www.elsevier.com/locate/cabpCognitive and Behavioral Practice 20 (2012) 362-374

What Latina Mothers Think of Evidence-Based Parenting Practices: A QualitativeStudy of Treatment Acceptability

Esther J. Calzada, Sevan Basil, and Yenny Fernandez, New York University Child Study Center

Keywqual

1077© 2Publ

Parent training has great potential to alter the developmental trajectories of young Latino children with or at risk for behavior problems.However, traditional parent training programs may seem culturally irrelevant or inappropriate to Latino parents as they promotepractices that are based on white, middle class standards. The current study of treatment acceptability used focus group and keyinformant interviewing methodology to investigate Latina mothers’ views on the causes of young children's misbehavior and theacceptability of evidence-based parenting strategies. The sample consisted of Spanish- and English-speaking Latina mothers of 3- to6-year-olds recruited from day-care centers and preschools in New York City. Focus groups were conducted with 34 mothers, and keyinformant interviews with 5 mothers whose children had behavior problems. Results showed that the most commonly viewed causes ofchild misbehavior were child temperament, fighting in the home, and negative peer influence. Mothers found some evidence-basedparenting strategies acceptable (e.g., the use of praise, social rewards) and others objectionable (e.g., selective ignoring in pubicsituations, the elimination of spanking). For some strategies, there was little consensus on its acceptability (e.g., time-out). Takentogether, results highlight the critical need for aligning parent and clinician goals at the outset of treatment, and of including a strongpsychoeducational component in parent training programs because not all of its components are consistent with Latino cultural normsand beliefs.

A CROSS various indicators, Latino youth are at highrisk for poor behavioral functioning. For example,

relative to non-Latino Whites and African Americans,Latinos have the highest rates of carrying a weapon atschool, being injured in a fight, and being threatened orinjured with a weapon (Centers for Disease Control andPrevention, 2008). In addition, Latino adolescents havehigher rates of illicit substance use and initiate other riskybehaviors, such as smoking and drinking, at earlier agescompared with other groups of adolescents (Centers forDisease Control and Prevention). Prevalence estimatesfor behavior disorders are high (Bird et al., 2001) andLatino boys enter the juvenile justice system at dispro-portionately high rates (Snyder & Sickmund, 1999). Theearly identification and treatment of childhood behaviorproblems is essential to alter the trajectories of at-riskLatino youth (Arnold, O'Leary, Wolff, & Acker, 1993) andto reduce the mental health disparities that are well--established by adolescence.

ords: parent training; treatment acceptability; Latino parents;itative research

-7229/11/362-374$1.00/0012 Association for Behavioral and Cognitive Therapies.ished by Elsevier Ltd. All rights reserved.

Parent training programs are considered the gold--standard treatment for early childhood behavior prob-lems (Brestan & Eyberg, 1998; Kazdin, 2005; Serketich &Dumas, 1996) and represent a promising approach toaddressing the mental health needs of Latino children. Yetseveral questions must be addressed if parent trainingprograms are to be broadly disseminated to Latino popula-tions. First, although a robust literature documents theefficacy and effectiveness of parent training programs withnon-Latino White families, scholars caution against assump-tions that such evidence can be generalized to diversepopulations (Bernal & Scharron-Del Rio, 2001; Chambless& Hollon, 1998; Eyberg, 2005; Forehand & Kotchick, 1996;Hall, 2001). In addition to the need for methodologicallyrigorous trials to establish efficacy in new populations,parent training programs must be widely accessed by Latinofamilies. There has been growing concern over the sig-nificant underutilization of mental health services by ethnicminority populations, and particularly Latinos and Asians(Alegría et al., 2007). According to a national survey onpast year mental health treatment (American PsychiatryAssociation, 2010), less than 7% of Latinos accessedmental health services, compared with 16% of non-LatinoWhites. These low rates have been attributed to a host offactors, including cost/lack of health insurance, lack ofknowledge of the health-care system, and lack of services

363Latino Views of Parenting Practices

in Spanish (Kouyoumdjian, Zamboanga, & Hansen, 2003).Beyond these practical barriers, ethnic minority parentsappear less likely to identify child behavior problems(Roberts, Alegría, Roberts, & Chen, 2005) and morelikely to rely on trusted family and community members,alternative medicines, and spiritual practices to deal withmental health problems when they are recognized (Yehet al., 2005), in part because of the stigma associated withmental illness and its treatment (Rojas-Vilches, Negy, &Reig-Ferrer, 2011).

