or early 
childhood special education eligibility of ASD or developmental delay; and their child 
experienced elevated behavior problems.  Further, parents needed to confirm that their 
child was in their custodial care and that they were interested in participating in a 16-
week stress reduction and behavioral skills training intervention.  For the Spanish-
speaking cohort, all caregivers were Hispanic who identified Spanish as their primary 
and/or only language.   
Recruitment took place through the distribution of informational flyers to doctor’s 
offices, specialty clinics, and regional service centers in the greater Inland Empire region 
of Southern California (Riverside and San Bernardino counties).  Potential participants 
were invited to call the PRO-Parenting project research office to express their interest in 
participating, and these caregivers were then contacted by a bilingual research assistant.  
In total, 207 Spanish-speaking caregivers expressed initial interest in this study.  We were 
able to speak with and screen 158 of these individuals for inclusion.  Of these, we 
18 
 
excluded 40 for not having a child between 3 and 5-years-old, three for not having a child 
identified with ASD or DD, and three for already being enrolled in a different type of 
parenting class or therapy.  An additional 52 chose not to participate due to a lack of 
interest after hearing a further description of the study, its purpose, and what would be 
required of participating parents.  Therefore, we ended up with a final sample size of 60, 
with 30 each being randomly assigned to BPT-E and BPT-M respectively.  See Figure 1 
for additional information.  Randomization occurred at the baseline assessment 
(described below). 
Primary caregivers for this cohort included 57 mothers, two grandmothers, and 
one grandfather.  At enrollment, 34 of these caregivers reported their child as having 
ASD; four reported that their child was currently identified with a different 
developmental delay but that they were on the waitlist for an ASD evaluation; and 22 
reported that their child had a developmental delay or disorder other than ASD, including 
speech delay or Down syndrome.  Additionally, of note, participants were an average of 
25.1 (and maximum of 76.3) miles away from Loma Linda University where the groups 
were to take place.  See Tables 1 and 2 for additional demographic information. 
Procedure 
 Eligible participants were assessed at baseline/pre-intervention in an initial home 
visit.   During the home visit, participants completed informed consent, an interview to 
collect demographic information, and a 15-minute parent–child interaction play-based 
observation.  Following these tasks, participants were then randomly assigned to either 
BPT-M or BPT-E, and completed a brief motivational interview as part of a Participant 
Enhancement Intervention (PEI; Nock & Kazdin, 2005), designed to improve parent 
19 
engagement in the interventions used in the study.  The PEI is designed to elicit self-
motivational statements from participants about desire to participate and their goals and 
hopes for intervention.  Enrolled participants were also contacted by study staff and 
completed a second PEI the week before the intervention.  
Intervention groups were run concurrently (i.e., BPT-E on Monday and BPT-M 
on Wednesdays) over the course of the 16 weeks.  Each session was scheduled for two 
hours, and was intended to be run in-person at Loma Linda University.  As recommended 
by Ratto et al. (2017), sessions were run in the evening so that parents were able to attend 
around their work schedules, snacks and childcare were provided to families at each 
session, and research staff communicated with families via text to check-in and provide 
reminders about group each week.  After week six of the intervention, coincidentally 
falling immediately after parents had completed the first part of the intervention, groups 
were paused temporarily due to COVID-19 school closures and restrictions on public 
gatherings.  Following a four-week pause, groups resumed with the BPT curriculum 
delivered in a synchronous, live telehealth format delivered via a HIPAA-protected and 
licensed Zoom platform.  Prior to resuming the groups online, participants were surveyed 
by study staff about their willingness and technological capability to access groups in this 
manner, with the vast majority responding positively to this potential change (McIntyre et 
al., 2021). 
As part of the larger RCT, participants in both groups will have post-treatment, 6-
month, and 12-month follow up assessments that include a battery of the same 
questionnaires and play activity as at baseline.  The post-treatment assessment included 
an additional measure of social validity/consumer satisfaction.  The current study used 
20 
data from the baseline assessment and post-treatment consumer satisfaction survey. 
Focus Groups 
Participants in the Spanish cohort also took part in focus groups approximately 
five months after completion of the interventions, to gather additional, qualitative, 
information about how acceptable and relevant parents found the intervention groups.  
Focus groups were run five months after the intervention so that they did not overlap with 
post-intervention assessments, and to see what intervention strategies were still being 
used some time after the intervention ended.  A total of four focus groups were run over 
Zoom in November, 2020.  Two focus groups were conducted in the morning (Monday, 
Wednesday) and two focus groups were conducted in the evening (Monday, Wednesday). 
Participants from the BPT-E condition were invited to attend a morning or evening focus 
group session on Monday and participants from the BPT-M condition were invited to 
attend a morning or evening focus group session Wednesday.  In order to be eligible to 
participate in the focus groups, participants needed to have attended at least one session 
of the first six weeks of intervention (MBSR or psychoeducation) and one session of the 
final 10 weeks of intervention (BPT), in order to have at least some knowledge of the 
content of the groups from which to base opinions.  All 38 participants who met this 
qualification were contacted and asked if they wished to participate in the focus group, 
and were given their choice of time. 
A total of 24 participants took part in the four focus groups (14 from BPT-E; 10 
from BPT-M).  These 24 participants had attended an average of 5.46 of the six initial 
psychoeducation or MBSR sessions, and an average of 8.29 of the 10 BPT sessions.  
Participants were compensated $25 to cover their time.  Each group met for about an hour 
21 
and was facilitated by the first author and assisted by other graduate students.  Focus 
groups utilized a semi-structured format to make sure specific areas were covered 
adequately at each group, but participants were encouraged to discuss and expand upon 
topics as they wished.  All focus groups began with the moderator briefly reviewing the 
content of the interventions they had participated in (i.e., psychoeducation and BPT for 
Mondays, MBSR and BPT for Wednesdays).  The remaining time of the focus groups 
was divided into three sections: 1) aspects of the interventions participants found most 
relevant/helpful and have continued using five months later; 2) aspects of the intervention 
they found least useful and barriers to implementing strategies; and 3) whether they felt 
the groups were well aligned with their individual/ familial/ cultural values, whether they 
thought other Hispanic families would feel comfortable using the strategies in the group, 
and how we could potentially adapt the content to be more relevant to Hispanic families.   
Measures 
For all measures utilized with the Spanish cohort, we either obtained a published 
copy of the measure in Spanish or translated the measure ourselves into Spanish using the 
forward-back translation method.  This method involves having one bilingual staff 
member translate the 
instrument from English to Spanish, and a different bilingual staff member translate the 
Spanish version back to English. The two versions are then compared and discrepancies 
resolved by the bilingual team with oversight by a bilingual psychologist.  
Demographics  
During the baseline appointment, all participants completed a demographic intake 
form with a member of the study staff to collect information such as caregiver and child 
22 
age, biological sex, race and ethnic background, language spoken at home, highest level 
of caregiver educational attainment, household income, and child diagnosis.  Caregiver 
education level was dichotomized as above or below high school graduate, as that 
represents a base level of education often needed for employment and other opportunities 
in the United States.  Income was dichotomized as above or below $30,000 because it 
roughly represents the federal poverty threshold for a family of four or five in the years 
the data were collected.  Finally, caregivers reported on their service utilization, including 
any outside services the caregiver or child was currently accessing.  
Acculturation 
The Vancouver Index of Acculturation (VIA; Ryder et al., 2000), a 20-item scale 
measuring two domains: orientations towards heritage and towards mainstream cultural 
groups, was used to assess acculturation in the study sample.  Items encompass an array 
of aspects related to the acculturation process, including values, social relationships, and 
adherence to cultural norms.  The VIA can be utilized generally for any immigrant group, 
rather than targeted at a specific population.  Items on the VIA do not target questions of 
language usage specifically.  The 20 items are generated in pairs with regard to content 
area, with one item referring to the mainstream culture and the other mirror item referring 
to the heritage culture.  Each item is answered on a 9-point Likert scale of agreement.  
Two separate scores are generated (Heritage Subscore and Mainstream Subscore), with 
higher score indicating a positive orientation toward the specific cultural group.  Internal 
consistency reliability for the VIA in the present sample was Chronbach’s α = .88 for the 
Heritage Subscore and Chronbach’s α = .90 for the Mainstream Subscore, indicating that 
there was high internal consistency. 
23 
Parenting Stress 
The Parenting Stress Index, Fourth Edition- Short Form (PSI-4-SF) is a self-report 