Also underlying the problem of underutilization arethe culturally rooted, often disparate views held byLatinos and their service providers about mental healthproblems, their causes and their solutions (Alegria et al.,2002). Originating from Western psychological theory,parent training programs are based on shared assump-tions from a social learning perspective about what causesand maintains behavior problems (Brestan & Eyberg,1998), and target culturally influenced childrearing goals,values, and practices (Dumas, Arriaga, Begle, & Longoria,2010; Forehand & Kotchick, 1996). Yet importantvariations in parenting exist across cultural groups. Forexample, relative to non-Latino Whites, Latinos tend tovalue obedience and respect more than assertivenessand independence in children, and to rely on physicaldiscipline and hierarchical parent-child relationships toinstill these values (Calzada, Fernandez, & Cortes, 2010).Thus, parent training programs may promote practicesthat are based on White, middle- class standards, andwhich in turn may be viewed as culturally irrelevant orinappropriate by Latino parents (Parra Cardona et al.,2012). Such standards may also make Latino parentingseem deficient (Peters, 1988; Slaughter & McWorter,1985).

One approach to addressing the cultural relevance ofparent training programs for Latinos is to examine theirsocial validity. Social validity refers to the acceptability ofand satisfaction with an intervention and its outcomes(Wolf, 1978). For parent training programs, social validitywould be supported if Latino parents agreed with thesocial significance of its goals; the social appropriatenessof its procedures (i.e., treatment acceptability); and thesocial importance of its outcomes (i.e., client satisfaction).Most treatment outcome research includes measures ofclient satisfaction, providing evidence that parents ofdiverse sociocultural backgrounds, including Latinos,report high consumer satisfaction with parent traininginterventions (Dumas et al., 2010; Eyberg & Robinson,1982; Forehand, Wells, & Griest, 1980; Patterson, 1982;Webster-Stratton, 1989). Importantly, though, thesestudies rely on samples of parents who were successfullyengaged and retained in parent training programs, andwho, given the low rates of service utilization seen amongLatino families, may not be representative of the larger

Latino population. An important goal is to examine issuesof social validity with a sample of Latino parents who arenot currently accessing mental health services.

Existing studies of the treatment acceptability of parenttraining generally show that reinforcement strategies(e.g., positive reinforcement, token economy) are moreacceptable than punishment strategies (e.g., time-out,spanking, differential attention; Calvert & McMahon,1987; Heffer & Kelley, 1987; Ho, Yeh, McCabe, & Lau,2011; Jones, Eyberg, Adams, & Boggs, 1998; Kazdin,1980a, 1980b; Miller & Kelley, 1992). These studies haverelied on quantitative methods in which parents arepresented with vignettes that depict a defiant anddisruptive young child and are asked to rate theacceptability of responding to the child's misbehaviorwith specific parenting strategies such as positive reinforce-ment, positive practice, time-out, response cost, differentialattention, spanking, and medication. Such questionnairesrequire participants to share their perspectives using aLikert scale, and thus limit the form, content, andcomplexity of participant responses. In contrast, qualita-tive data has the potential to contribute to understandingof the beliefs and attitudes that undergird parentingstrategies, which ultimately allows clinicians to offer moreengaging and effective services to an underservedpopulation such as Latinos. Yet while scholars have issueda call to “have Latino parents inform us about the ‘what’and ‘why’ of parenting behaviors and techniques” (Zayas& Rojas-Flores, 2002, p. 236), no qualitative studies of theacceptability of parent training have been conducted todate.

Quantitative studies of the treatment acceptability ofparent training programs focused on the Latino popula-tion are similarly lacking. In a notable exception, Borregoand colleagues (2007) showed that acculturated, English--speaking Mexican American parents found response costthe most acceptable, followed by time-out and positivereinforcement, and found medication the least accept-able, followed by differential attention and spanking, ofthe strategies to deal with child misbehavior. The clinicalimplications of this study are significant for both treatmentengagement and adherence; it is unlikely that MexicanAmerican parents who find certain strategies objectionablewill commit to an intervention based on that approach. It isnot clear, however, whether these findings would general-ize to other Latino subgroups, to Spanish-speaking Latinoparents or to Latino parents of children with elevated levelsof behavior problems.

This paper examines the treatment acceptability com-ponent of social validity of parent training programs withSpanish- and English-speaking Latina mothers of youngchildren between 3 and 6 years old. We recruited a com-munity sample and also identified mothers of childrenwith behavior problems to serve as key informants. Using

364 Calzada et al.

qualitative methodology, we were able to move beyondrankings of strategies and focus on mothers’ underlyingviews of evidence-based parenting strategies and, morespecifically, the reasons for which mothers found a givenstrategy acceptable or not. Findings from this in-depthexploration of treatment acceptability will inform efforts toengage and retain Latino families in parent trainingprograms and may ultimately help to address problems ofmental health disparities.

Method

Participants

Participants were 39 Latina mothers (5 key informants;34 focus group participants, as described below) recruitedfrom day-care centers and preschools in New York City.Key informants were mothers of children with behaviorproblems (as identifiedby school staff)whowere interviewedindividually, and focus group participants were mothers ofchildren from community day-care and preschool programswho participated in a focus group discussion. Demographiccharacteristics of both samples are presented in Table 1.All participants from the focus groups and the interviewswere the biological mother of the target child. Children ofmothers in the focus groups (n=34) had a mean age of3.90 years (SD=1.00) and about half (46%) were male. Onaverage, focus group mothers were 29.41 years (SD=5.50),weremarried to or living with a partner (82%), had relativelylow levels of formal education (44%hadnot completed highschool), and were not working outside the home (67%).Average household monthly income was $1,781.29(SD=954.55). The vast majority of mothers were foreign--born (97%) and came from Mexico, the DominicanRepublic, Puerto Rico, Argentina, Nicaragua, Ecuador, andVenezuela.

Children of mothers who were interviewed (n=5) hada mean age of 3.50 years (SD=1.26) and were 80% male.

Table 1Demographic Characteristics Focus Group and Key Informant Partic

Focus GroupsM (SD)

Child age 3. 90 (1.00)Mother's age 29.41 (5.50)Length of residence in US (in years) 9.81 (4.65)Household income (per month) 1781.29 (954.5

%

Child gender- Male 47.4Foreign-born status 44.2Two-parent household 89.7Mother education (%bHS) 60.3Mother works for pay 19.5Prefer English for study activities 81%

Key informant mothers were 34.15 years (SD=7.23) onaverage. Three (60%) of the mothers had not completedhigh school, one was a high school graduate and one hadcontinued her formal education beyond high school. Onlyone mother worked outside the home for pay. Averagehousehold monthly income was $1,841.50 (SD=1063.39),although there was significant variability in reportedincomes. None of the mothers were married, but one waslivingwith a partner.Of the fivemothers, (twoMexican, twoDominican, one Puerto Rican) four (80%) were bornoutside of the mainland U.S. (including Puerto Rico) andone was U.S.-born. According to maternal report, four ofthe five children (80%) were receiving special services,including psychotherapy, physical therapy, and speechtherapy, and two (40%) of the families had been referredfor (but had not yet enrolled in) parent training.