questionnaire that includes 36 items assessing parenting stress (Abidin, 2012).  These 
items are broken into three domains: Parenting-Child Dysfunctional Interaction (9 items), 
Difficult Child (9 items), and Parental Distress (9 items), with the sum of these domains 
forming an overall Total Parenting Stress Score.  Items are rated on a 5-point Likert scale 
with scores ranging from 1 (strongly agree) to 5 (strongly disagree).  Research has 
supported similar alpha coefficients and factor structures for the Spanish version of the 
PSI used with Hispanic mothers and other high-risk samples, supporting the cross 
cultural utility of this measure with this population (Solis & Abidin, 1991; Barroso et al., 
2016).  Internal consistency reliability for the PSI in the present sample was Chronbach’s 
α = .88 for the Total Parenting Stress score, indicating that there was high internal 
consistency. 
Child Problem Behaviors 
Child problem behaviors were measured in this study utilizing parent report on 
the Child Behavior Checklist for children 1.5 to 5 years old (CBCL; Achenbach & 
Rescorla, 2000).  The CBCL is a 99-item standardized questionnaire designed to measure 
emotional and behavioral problems in young children and includes internalizing and 
externalizing items.  The caregiver or adult who spends the most time with the child of 
interest completes the items based on whether each behavior is not true, 
somewhat/sometimes true, or very/often true.  The items then load onto eight different 
domains of potential problem behaviors, which are: Emotionally Reactive, 
Anxious/Depressed, Somatic Complaints, Withdrawn, Attention Problems, Aggressive 
24 
Behavior, and Sleep Problems, with the sum of these domains forming an overall Total 
Problem Behaviors Score.  The CBCL has strong psychometric properties, and research 
has supported the equivalence of the CBCL across different racial/ethnic and 
socioeconomic groups (Gross et al., 2006).  Additionally, the CBCL has been translated 
and culturally adapted into Spanish for Hispanic caregivers in the United States, using a 
rigorous process that involved translation, back translation, and testing of psychometric 
properties (Rubio-Stipec et al., 1990; Wild et al., 2012). Internal consistency reliability 
for the CBCL in the present sample was Chronbach’s α = .95 for the Total Problem 
Behaviors score, indicating that there was very high internal consistency. 
Engagement 
Participant engagement was designed to be measured in two ways.  The first way 
that engagement was measured was simply by attendance at intervention sessions.  The 
number of sessions attended by each participant was averaged to create a mean 
attendance score for each of the two intervention groups.  See Figure 2 for attendance in 
the Spanish cohort and Figure 3 for attendance in the English cohorts.  We had also 
planned to measure engagement of parents during the Spanish BPT sessions (i.e., how 
often caregivers talked or participated in role-play activities, as we had been done with 
the English-speaking cohorts), but this proved to be too difficult and unreliable to do for 
telehealth sessions.  Given that parents were in their homes and faced with distractions 
that would not have occurred in a clinic setting (i.e., children, other family members, 
pets, environmental noise, etc.), and using a technology/platform with which they had 
little experience, it felt too difficult to accurately rate their engagement with the 
intervention, especially since cameras were turned on and off at times through the 
25 
session. 
Acceptability 
The acceptability, or social validity, of the intervention groups was measured at 
the end of the intervention phase (post-treatment) using the Parent Satisfaction 
Questionnaire, an adapted version of the Consumer Satisfaction Questionnaire (Forehand 
& McMahon, 1981).  This measure has been adapted and utilized in numerous previous 
trials investigating versions of the Incredible Years (i.e., Webster-Stratton, 1994; Reid et 
al., 2001; McIntyre, 2008a).  Parents complete this measure based on their satisfaction 
with the group leader, group dynamics, video vignettes, content covered, and methods 
utilized.  Caregiver responses on 15 seven-point Likert scale items are summed to create 
an Overall Satisfaction score between 15 and 105, with higher scores indicating greater 
satisfaction (Reid et al., 2001).  This tool has previously demonstrated adequate 
psychometric properties (McIntyre, 2008a).  For the Spanish-speaking cohort, seven 
items selected from this measure that applied to the first portion of the intervention were 
administered to participants after week six, to get a gauge of treatment satisfaction for 
psychoeducation and MBSR before beginning the BPT portion.  The full measure was 
then collected again during the final session, or week 16.  Unfortunately, only about half 
of participants attended the week six session (n = 32) and week 16 session (n = 28), and 
thus we only have satisfaction data from these caregivers.  This measure was also only 
collected for the English-speaking cohorts at week 16, or to assess the program overall, 
rather than for the six and ten week groups separately. 
Analysis Plan 
Quantitative Data 
26 
Data review and analyses were performed using Statistical Package for the Social 
Sciences (SPSS) Version 24 (IBM Corp, 2016) and R (R Core Team, 2015).  Initially 
preliminary or exploratory analyses were run to better understand the data, including 
descriptive statistics for variables of interest, including acceptability, key demographics, 
parental stress, acculturation, and child challenging behaviors.  Those who had completed 
the Parent Satisfaction Questionnaire were compared with those who had not, examining 
differences in key demographics, including caregiver educational attainment and family 
income, parenting stress, acculturation, and child challenging behavior.  These groups 
were compared using chi-square tests for categorical variables (i.e., educational 
attainment and household income) and independent samples t-tests for continuous 
variables (i.e., parent stress, acculturation, and child challenging behavior).  These same 
comparisons were run to distinguish the English-speaking and Spanish-speaking cohort 
participants. 
To address each of the three main research questions, the following techniques 
were used for primary analyses: 
1) BPT-E vs. BPT-M satisfaction and attendance for Spanish groups only:
independent samples t-tests examining intervention group as independent
variable, with satisfaction (and then attendance separately) as dependent variable.
We have satisfaction and attendance data for the Spanish cohort both for part one
(week six) and overall (week 16).
2) Psychoeducation vs. MBSR attendance for Spanish groups vs. English groups:
Analysis of Covariance (ANCOVA) examining intervention type and delivery
language as independent variables, with attendance as dependent variable, and
27 
controlling for covariates of caregiver ethnicity, income/education, acculturation, 
stress, and child problem behaviors. We do not have data on English cohort 
satisfaction after week six, and thus can only compare these groups on attendance. 
3) BPT-E vs. BPT-M satisfaction and attendance for Spanish vs. English groups:
ANCOVA analysis examining delivery language and intervention group as
independent variables, with satisfaction (and then attendance separately) as
dependent variable, and controlling for covariates of caregiver ethnicity,
income/education, acculturation, stress, and child problem behaviors.
In order to determine whether we have an adequate sample size to detect medium 
effects, an a priori power analysis was conducted using G*Power3 (Faul, Erdfelder, 
Lang, & Buchner, 2007) for an ANCOVA model with six predictors (two variables of 
interest and four covariates).  Parameters were set for a medium effect size (f 2 = 0.25), 
and an alpha of .05.  Results showed that to achieve a power of .80, there would need to 
be a total sample of 128 participants, less than the total sample of 140.  This means the 
analyses will be underpowered for analyses involving satisfaction, which had fewer 
respondents, but will be sufficient for the analyses of attendance.  Overall, the sample 
size reflects the exploratory/pilot nature of the research.  As these analyses may be 
underpowered, it will be important to look at and report effect sizes rather than just 
statistical significances. 
Qualitative Data 
All focus group recordings were transcribed verbatim and anonymized.  We used 
thematic analysis (Braun & Clarke, 2006) to analyze the data.  As part of this process, 
data were initially coded separately by the first author, a bilingual graduate student, and 
28 
another bilingual/bicultural graduate student.  During this phase, data were coded and 
initial discursive themes were identified.  Coding involved reading through the data and 
re-watching the focus groups multiple times, then developing a set of broad descriptive 
codes based on the protocols.  Coders then met together to reach consensus on these 
codes and to identify and interpret some of the broader themes into which these codes 
could be grouped.  Codes were first collapsed within each intervention group (i.e., to 
establish a set of codes for BPT-E and BPT-M groups respectively), regardless of 
whether they had done the morning or evening focus group for that intervention.  These 
codes were then compared against each other to identify which codes were intervention-
specific, and which could apply to the overall trial.  Codes were similar across groups, 
ultimately resulting in five themes that held across both intervention groups, and one each 
that was specific to BPT-E and BPT-M interventions respectively. 
29 
III. RESULTS
Quantitative Data 
Prior to the analyses addressing the primary research questions, correlations were 
run between predictor variables.  Unsurprisingly, VIA acculturation mainstream and 
heritage subscores were highly positively correlated with each other (r = .53, p < .001.).  
No other predictor variables correlated with one another at r = .5 or greater, the typical 
diagnostic cutoff for multicollinearity (Vatcheva et al., 2016), and thus all other 
predictors were included in subsequent analyses.  For parsimony, it was determined that 
only VIA mainstream subscores would be included in the final model, as those are likely 
to more accurately represent willingness to buy-in and engage with an intervention 
delivered in the mainstream culture, as the one used in the present study. 
Individuals who had completed the satisfaction measure were then compared with 
those who had not.  There were no differences between responders and non-responders 
on baseline stress (PSI), challenging behavior (CBCL), or acculturation (VIA 
mainstream) scores, or on delivery language, intervention group, or income (p < .05).  
There were, however, statistically significant differences between responders and non-
responders on ethnicity (p = .038) and education (p = .029), with Hispanic participants 
and those with lower levels of formal education being less likely to have completed the 
measure.  This is discussed further in the limitations section of the Discussion. 
BPT-E vs. BPT-M Satisfaction and Attendance for Spanish Groups  
The first set of analyses involved comparisons between intervention groups within 
the Spanish-speaking cohort.  In the larger study, participants were randomized to either 
the BPT-E or BPT-M condition. Thus, participants were well-matched across BPT-E and 
30 
BPT-M conditions in this cohort, and there were no significant differences in 
demographic variables (see Table 1).  Distribution of satisfaction scores and attendance 
were unimodal and approximately normal with no severe skew or outliers, and thus the 
use of parametric testing methods was appropriate. For the Spanish-speaking cohort, after 
week six, ratings of satisfaction were high in both groups, with mean satisfaction scores 
of 42.81 and 44.31 (out of 49) for those who participated in psychoeducation and MBSR 
respectively.  These equate to average item scores of 6.12 and 6.33 respectively (on a 7-
point Likert scale) across the seven items that were used to assess satisfaction at this time 
point.  These differences were not statistically significant, t(30) = -0.97, p = .341.   
Similarly, after week 16, ratings of satisfaction were still high in both groups, 
with mean satisfaction scores of 95.21 and 90.31 (out of 105 maximum score) for those 
who participated in BPT-E and BPT-M respectively.  These equate to average item scores 
of 6.35 and 6.02 respectively (on a 7-point Likert scale) across the 15 items that were 
used to measure overall intervention satisfaction.  These were also not statistically 
significantly different from one another, t(25) = 1.93, p = .065.  In examining specific 
satisfaction items, the highest-rated item for both BPT-E and BPT-M was “I would 
recommend the program to a friend or relative.”  The lowest-rated item for both 
intervention groups was “My child’s problems which I have not tried to change using the 
methods presented in this program are greatly improved.”  We also ran analyses on 
intervention attendance for the Spanish cohort.  There were no significant differences 
between BPT-E and BPT-M attendance for either the first six week, in-person, sessions, 
t(58) = 0.41, p = .684, or the latter 10 week, virtual BPT sessions, t(58) = -0.06 , p = .951.  
BPT-E vs. BPT-M Satisfaction and Attendance for Spanish vs. English Groups  
31 
The second set of analyses involved comparisons between the Spanish-speaking 
cohort and the previously completed English-speaking cohorts.  There were several 
statistically significant differences between participants in the Spanish and English 
cohorts, even after breaking down the English-speaking participants by ethnicity; these 
differences include caregiver age, baseline stress, education, and income (see Table 2).  
Post-hoc comparisons revealed that all statistically significant differences between groups 
were between Spanish-speaking and English-speaking cohorts.  There were no 
differences between the two subgroups (Hispanic, non-Hispanic) of the English-speaking 
cohorts. 
Again, distribution of satisfaction scores and attendance were unimodal and 
approximately normal with no severe skew or outliers, and thus the use of parametric 
testing methods was appropriate.  An ANCOVA was conducted examining attendance at 
the psychoeducation versus MBSR sessions.  There was no significant overall effect of 
intervention and language on attendance through week six, after controlling for ethnicity, 
income, education, acculturation, stress, and child problem behavior, F(9, 99) = 0.73, p = 
.677.  There was, however, a significant main effect of delivery language, F(1, 99) = 
5.05, p = .027.  This was a small to medium effect, partial η2 = .05.  No other predictors 
or covariates had significant effects on attendance through week six.  See Table 3 for a 
summary of these results. Participants in the Spanish psychoeducation (M = 4.50, SD = 
2.09) and Spanish MBSR (M = 4.43, SD = 1.91) groups had higher attendance than those 
in the English psychoeducation (M = 3.77, SD = 2.16) and English MBSR (M = 3.89, SD 
= 1.95) groups across the first six sessions.  
The above ANCOVA was then run with the dependent variable of attendance at 
32 
the BPT sessions.  There was again no significant overall effect of intervention and 
language on attendance, after controlling for ethnicity, income, education, acculturation, 
stress, and child problem behavior, F(9, 99) = 0.81, p = .613.  No predictors or covariates 
had significant effects on attendance for weeks seven through 16.  See Table 4 for a 
summary of these results.  Participants in the Spanish BPT-E (M = 6.27, SD = 3.82) and 
Spanish BPT-M (M = 6.14, SD = 3.86) groups had comparable attendance to those in the 
English BPT-E (M = 5.52, SD = 4.24) and English BPT-M (M = 5.14, SD = 4.10) groups 
across the BPT sessions, which were the final 10 weeks of intervention.  See Figure 3 for 
the visual representation of attendance across the study. 
The same ANCOVA was then used to evaluate treatment satisfaction following 
completion of the entire 16-week intervention.  There was a significant overall model 
effect of intervention and language on satisfaction, after controlling for ethnicity, income, 
education, acculturation, stress, and child problem behavior, F(9, 56) = 2.31, p = .027, 
accounting for 27.1% of the variance in total satisfaction.  While neither intervention type 
nor language was significant on its own after controlling for the covariates, the 
interaction effect of intervention type by language was significant F(1, 56) = 7.16, p = 
.010.  This was a medium to large effect, partial η2 = .11.  No other predictors or 
covariates had significant effects on overall treatment satisfaction.  See Table 5 for a 
summary of these results.  Participants who completed the BPT-E intervention in Spanish 
reported greater average satisfaction (M = 95.17, SD = 7.41) than those who completed 
the BPT-E intervention in English (M = 87.48, SD = 8.09).  The reverse was true for 
BPT-M, in which those who completed the intervention in English (M = 94.00, SD = 
5.75) reported greater satisfaction than those who completed it in Spanish (M = 89.82, SD 
33 
= 6.26).  This pattern held even after breaking down the English-speaking participants by 
ethnicity.  See Figure 4 for the visual representation of this effect. 
Qualitative Data 
Our thematic analysis revealed that participants found many aspects of the 
interventions beneficial, while other aspects of the groups created greater challenges or 
barriers in either their relatability to families or sustainable use.  Seven themes emerged 
from focus group discussions of intervention strategies, two of which seemed unique to 
their specific intervention, and five of which appeared to cut across intervention 
condition. The seven themes were: (1) BPT-M: inconsistent use of MBSR strategies; (2) 
BPT-E: great value in discussions around school advocacy and their child’s Individual 
Education Program (IEP)/; (3) Both conditions: enjoyed learning from other parents and 
feeling less isolated, peer-to-peer, other parents as models; (4) Both conditions: most felt 
behavioral strategies were useful (i.e., praise, rewards, focus on positive/ ignoring 
negative behaviors, strategies for virtual school during COVID); (5) Both conditions: 
experienced successes and challenges getting other family members on board; (6) Both 
conditions: found content culturally acceptable, other than video examples; appreciated 
groups being delivered in Spanish; (7) Both conditions: mixed on delivery modality of in-
person versus via telehealth.  As a note, all parent quotations provided in this section 
have been translated to English.  See Appendix B for the original Spanish quotations.  
Additionally, any names used in quotations are pseudonyms to avoid identifying any 
participating family. 
Theme 1: Inconsistent Use of MBSR Strategies  
34 
Participants in BPT-M reported rather differing opinions about the extent to 
which they continued to use MBSR strategies, such as meditation, visualization, and 
breathing, in the five months following the completion of intervention. 
Successes with MBSR Strategies. There were several parents who reported that 
they had been able to continue using MBSR strategies and found them helpful in both 
everyday life and in moments when they were feeling particularly stressed.  One mother 
who felt strongly that these techniques had been useful for her reported: 
What I really liked was the mindfulness, and I have tried to do it. I don't do it 
daily, but it does help me a lot with stress, feeling relaxed and I think that for me 
it was the best of everything. 
Challenges with MBSR Strategies. In contrast, other parents described 
challenges they had with maintaining use of the MBSR practices beyond the intervention 
sessions.  While even those parents who were not still using the MBSR strategies 
reported finding benefit in them at the time of the groups, they detailed a number of 
logistical barriers to the ongoing practice, including having trouble finding the time/space 
to do it, and struggling to engage in meditation without the group leader to guide them. 
One parent summarized these challenges: 
Honestly, I have not used the breathing much. At first when I was practicing it, I 
did feel that it helped me a lot. I was helped by what I learned about not worrying 
about things that will happen. It has helped me a little to [have] less stress, but 
honestly I have not practiced it. I forget, I don't have the time, I always have many 
things to do and I end up forgetting about it. 
Theme 2: Helpfulness of Psychoeducation 
35 
 