MeasuresAbbreviated Multidimensional Acculturation Scale (AMAS;Zea, Asner-Self, Birman, & Buki, 2003)

The AMAS is a measure of acculturative status(i.e., acculturation, enculturation) that can be used withany ethnic group. The AMAS taps into cultural competenceand identity; cultural competence refers to the individual'sknowledge of the culture as well as his or her ability tofunction competently within it. The AMAS measures threedomains: cultural knowledge, language use, and identity.The 42 items are rated from “not at all” (1) to “extremelywell” (4). All domains are measured for both the culture oforigin (enculturation) and mainstream/"U.S. American"culture (acculturation), allowing for an examination ofacculturative status as a bidimensional construct. The AMASwas developed and standardized in English and Spanishwith Latino university students from various countries oforigin and showed adequate psychometric properties (Zeaet al., 2003). Sample items include, “I feel like I am part of

ipants

Key InformantM (SD)

p

3.48 (1.26) .4334.15 (6.94) .098.00 (3.46) .51

5) 1841.50 (2126.77) .92

%

53.8 .1846.0 .2363.0 b .00127.3 b .00163.6 b .00160% .16

365Latino Views of Parenting Practices

US/MA/DR culture,” (identity) “How well do you know thehistory of US?” (knowledge), and “How well do you speakEnglish with strangers?” (language). Internal consistencieswere high for all subscales (α=.81–.99).

Parenting Styles and Dimensions (PSD; Robinson, Mandleco,Olsen, & Hart, 1995)

The PSD is a 32-item parent report measure ofparenting practices with three orthogonal factors corre-sponding to Baumrind's (1995) parenting style typology.Parents respond to each item on a 5-point Likert scaleanchored by “never” (1) and “always” (5). The PSD hasbeen standardized for parents of young children, and hasbeen used with samples of various ethnic backgrounds(Hart, Nelson, Robinson, Olsen, & McNeilly-Choque,1998), including community samples of Spanish- andEnglish-speaking Dominican, Mexican, and Puerto Ricanmothers (Calzada & Eyberg, 2002; Calzada, Huang,Anicama, Fernandez, & Brotman, 2012). The currentstudy used the authoritative (α= .79) and authoritarian(α= .62) subscales of the PSD.

Behavior Assessment System for Children, Parent Rating Scaleand Teacher Rating Scale (BASC PRS, BASC TRS; Reynolds &Kamphaus, 1998)

The BASC is a measure of child behavior andemotional functioning for children between the ages of2 and 18 years with well-established psychometricproperties (Reynolds & Kamphaus, 1998). The BASChas both a parent report form (PRS) and a teacher reportform (TRS). The PRS is available in Spanish, and allsubscales showed adequate internal consistencies inthe present study (α= .82–.87). The broad domainsof Externalizing Problems (e.g., aggression, conductproblems) and Internalizing Problems (e.g., depression,anxiety) were used in the present study.

Procedure

Mothers were recruited through day-care and pre-school programs serving Latino families in NYC in 2008.At collaborating sites, fliers advertising the study inSpanish and English were posted and sent home withchildren. On the day of the scheduled focus group,research staff, fluent in Spanish and English, was presentto recruit additional parents into the study. School staffalso assisted in recruitment (i.e., discussed the study withmothers and reminded them of the scheduled focusgroups). Interested mothers came to the group, wherethey were consented individually before the focus groupbegan. A battery of questionnaires was completed byeach mother (via an in-person interview in the languageof her choice) either before or after the focus group,depending on her arrival time relative to the start time ofthe focus group. Five focus groups were conducted, with

(SD=3.06) participant mothers in each. All but one of thefocus groups was conducted in Spanish. The first author,a bilingual clinical psychologist, facilitated the focusgroups.

Mothers who participated as key informants wereidentified by school staff as having children with behaviorproblems. Mothers who expressed an interest in the studywere scheduled for an appointment at their child's schoolor in their neighborhood (e.g., at a local park or eatery)where they were consented and interviewed using thesame battery of questionnaires by the same bilingualclinical psychologist. Two of the mothers (40%) chose tobe interviewed in English; the rest were interviewed inSpanish.