Participants in BPT-E reported great benefit, including increased self-efficacy, 
from the discussions around school advocacy and developing their child’s IEP.  These 
participants detailed how their increased knowledge in these service systems increased 
their confidence in working with school teams and even changed some immediate 
outcomes for their children.  One caregiver provided a very specific and timely example 
of how she had used the information from the groups to feel confident protecting her 
rights in a school team meeting: 
It helped me from the beginning, since I started with you with my son. It has 
changed a lot. In fact, we are going to have my son's IEP on Thursday. I asked the 
teacher, because she sent me a message saying, “On Wednesday I will send you 
the IEP papers”; I said, "No, I need you to send them before because I need to 
review them, see that everything is okay and also I need to tell you that my son's 
coordinator from the regional center will be at the meeting, [his] ABA [team] will 
also be at the meeting, the supervisor and the one who comes to my house for 
therapy as well.”  I didn't ask her, rather I said, "I hope that’s okay” because I 
know it's going to be okay. 
Another mother shared how her increased knowledge in these areas changed how her 
child’s school viewed her and even resulted in an improvement in her child’s education 
placement: 
With the information that you gave us, I have been able to discern and adjust 
these two legal documents that are very important... Effectively, it changed the 
posture of the IEP team. They had to change my daughter from where she was. 
She was in a harsh system, [but] now she is in an autism group, completely. 
36 
Theme 3: Sense of Community 
Participants in both intervention conditions reported learning a lot from the other 
parents in their group, and seeing the other parents as role models who they hoped to 
emulate with their own parenting practices.  Participants also reported feeling less 
isolated as a result of the groups, and appreciated being able to meet and talk to other 
parents of children with developmental disabilities. 
Learning from Other Parents. Many of the caregivers felt that they learned a lot 
of strategies from the other participants in the group, and found it particularly useful to 
hear that things worked for those with similar lived experiences to themselves.  One 
mother shared: 
Hearing experiences from others helps you, what didn't work for me, maybe it 
worked for others. You take in all these experiences, because it is very varied, 
learning is without limit. There is no child that’s the same [as yours], what works 
for another doesn’t always work for you, but sometimes it is good to know 
different techniques. Especially if it comes from another parent's experience. 
Similarly, other caregivers reported learning about the character and strength of other 
parents in the group from hearing their stories, in addition to just strategies they have 
used.  One participant disclosed that learning from other parents had changed her outlook 
in important ways: 
I learned to appreciate, and the truth is that you all are like heroes, because I don't 
know how you do it with two children, with more children. I imagine it must be 
very difficult, but I learned to value everything, and I learned a lot about how you 
all are fighters and how you are-- that you are not ashamed of your children-- 
37 
 
because before I was ashamed. But in therapy with you all, in the classes, I 
learned a lot of things and I learned to have more love for my son, more 
dedication, more time, everything. I especially learned a lot from those of you that 
have more than one child. It's amazing how strong you all are, truly. 
Feeling Less Isolated. The parents in both intervention conditions, although 
slightly more in the BPT-E group where this was an explicit focus of the first six weeks 
of intervention, also noted the importance of just knowing there were so many people 
near them with similar stories.  A participant shared that: 
The part that I liked the most was the beginning, where I met other parents, where 
I listened to the stories, where I felt understood, knowing that I am not alone, that 
I am not the only mother or father in this city, in this world. 
One father who regularly attended the BPT-E groups added that he felt this reduction of 
isolation was particularly important for Hispanic families: 
Culturally, obviously we are like-- from Mexico to Chile we are more passionate 
and a little more sociable. What got us involved was during the first six weeks of 
getting to know each other, understanding one another and saying, “Okay, I'm not 
a unicorn and we all have the same difficulties.” 
Another participant also felt that seeing others parents of children with similar challenges 
had allowed her to value and appreciate her own situation more: 
Before, I felt blind. I didn't know where to start, what to do. Even though from the 
age of three she was with the regional center, therapies and all this. But it wasn't 
until we got to this group that I felt like I could see... I look at my daughter and 
say, "my girl is fine," she has her moments, but I say, "okay." And as Lucia said, 
38 
if they [other moms] can do it, why can't we? They are the example that we must 
see and follow. 
Theme 4: Utility of Behavioral Strategies 
The majority of participants across both intervention conditions reported that the 
behavioral strategies learned during the final 10 weeks of intervention (BPT) were useful 
and that they continued to use them.  The most commonly reported strategies that parents 
were using were praise and rewards systems:  
I think that praise-- praise has worked very well for me. They, I have two that are 
twins, they get very frustrated, and to help them do something, and so that they 
are not so frustrated when they are doing it, I always tell them, “You are doing 
very well,” or “good job” … I see that they get motivated, and that helps a lot. 
Also, another thing is the rewards. It is also something that works well for me for 
all their behaviors. 
Other behavioral strategies that participants reported continuing to use included 
understanding and intervening based on functions of behavior, following the child’s lead 
during play, and having more patience/ giving fewer commands.  One parent reported 
understanding functions of challenging behavior: 
In general, for me it was a very good experience, we learned a lot. Quite simply it 
has simplified many things that we had mental barriers about, now [the strategies] 
allow us to handle a situation a little more calmly and understand why the 
behavior is happening and what we need to do to help it. The truth is that we have 
seen a great difference, there was a great ‘before and after.’ 
Theme 5: Incorporating Other Family Members 
39 
 
Participants across the groups reported both successes and challenges integrating 
other family members into using the strategies. Although participants were allowed to 
bring one other caregiver with them to the groups, many came by themselves and had to 
determine how and whether they would disseminate the information to their families. 
Successes. Several participants discussed the benefits they had seen in being able 
to teach strategies from the groups to other members of their family (e.g., spouses, 
parents, older children) who regularly took care of the child with a developmental 
disability.  One participant who did regularly attend the intervention together with her 
husband commented: 
In general, I think it helped me, at least me and my family a lot, especially [in 
helping] my husband to understand. He understood a lot more, because he is 
working all day, he has not been able to be like me in therapies with our child. 
Another participant, whose family members did not attend sessions with her, added: 
It is very helpful, both for us as parents and the family, because we are-- at least 
on my end-- I am one of those people who shares with the whole family. I try to 
share everything I learned, so that tomorrow if they are with my son alone…they 
have the knowledge to take care of him. They know that they have to have a 
requirement or a path, I form a path for them to follow forward. I see that it has 
helped me a lot with the family. 
Challenges. On the other hand, there were also participants who reported 
difficulties implementing strategies from the interventions because other family members 
who did not attend the groups did not understand or know how to use the same strategies. 
One participant detailed the challenges of this: 
40 
I also try to ignore the things that I don't want him to do. Sometimes it is a bit 
difficult because my husband is here right now and he pays attention to him. [My 
son] wants to get his attention and we are not on the same page, thinking the 
same. Because sometimes I tell him, “Don't even turn to look at him, because 
that's already getting your attention. Don't say anything to him.” It's a little 
difficult because I want to do it one way and he does something else. 
Suggestions. One participant suggested that it may be beneficial in future 
iterations of these interventions to make a more conscious effort to invite and encourage 
other family members to attend sessions, rather than just one primary caregiver.  This 
mother reasoned: 
Offer the invitation to the child's family so that they can also help the child, rather 
than just having the support of us mothers, who in reality are the ones who have 
the responsibility and duty as good mothers to be there for our children, but also 
you could involve the families in the groups so that they realize what we are 
learning. 
Theme 6: Cultural Acceptability 
Participants in both groups generally found the content culturally acceptable, and 
appreciated having groups in Spanish. Video examples that came as part of the IYPT 
curriculum were the only element reported to be culturally unaligned. 
Overall Interventions. In general, participants did not feel that group strategies 
had any culturally specific leanings toward them, and appreciated what they saw as 
‘neutrality’ in how different ideas were presented.  Others also noted that it would be 
41 
 