Individual interviews lasted approximately 60 minutesand focus groups lasted between 70 to 90 minutes; allmothers were paid $35 for their participation. Theinterviews and focus groups followed an identicalsemistructured format with open-ended questionsdesigned to elicit mothers’ views on: (a) the causes ofchild misbehavior (e.g., What makes a child misbehave, likedisobey or act aggressively with peers?); and (b) acceptability ofevidence-based parenting strategies including parent-childplay, positive reinforcement (through praise, rewards and privi-leges), selective ignoring (at home and in public, given theimportance of proper demeanor in the Latino culture),time-out, loss of privileges, and (eliminating) harsh discipline suchas spanking and yelling. Each strategy was presented (in theorder listed above) with a definition and the context inwhich it would be recommended for use. For example, wemade clear that selective ignoring would be recommendedonly in response to mild (i.e., not dangerous or defiant),attention-seeking misbehaviors, and that positive reinforce-ment was the use of rewards contingent on good behavior.Mothers were then askedwhether they believed the strategywould be effective in addressing children's misbehavior(e.g., What would you think if a therapist told you to ignore yourchild when he is having a tantrum? How much would that makeyour child tantrum less?), whether they would be willing to usethe strategy (e.g., Would you ignore your child's tantrum if atherapist recommended that to you?), and what they thought thecommunity reaction to the use of the strategy would be(e.g.,What would your family, friends and neighbors think if theysaw you ignoring your child's tantrum?).

Focus groups and interviews were audiotaped andtranscribed in the language in which they were conducted.The first and third authors, both Spanish-speaking Latinaresearchers, analyzed the data. The first author conductedall of the focus groups and interviews whereas the thirdauthor did not lead any. The data were coded following thestructural coding method (MacQueen, McLellan-Lemal,Bartholow,&Milstein, 2008) using codes established a prioribased on the research questions of the study. Structuralcodes included: causes of child misbehavior; acceptance

366 Calzada et al.

of/objection to parent-child play, positive reinforcement (throughpraise, rewards and privileges), selective ignoring, time-out, loss ofprivileges, and eliminating harsh discipline such as spanking andyelling; reasons for acceptance/rejection of each strategy;willingness to use each strategy; and barriers to use of eachstrategy. In following the structural coding method, codeswere collapsed into categories that were then grouped intothemes reflecting shared meaning. For example, within the“reasons for child misbehavior” structural code, categoriesof “parents do not spend enough time with children,”“parents are not strict enough in their discipline,” and“parents spoil their children” were grouped into a theme of“ineffective parenting.”Thedata were coded independentlyby the first and third authors, and intercoder reliability wasfound to be high (kappa=.94). The few discrepancies thatwere found were discussed until consensus was reached.

Results

Acculturation and Parenting Practices

Table 2 presents the descriptive statistics for the accul-turation, enculturation, and parenting practices measures.There were no significant differences on acculturation, en-culturation, and parenting betweenmothers from the focusgroups and the key informant interviews. On average,mothers reported high levels of enculturation (i.e., ethnicidentity, Spanish language competence, and ethnic culturalknowledge). In contrast, mothers reported relatively lowlevels of acculturation (i.e., U.S. American identity, English

Table 2Descriptive Statistics of Study Variables

Focus Groupsn=34

Key Informantsn=5

M (SD) M (SD) p

Acculturation/Enculturation1. US Identity 2.12 (.76) 2.87 (1.25) .262. US Knowledge 1.78 (.49) 2.50 (.87) .103. English Competence 1.95 (.66) 2.67 (1.25) .324. Ethnic Identity 3.93 (.19) 3.80 (.45) .455. Ethnic Knowledge 2.94 (.82) 2.83 (.80) .826. Spanish Competence 3.90 (.22) 3.67 (.75) .07

Parenting Practices7. Authoritative 3.83 (.64) 4.39 (.57) .078. Authoritarian 1.79 (.40) 1.95 (.61) .48