unfair to group all Hispanic parents under one umbrella set of beliefs, particularly since 
multiple nationalities were represented: 
It would be very difficult, I imagine, to understand all the cultures that were there. 
I really liked the way it was handled because it was not just, “Okay, Mexicans 
educate their children doing this and this,” but rather it was universal for 
everyone. In fact, I liked that because I did not feel discrimination towards any 
type of race that was there. That is my opinion. 
Many participants noted that having the groups delivered in their native language of 
Spanish were particularly meaningful, and hoped that such opportunities would continue 
for other Hispanic parents. One participant summarized: 
I think that, speaking for everyone, that you should continue with this project, that 
you don’t let it end here, and that you continue to include us. If we were the ones 
who inaugurated the class in Spanish, then you should continue because, really, us 
parents of this diverse group of children need that help. 
Video Examples. The IYPT video examples were the only aspect of any of the 
interventions that participants across focus groups felt were inappropriate, both in terms 
of culture and content.  These videos were over 20 years old, featured predominantly 
children without disabilities, and included mostly White families, who were dubbed over 
in Spanish.  Participants struggled to relate to the videos: 
About the videos, in my opinion, they seem to me to be very bland. For my 
thinking they required sincerer people, because it was as if they did not take into 
account if they could really be used with people who are Latino. They were 
videos of people who speak English, with an intermediary to tell us in our 
42 
language. To do these groups for Latino people it would be better to use parents 
who are really Latino and could personalize it more, in my point of view. 
Another participant added that the video examples were really the only place that they 
felt the groups were culturally misaligned: 
In the videos I would say, “You can tell the culture or form is different,” but the 
strategies I think that no, the strategies would be the same if it is for Americans or 
for Latinos or any other it would be the same. The strategies for me I do not think 
they should change, for me they are good no matter what race we may be, I think 
that the strategies work the same. 
Theme 7: Delivery Modality 
Participants across groups had mixed feelings with regard to intervention delivery 
modality of in-person versus via telehealth.  Although the program was never intended to 
be delivered remotely, all of the BPT intervention for both groups was delivered as such 
due to COVID-19.  While some participants appreciated not having to travel to the 
university for sessions, others found it difficult to engage in telehealth learning. 
Support for In-person Delivery. Participants who expressed preference for in-
person delivery of groups identified several advantages to this style of learning, while 
noting additional barriers to doing them virtually.  The most commonly endorsed 
advantages were the ability to meet people in person and establish better connections, and 
because the in-person groups provided childcare to take that burden away from parents 
during sessions.  One participant summarized:  
Doing it through Zoom is the only option right now but when times are better it 
would be better in person, because you learn, you meet people in person, you 
43 
become familiar, you give your points of view, yes, I prefer a thousand times in 
person than by Zoom. There are like the children, we are [in group] but suddenly 
someone passes by, we get distracted and we forget what we learned. 
Support for Telehealth Delivery. In general, the caregivers who preferred the 
telehealth delivery noted the convenience of being in one’s own home and not having to 
travel to the university to receive services.  As noted in the methods section, participants 
were traveling from an average of 25.1 miles away, and required significant time 
commitment for those coming from further away.  
Everything you have developed now in this approach that you came up with on 
the Zoom platform, it became much better for me. The reason is that I was at 
home, more comfortable, I was seeing my daughters, you don't have to travel. I 
feel that there was much better absorption of all the information. It was perfect for 
me. 
44 
IV. DISCUSSION
We delivered a series of evidence-based parenting interventions to Hispanic 
caregivers of children with IDD, the group least often included in intervention studies 
(West et al., 2016).  These groups were delivered entirely in Spanish, consistent with 
caregiver input that this would be of greater benefit than interventions delivered in 
English with live interpreters (Neece et al., 2019).  Furthermore, due to the unfortunate 
circumstances brought on by COVID-19, intervention groups for Spanish-speaking 
caregivers of children with IDD were delivered via telehealth for the first time (McIntyre 
et al., 2021).  Despite the uncertainty of both running such interventions for the first time, 
and the impact of the COVID-19 pandemic (Neece et al., 2020), Spanish-speaking 
participants engaged in the interventions similarly to those who had participated in the 
previous English-speaking cohorts.  This was demonstrated by the fact that the Spanish-
speaking groups had slightly higher attendance than the English-speaking groups for the 
first six weeks and non-significantly different attendance for the latter 10 weeks, after 
controlling for key demographic variables.  This was consistent with the findings of Ogg 
and colleagues (2014) and McCabe and Yeh (2009), that parent training groups could 
draw comparable attendance in either language. 
In examining intervention satisfaction, there was a very interesting crossover 
effect wherein neither intervention type (MBSR vs. psychoeducation) nor language of 
cohort (English vs. Spanish) predicted treatment satisfaction on their own, but the 
interaction of the conditions (intervention x language) did, even after controlling for key 
demographic variables.  This indicated that, in general, those in the Spanish-speaking 
cohort had a relative preference for BPT-E over BPT-M, while those in the English-
45 
speaking cohorts preferred the reverse. Interestingly, this effect held even after 
accounting for the fact that approximately half of the participants in the English-speaking 
groups identified their ethnicity as Hispanic.  As was noted in the demographics section 
and Table 2, the Hispanic and non-Hispanic participants in the English cohort were much 
more similar in demographics/SES to each other than they were to the individuals in the 
Spanish cohort.  This likely means that language of participation is serving as a proxy for 
SES and acculturation among the Hispanic participants, even beyond attempts to measure 
and quantify these factors.  Thus, the satisfaction differences may reflect these factors in 
addition to just language itself.  These differences are often noted in the extant literature, 
with language preference (Spanish vs. English) being highly associated with level of 
acculturation (Calzada et al. 2012), and demonstrated to predict differences between 
Hispanic families in treatment (Kim et al., 2015).  In fact, Kim and colleagues (2015) 
found that predominantly Spanish-speaking, less acculturated, Hispanic parents had 
greater satisfaction and were less likely to prematurely dropout of community-based 
parent and child treatments than were their more acculturated peers.  Less acculturation in 
Hispanic parents may serve as a protective factor for engaging in certain types of 
interventions even as factors such as immigration status serve as significant barriers to 
accessing more traditional mental health treatment services (Finno-Velasquez et al., 
2016). 
There are several other potential reasons why this crossover interaction occurred.  
It may be that those in the English-speaking psychoeducation groups did not find the 
same benefit from connecting with others, did not feel the same sense of community 
meeting other parents of children with ASD or DD, or did not find the information 
46 
presented in the groups to be as novel or relevant to them or their families as it was for 
those in the Spanish group.  Qualitative data gathered from the focus groups also 
corroborate these findings.  Participants in the Spanish language BPT-E group reported 
that they felt increased parenting self-efficacy and knowledge of their parental rights 
stemming from implementing the information they had learned in this group, consistent 
with the existing literature on psychoeducation groups with this population (Lopez et al., 
2019; Magaña et al., 2017).  These findings indicate the importance of providing 
underserved parent groups, such as Spanish-speaking Hispanics, the information to be 
able to feel confident in advocating for their child, as they may be less likely to gain that 
knowledge from other sources (Chlebowski et al., 2018).  In terms of specific 
psychoeducation topics that may be particularly valuable for this population, focus group 
participants repeatedly referenced the importance of being able to advocate for their child 
in school via the IEP process.  A literature review by Wolfe and Duran (2013) 
highlighted the complexities of the IEP process as being especially difficult for culturally 
and linguistically diverse families, in part due to insufficient information on how to 
become involved and advocate.  Therefore, it makes sense that school advocacy would be 
a highly desired, and often overlooked, area of knowledge for these families. 
Conversely, participants in the English-speaking groups may have found the 
techniques taught in MBSR to be more promising, as well as more acceptable or feasible 
within their value systems, beliefs, or lifestyles.  This would make sense given that many 
of the existing findings of MBSR for parents of children with IDD have been found with 
majority White, middle-income families (e.g. Dykens et al., 2014).  Focus group data also 
indicate why MBSR may have been rated as less satisfying for the Spanish-speaking 
47 
parents in the present study, despite some prior studies finding comparable effects for this 
population (Castellanos et al., 2020).  Participants in this study were mixed in the degree 
to which they continued to use MBSR strategies several months after the intervention, 
with multiple caregivers expressing they did not have time in their daily lives to carve out 
for such self-care activities, or were not able to do the activities without the group leader 
to guide them.  Although it is unclear if the barriers to implementing MBSR practice 
were related to the impact the COVID-19 pandemic had on family daily life, future 
iterations of MBSR for this population could be enhanced.  For example, more 
information about the importance of establishing a self-care routine could be added, as 
well as building in more scaffolded practice opportunities so parents could feel more 
comfortable using the strategies at home without the group leader present. 
Other major takeaways from this study stem from the qualitative data gathered 
from the participant focus groups.  Participants in both intervention groups reported 
appreciating and getting a lot of benefit from meeting other parents with similar stories to 
their own (i.e., other Spanish-speaking Hispanic caregivers of a child with a disability), 
learning what strategies other parents had found effective, and viewing fellow 
participants as role models from which to base their own parenting behaviors and 
attitudes.  Taken together, these principles can be viewed under the common umbrella of 
learning through community or collective experience, referred to in the literature as 
convivencia.  While the term convivencia does not translate directly to any one word in 
English, Jasis and Ordonez-Jasis (2004) define it as “the flowing moments of collective 
creation and solidarity, the bonding that developed from a joint, emerging moral quest 
against the backdrop of experiential learning” (p. 35).  This ability to come together as a 
48 
group and learn from one another speaks to the importance of group-based intervention 
for Hispanic, Spanish-speaking populations.  It also highlights the value of allowing 
participants to share their own stories and experiences as part of the intervention process, 
rather than simply treating an intervention as passing along information. 
Overall, behavioral strategies were rated favorably both with the satisfaction data 
and in the focus groups.  This was generally aligned with the literature on how Hispanic 
caregivers view common, “evidence-based,” parenting strategies.  Consistent with the 
findings of Calzada and colleagues (2013), the majority of caregivers in the present study 
found the use of praise and rewards to be acceptable and beneficial.  Strategies that 
mothers in the Calzada et al. (2013) study found less acceptable, such as using time-out 
and eliminating spanking, were not explicitly addressed as part of the adapted IYPT 
curriculum (McIntyre, 2008a) used in this trial.  Our promising findings on the 
acceptability of BPT strategies with this population correspond with what prior studies 
have found.  Although they utilized a different behaviorally-based parenting intervention, 
PCIT, separate studies by McCabe and Yeh (2009) and Ramos and colleagues (2018) 
both found Hispanic caregivers demonstrated high levels of satisfaction and buy-in with 
the strategies presented.  DuBay and colleagues (2018) similarly found that Hispanic 
caregivers of children with ASD considered the majority of behaviorally-based strategies 
to be acceptable. 
Another important takeaway from the present study is around the importance of 
family, or familismo, in these interventions.  Familismo, or strong bonds among the 
nuclear and extended family members, is a commonly identified value reported in the 
Hispanic parenting literature (e.g., Ramos et al., 2018).  Estrada and Deris (2014) found 
49 
that Hispanic families with a child with ASD relied on more members of the family than 
just the parents as caregivers, including grandparents, aunts/uncles, and older siblings of 
the child.  During the focus groups, participants reported both successes and challenges 
with incorporating other members of the family in using the strategies that they had 
learned during the groups.  One participant suggested that future iterations of this work 
make it a greater priority to invite the whole family to take part in interventions.  While 
the study did allow primary caregivers to bring one alternative caregiver with them to the 
groups, this consideration of the importance of the whole family, and how to best convey 
information and get extended family members more involved, could be of significance 
for maximizing the effectiveness of these programs. 
Additionally, although the current study did not make any explicit cultural 
adaptations beyond the direct translation of the interventions and program materials, the 
majority of participants reported that the program was well aligned with their cultural and 
familial values.  It is often assumed that interventions that have been primarily developed 
and utilized with one population (i.e., higher SES and White) inherently will not work as 
well with other groups (Lau, 2006; Parra Cardona et al., 2012).  While there is evidence 
that parent training programs culturally adapted for ethnic minority parents are effective 
at improving parenting behavior (van Mourik et al., 2017), they may not necessarily be 
better than directly translated evidence-based interventions (McCabe & Yeh, 2009).  As 
predicted, participants in the present study greatly appreciated being able to receive this 
intervention in their native language (Neece et al., 2019), and felt the interventions had 
generally been appropriate for them despite no other tailoring.  Some participants even 
noted that they appreciated that the content was not specifically culturally targeted to 
50 
Hispanic populations.  While intervention strategies have been developed primarily from 
one cultural lens, they may be more generalizable than believed.  Participants did 
specifically note that video examples used in the intervention could be made to be more 
representative and relevant for Hispanic populations.  This may point to a need to 
increase representation in examples, if not necessarily the need to overhaul content, to 
improve buy-in. 
Finally, there remain a lot of unknowns with regard to delivery modality of 
interventions for this population.  Participants had mixed reactions to the intervention 
delivery via telehealth, with several notable pros (i.e., not having to drive to intervention 
sessions, more comfortable at home) and cons (i.e., increased distractibility at home, lack 
of child care, difficulty with technology).  Telehealth may reduce barriers to intervention 
access particularly for those living in more rural areas (Bearss et al., 2018).  Participants 
in this cohort were traveling in from an average of 25 miles away, which likely added to 
the perceived benefits of telehealth for those individuals.  Also of note is that the 
participants in the present trial did not originally sign up for treatment to be delivered 
remotely via telehealth, but were rather thrust into it as necessitated by COVID-19.  
Therefore, their opinions may differ from individuals who originally agree to be included 
in a telehealth study, and must be treated with caution.  McIntyre et al. (2021) provides a 
much deeper, and more specific, look into the adaptations that were made to move this 
intervention to telehealth, the technology support provided to participants, and the 
reactions of participants to these changes.  
Limitations 
There are several limitations to the present study, many of which relate to 
51 
attendance/response rates of participants within the study and challenges comparing the 
Spanish-speaking and English-speaking cohorts.  Attendance was less than desired with 
all of the intervention groups and cohorts, averaging about 50% across the study, despite 
efforts to increase buy-in and engagement through the motivational interview PEI 
enhancement.  This included several participants who were randomized to a condition but 
never attended a session.  Furthermore, overall intervention satisfaction data were 
collected only at the week 16 (final) session from those who were in attendance, and thus 
we only have that data from 71 of the 140 (51%) participants to have completed the 
intervention thus far.  We also did have notable demographic differences between those 
who completed the satisfaction survey and those who did not, which may impact the 
generalization of these results.  Similarly, with the focus groups, the participant pool was 
only those who attended at least one session from the first six 6 weeks, at least one 
session from the latter 10 weeks, and were willing to do a focus group.  Thus, these data 
may be an unfair representation of the overall recruited participants, as we may have an 
inadvertent sampling bias for those who were most enthusiastic or bought-in to the 
groups.  Additionally, in comparing the English and Spanish cohorts on BPT, we have an 
inherent major difference in delivery modality, given that the intervention had to be 
delivered online for the latter group.  We may have seen different levels of attendance or 
satisfaction with BPT components if they had been delivered in the same way across 
cohorts.  Finally, the present study does not examine any intervention outcomes or 
effects.  These types of data, including changes in parent stress and child behavioral 
measures, are aims of the larger NIH-funded grant (McIntyre & Neece, 2018), and thus 
will not be analyzed until all cohorts are completed.  Therefore, while this study is able to 
52 
 
describe satisfaction and attendance of participants across interventions, we cannot yet 
determine whether either group had greater impact on these key outcomes.  Despite these 
limitations, this study makes a valuable contribution to the literature by piloting several 
parenting interventions for the first time with Spanish-speaking Hispanic parents of 
preschool-aged children with DD and ASD, thus laying the groundwork for future 
research in these important areas. 
Future Directions 
 The future directions of this study will involve completing analyses of key 
outcomes (parent stress, parenting behavior, and child behavior), and using this in 
conjunction with the satisfaction and focus group results to further develop and adapt 
these interventions for this population.  This study further illuminated the value that 
Spanish-speaking Hispanic caregivers of children with IDD place on being able to meet 
and learn from others like them, and thus this format should be retained in future 
iterations.  Similarly, incorporating psychoeducation or knowledge of how best to 
advocate for the rights of their children may be of greater benefit for these families, and 
should continue to be interwoven within intervention work.  While there remain more 
unanswered questions about other aspects of these groups (e.g., MBSR, delivery 
modality) these core elements of community, psychoeducation, and support are not 
necessarily unique to caregivers of children ages three to five, and could serve as a 
foundation for any future work done with Hispanic caregivers of children with IDD.  
Educational and medical professionals in other settings may also benefit from enhanced 
training in service delivery for Hispanic, Spanish-speaking children and families so that 
there are fewer knowledge gaps needing to be closed with outside psychoeducation. 
53 
Additionally, future iterations of these interventions with this population should 
consider the use of greater cultural adaptation of program materials and strategies, such 
as the adaptations proposed by Kuhn et al. (2020).  Based on the high levels of 
satisfaction and positive feedback from those who participated in the present study, it is 
unclear whether it is necessary to undergo a complete ‘cultural adaptation’ of the content 
of these interventions.  One specific idea would be to incorporate video vignettes that are 
better tailored to the participants, include Hispanic caregivers and children with IDD, and 
are set within a few years of the intervention being delivered.  Unfortunately, the 
production of such materials are costly and quickly get outdated.  Apart from holding 
groups in Spanish, more relatable videos, and other such adaptations can only add to the 
inclusivity in which these groups were intended.  In their present forms, the interventions 
used in this study would be considered a surface level cultural adaptation, as they are 
matched to “superficial” characteristics of the target population such as names and 
languages (Resnicow et al., 1999).  In order to achieve a deeper, structural, adaptation the 
interventions will need to more consciously target the values, beliefs, context, etc., of the 
population being intervened on.  Researchers have proposed an ecological validity 
framework that details the iterative process of taking an existing intervention and going 
from a surface level adaptation to a deeper level adaptation (Kuhn et al., 2020).  This 
process involves developing, piloting, and receiving feedback on a surface level 
adaptation, which we have now done with the focus groups in the present study, and 
using that information to inform a second iteration that attempts deep structure 
adaptation.  Furthermore, there are increasing calls in the field to directly test the 
effectiveness of surface level and deep level adaptations against one another (Ortiz & Del 
54 
Vecchio, 2013).  A critical future study could involve examining the additive benefits of 
a deep structure cultural adaptation of BPT-E and BPT-M compared to the surface level/ 
directly translated programs in both satisfaction and outcomes.  This proposed study 
would greatly inform future directions for the field of culturally diverse IDD research as a 
whole. 
Conclusion 
The current study piloted three interventions (MBSR, psychoeducation, and 
modified IYPT) with a relatively large sample of lower-income, Spanish-speaking 
Hispanic caregivers of children with IDD.  The primary goal was to determine whether 
these interventions could feasibly be used with this population, as measured by their 
engagement (attendance) in and acceptability (satisfaction) of the groups.  Overall, the 
Spanish-speaking participants were comparable to their English-speaking counterparts in 
attendance, and even slightly higher after controlling for demographic factors.  The 
Spanish-speaking participants demonstrated high levels of satisfaction with the 
interventions in general, with preference for BPT combined with psychoeducation 
compared to English speakers’ preference for BPT combined with MBSR.  Qualitative 
focus groups revealed that there may be cultural values, including communal learning, 
and societal factors, such as reduced access to psychoeducation from other sources, 
explaining such differences.  In sum, this study adds to the literature by providing much 
needed child behavioral and caregiver mental health services to an often underserved 
population in their own language.  The data gathered from this study will lay the 
groundwork for important future work on how to best adapt these interventions to meet 
the needs of these families. 
55 
APPENDIX A: TABLES AND FIGURES 
Table 1 
Descriptive Statistics for Spanish-speaking Cohort Participants (N = 60) 
BPT-E BPT-M 
Demographic (n = 30) (n = 30) 
M (SD) or % M (SD) or % t p 
Target Child Age in Years 3.90 (0.71) 3.87 (0.90) 0.16 .874 
Primary Caregiver (PC) Age 39.83 (7.12) 38.83 (8.89) 0.48 .633 
PC Baseline Stress (PSI) 113.23 (22.34) 118.28 (18.87) -0.94 .354 
Child Total Problems Raw 73.89 (31.55) 86.66 (34.98) -1.45 .154 
Score (CBCL)  
PC Acculturation (VIA 64.67 (21.22) 61.62 (14.09) 0.56 .579 
Mainstream Subscore) 
χ2 
Household Income (< $30,000) 53.3% 63.3% 0.62 .432 
PC Education (No HS 50.0% 66.7% 1.71 .190 
Diploma) 
PC Sex (female) 100.0% 96.7% 1.02 .313 
TC Sex (male) 63.3% 76.7% 1.28 .260 
PC Race/ethnicity Hispanic 100% 100% 
Note. There were no significant between-group differences on any demographic 
variables. 
56 
Table 2 
Descriptive Statistics for Spanish-speaking vs. English-speaking Cohort Participants (N 
= 140) 
Spanish, English, English,  
Hispanic Hispanic non-Hispanic 
Demographic (n = 60) (n = 36) (n = 44) 
M (SD) or % M (SD) or % M (SD) or % F p 
Target Child 3.88 (0.80)a 3.81 (0.86)a 3.80 (0.90)a 0.17 .847 
(TC) Age 
Primary 39.33 (8.00)a 33.83 (6.92)b 36.41 (8.51)ab 5.62 .004 
Caregiver (PC) 
Age 
PC Baseline 115.71 (20.69)a 103.21 (23.87)b 110.00 (21.84)ab 3.56 .031 
Stress (PSI) 
Child Total 80.39 (33.66)a 72.03 (21.46)a 81.88 (23.71)a 1.29 .279 
Problems Raw 
Score (CBCL) 
PC 63.24 (18.11)a 69.69 (18.290)ab 72.95 (15.82)b 3.30 .041 
Acculturation 
(VIA 
Mainstream 
Subscore) 
χ2 
TC Sex (male) 70.0% 61.1% 68.2% 0.84 .658 
Household 58.3% 22.2% 11.4% 27.99 <.001 
Income (< 
$30,000) 
PC Education 58.3% 11.1% 0.0% 49.74 <.001 
(No HS 
Diploma) 
Note. Means sharing a letter in their superscript in each row are not significantly different 
at the .05 level according to Tukey post-hoc comparisons. 
57 
Table 3 
ANCOVA Results with Psychoeducation/ MBSR Attendance as Dependent Variable 
Source df SS MS F p 
Ethnicity 1 5.93 5.93 1.41 .238 
Household Income (< $30,000) 1 0.58 0.58 0.14 .711 
PC Education (No HS Diploma) 1 3.12 3.12 0.74 .391 
PC Baseline Stress (PSI) 1 6.71 6.71 1.60 .210 
Child Total Problems (CBCL)  1 1.11 1.11 0.26 .609 
Acculturation (VIA) 1 1.15 1.15 0.27 .603 
Group 1 < 0.01 < 0.01 < 0.01 .994 
Language 1 21.23 21.23 5.05 .027 
Group x Language 1 0.06 0.06 0.01 .906 
Error 99 416.47 4.21 
Total 109 2261.00 
Note. The model accounted for approximately 6% of the total variability in 
psychoeducation/MBSR attendance, which was not significant, F(9, 99) = 0.73, p 
= .677. The magnitude of the significant Language effect was partial η2 = .05. 
58 
Table 4 
ANCOVA Results with BPT Attendance as Dependent Variable 
Source df SS MS F p 
Ethnicity 1 12.46 12.46 0.76 .385 
Household Income (< $30,000) 1 3.87 3.87 0.24 .628 
PC Education (No HS Diploma) 1 3.51 3.51 0.21 .645 
PC Baseline Stress (PSI) 1 4.03 4.03 0.25 .621 
Child Total Problems (CBCL)  1 62.68 62.68 3.83 .053 
Acculturation (VIA) 1 0.21 0.21 0.01 .911 
Group 1 7.33 7.33 0.45 .505 
Language 1 43.42 43.42 2.65 .107 
Group x Language 1 3.64 3.64 0.22 .638 
Error 99 1621.47 16.38 
Total 109 5244.00 
Note. The model accounted for approximately 7% of the total variability in BPT 
attendance, which was not significant, F(9, 99) = 0.81, p = .613.  
59 
Table 5 
ANCOVA Results with Total Satisfaction as Dependent Variable 
Source df SS MS F p 
Ethnicity 1 7.92 7.92 0.17 .685 
Household Income (< 1 1.03 1.03 0.02 .884 
$30,000) 
PC Education (No HS 1 90.87 90.87 1.90 .173 
Diploma) 
PC Baseline Stress (PSI) 1 99.55 99.55 2.08 .154 
Child Total Problems  1 61.93 61.93 1.30 .260 
(CBCL)  
Acculturation (VIA) 1 17.14 17.14 0.36 .552 
Group 1 9.94 9.94 0.21 .650 
Language 1 97.41 97.41 2.04 .159 
Group x Language 1 342.00 342.00 7.16 .010 
Error 56 2675.11 47.77 
Total 66 555505.00 
Note. The model accounted for approximately 27% of the total variability in 
Satisfaction, which was significant, F(9, 56) = 2.31, p = .027. The magnitude of 
the significant Group by Language effect was partial η2 = .11. 
60 
 
 
 Assessed for eligibility Excluded based on 
and inclusionary criteria child’s age (n = 40) 
 
(n = 158)  
Excluded for not having 
 diagnosis of ASD or DD 
(n = 3) 
  
Excluded for already 
 enrolled in other class or 
therapy (n = 3) 
  
Enrolled and randomized Withdrew due to lack of 
 (n = 60) interest (n = 52) 
   
 (n = ) 
 
 
 
Allocated to BPT-E (n = 30) Allocated to BPT-M (n = 30) 
 
 Attended at least one session  Attended at least one  
(n = 23) session (n = 25)  
 
 
Figure 1. CONSORT diagram of participant inclusion. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
61 
Figure 2. Attendance at Spanish cohort intervention sessions. 
62 
Figure 3. Attendance at intervention sessions across cohorts. 
63 
Figure 4. Treatment satisfaction by intervention group and language of delivery. 
64 
APPENDIX B: FOCUS GROUP QUOTES IN SPANISH 
Theme 1: 
A mí lo que me gustó mucho fue la atención plena y lo he intentado hacer. No lo hago 
diario, pero sí me ayuda mucho con el estrés, de sentirme relajada y yo creo que para mí 
fue lo mejor de todo. 
Sinceramente yo no he practicado mucho la respiración. Al principio cuando lo 
practicaba, sí sentí que me ayudó bastante. Me sirvió lo que aprendí de no estarme 
preocupando por las cosas que van a pasar. Sí me ha servido un poco para menos estrés, 
pero sinceramente no lo he practicado. Se me olvida, no tengo el tiempo, siempre tengo 
muchas cosas qué hacer y termina olvidándoseme. 
Theme 2: 
A mí me sirvió desde el principio, desde que empecé con ustedes con mi hijo. Ha 
cambiado mucho, de hecho vamos a tener el IEP de mi hijo el jueves. También le pedí a 
la maestra, porque ella me mandó un mensaje diciendo, "El miércoles yo te mando los 
papeles del IEP", le dije, "No, necesito que los mandes antes porque yo necesito 
revisarlos, ver que todo esté bien y también necesito decirte que la coordinadora de mi 
hijo de regional center va a estar en la junta, también ABA va a estar en la junta, la 
supervisora y la que viene a la terapia a mi casa también". No le pregunté, más bien le 
dije, "Espero que esté bien", porque yo sé que va a estar bien. 
Con la información que se nos dio, yo lo he podido discernir y poder ajustar a estos dos 
documentos legales que son muy importantes… Efectivamente, le cambió la postura en el 
equipo del IEP. A mi hija la tuvieron que cambiar de lo que estaba. Estaba en un sistema 
severo, ahorita está en un grupo de autismo, completamente. 
Theme 3: 
Oír experiencias de otros te sirve, lo que no me funcionó a mí a lo mejor a ellos les 
funcionó. Agarras experiencia, porque es muy variado, el aprendizaje es sin límite. No 
hay un niño igual, lo que le sirve a uno a otro no, pero a veces es bueno saber diferentes 
técnicas. Especialmente si viene de la experiencia de otro papá. 
Yo aprendí a apreciar y la verdad son como unos héroes ustedes, porque no sé cómo le 
hacen ustedes con dos niños, con más niños. Me imagino que debe ser muy difícil, pero 
aprendí a valorar todo, y aprendí muchísimo de cómo son luchadoras y cómo son-- Que 
no se avergüenzan de sus hijos, porque yo antes me avergonzaba. Pero en la terapia con 
ustedes, en las clases yo aprendí muchísimas cosas y aprendí a tenerle más amor a mi 
hijo, más dedicación, más tiempo, de todo. En especial aprendí mucho de ustedes que 
tienen más de un niño. Es amazing cómo ustedes son tan fuertes, la verdad. 
65 
La parte que a mí más me gustó fue la primera, donde conocí a otros papás, donde 
escuché las historias, donde me sentí entendida, saber que no estoy sola, que no soy la 
única mamá o papá en esta ciudad, en este mundo. 
Culturalmente, obviamente somos como-- Desde México hasta Chile somos más 
pasionales y un poco más sociables, lo que nos lidió fueron las seis primeras semanas de 
conocernos, entendernos unos a otros y decir, "Okay, no soy un unicornio y todos 
tenemos las mismas dificultades". 
Yo me sentía ciega, no sabía por dónde empezar, qué hacer. Aunque desde los tres años 
estuvo con el centro regional, terapias y todo esto. Pero no fue hasta que llegamos a este 
grupo que yo sentí que pude ver… Yo veo la mía y digo, "Mi niña está bien", tiene sus 
ratos, pero digo, "Está bien", y como dijo Lucia, si ellas pueden, ¿por qué nosotros no? 
Ellos son el ejemplo con lo que nosotros debemos de seguir y ver. 
Theme 4: 
Pienso que los elogios -- Para mí ha funcionado muchísimo los elogios. Ellos, yo tengo 
dos que son gemelos, se frustran mucho, y para ayudarlos a hacer alguna cosa, y que no 
se estén frustrando tanto cuando están haciendo siempre les digo, "Estás haciendo muy 
bien, o good job." A veces, hasta digo, "Sueno como mucho," pero yo veo que se 
motivan, y les ayuda bastante eso. También otra de las cosas es las recompensas , 
también es algo que me funciona mucho para todos sus comportamientos. 
En general para mí fue una muy buena experiencia, aprendimos muchísimo, simplemente 
ha simplificado muchas cosas de las que teníamos barreras mentales, ahora nos permiten 
llevar con un poco más de calma la situación y entender por qué el comportamiento  y 
qué necesitamos hacer para ayudarlo. La verdad nosotros sí hemos visto una gran 
diferencia, hubo un gran antes y un después. 
Theme 5: 
En general creo que a mí me sirvió, al menos a mí y a mi familia muchísimo, 
especialmente que mi esposo entendiera, entendió muchísimo más, porque él está 
trabajando todo el día, no ha podido estar como yo en las terapias con el niño. 
Es de mucha ayuda, tanto para nosotros como padres y la familia, porque somos al menos 
de mi parte, soy de las personas que comparten con toda la familia, trato de compartir 
todo lo que aprendí, para que así el día de mañana si ven a mi hijo solo…tienen el 
pensamiento de educarlo. Saben que tienen que tener un requisito o un camino, yo les 
formo un camino para que ellos puedan seguir adelante, eso veo que me ha ayudado 
bastante con la familia. 
También trato de ignorar las cosas que no quiero que haga.  A veces es un poco difícil 
porque mi esposo ahorita está aquí y él le hace caso, quiere llamarle la atención y no 
estamos en lo mismo, pensando igual. Porque a veces le digo, "Ni siquiera voltees a 
66 
mirarlo, porque eso ya está llamando tu atención. No le digas nada". Es un poquito difícil 
porque yo lo quiero hacer de una forma y él hace otra cosa. 
Hacerle la invitación a la familia del niño para que ellos puedan ayudar también al niño, 
no nada más el soporte de nosotras las mamás, que en realidad somos las que tenemos la 
responsabilidad y el deber como buenas mamás, estar ahí por nuestros hijos, pero 
también que involucraran a las familias en los grupos para que se den cuenta de lo que 
nosotros estamos aprendiendo. 
Theme 6: 
Sería muy difícil me imagino, entender a todas las culturas que estábamos ahí. La verdad 
me gustó la manera que se tocó porque no fue nomás, "Okay, los mexicanos educan a sus 
hijos haciendo esto y esto", sino que fue universal para todos. De hecho me gustó eso 
porque no sentí discriminación hacia ningún tipo de raza que estábamos ahí, esa es mi 
opinión. 
Yo pienso que a voz de todas, que sigan con este proyecto, que no se acabe aquí, que nos 
sigan incluyendo, si fuimos las que inauguramos esa clase en español, que sigan porque 
realmente nuestros papás de esta diversidad de niños necesitamos esa ayuda. 
Acerca de los videos, a mi parecer, se me hacen como que estaban muy acartonados, para 
mi pensamiento se requería de unas personas más sinceras, porque como que no tomamos 
en cuenta si se podrían utilizar con personas que realmente son latinas, eran videos de 
personas que hablan inglés, había un intermediario para que nos lo dijera en nuestro 
idioma y para hacer esos grupos para personas latinas sería mejor utilizar padres que 
realmente son latinos y pudieran personalizarlo más en mi punto de vista. 
En los videos yo diría, "Se nota la cultura es diferente o la forma", pero las estrategias yo 
pienso que no, las estrategias serían igual si es para americanos o para latinos o de 
cualquier otra sería igual.  Las estrategias para mí no creo que deberían cambiarlas, para 
mí están buenas siendo de la raza que seamos o lo que sea, pienso que las estrategias 
funcionan igual. 
Theme 7: 
Hacerlo por Zoom es la única opción ahorita pero cuando sea el mejor tiempo estaría 
mejor en persona, porque se aprende, conoces a la gente en persona, te vas 
familiarizando, vas dando tus puntos de vista, eso sí, prefiero yo mil veces en persona que 
por Zoom. Son como los niños, estamos pero de repente pasa alguien, ya nos distrajimos 
y lo que aprendimos se nos olvida. 
Todo el desarrollo de lo que tuvieron ahora ustedes en este planteamiento que dieron con 
la plataforma Zoom, a mí se me hizo mucho mejor. La razón es que estaba en casa, más 
cómoda, estaba viendo a mis hijas, no tienes que trasladarte. Yo siento que hubo mucho 
mejor absorción de toda la información. A mí se me hizo perfecto. 
67 
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