Child Functioning9. BP-EXT 75.21 (9.38) 87.75 (9.36) .0210. BP-INT 92.93 (10.88) 94.00 (9.25) .84

Note. Enculturation and Acculturation based on the AbbreviatedMultidimensional Acculturation Scale. Parenting Practices based onthe Parenting Styles and Dimensions. BP-EXT=BASC ParentReport, Externalizing Behavior Composite. BP-INT=BASC ParentReport, Internalizing Behavior Composite.

language competence, and U.S. American cultural knowl-edge). Mothers also reported high levels of authoritativeparenting (a mean corresponding to “very often”), and lowlevels of authoritarian parenting (amean corresponding to“once in a while”); these means are comparable to thosereported in a separate study with a community sample ofDominican andMexicanmothers of young children inNYC(Calzada et al., 2012). Children of key informants hadsignificantly higher levels of externalizing problems thanchildren of focus group informants (pb .05). Notably,though, children from both groups had elevated scores onboth the Externalizing and Internalizing composites. On theBASC, the T-scores of all the key informant children wereelevated (range: 74– 109), and averaged 87.75 (SD=9.36) onthe Externalizing Problems composite and 94.00 (SD=9.25)on the Internalizing Problems composite. The childrenof focus group participants were also rated as having clini-cally significant problems, with an Externalizing Problemscomposite score of 75.21 (SD=9.38) and an InternalizingProblems composite score of 92.94 (SD=10.88).

Qualitative AnalysesCauses of Misbehavior

Several themes emerged in relation to maternal viewson causes of child misbehavior, as listed in Table 3, whichis organized according to findings from each interviewand focus group. Themes were categorized as individualchild, familial, and extrafamilial factors. Extrafamilial in-fluences included exposure to violence on television andpeers who misbehave at school and in the neighborhood.Among individual child factors, the most common waschild temperament. Mothers (both focus group and keyinformant) believed that some children are born with atendency to misbehave, as illustrated in the followingcomment:

I think that every child brings something like his own way ofbeing [into the situation]. Because I compare [my son] withother kids in his classroom and there are children who aretold to sit down, and they sit down. And I speak loudly, Ispeak softly, I take great care in how I speak to [my son], andyou know, I can't find any way [to make him obey].

Developmental delays, particularly delays in languageand communication, were also commonly discussed, mostoften by key informants. Finally, mothers from the focusgroups noted that child misbehavior is common duringcertain developmental periods, including the toddler andpreschool years.

In terms of familial factors, the most commonly refer-enced cause was fighting in the home. This theme emergedin virtually every discussion (group and individual) andreferred to a range of situations from arguing betweenparents to domestic violence in the home. One keyinformant viewed the domestic violence she experienced

Table 3Latina Key Informant and Focus Group Views of the Causes of Child Misbehavior

Key Informants (KI; n=5) Focus Groups (FG; n=34)

KI1 KI2 KI3 KI4* KI5* % agreed FG1* FG2 FG3 FG4 FG5 % agreed

CHILD FACTORSChild temperament • • • • 80% • • • • 80%Child age/developmental stage • • 40% • • • • 80%Developmental delays • • • 60% • 20%

FAMILY FACTORSIneffective parenting • 20% • • • • • 100%In the home • • • • 80% • • • • 80%Negative sibling influence • • 40% • 20%

OTHER CONTEXTUAL FACTORSNegative peer influence • • • 60% • • • • • 100%Violence on television • 20% • • • 60%

Note. * interview/focus group conducted in English. • indicates factor was viewed as causal by key informant or consensus of focus group.% agreed = % agreed on factor as causal.

367Latino Views of Parenting Practices

during her pregnancy as a causal factor in the behavioraldifficulties of her 3-year old son:

TJ is the way he is because I always used to argue all the time,all the time with my baby's father. I used to get into physicalfights all the time and that's why I think he's like wild andcrazy. Because he was always in my belly, always hearing loudnoise and arguing, arguing all the time.

Other family factors mentioned were childrearingconflict between extended family members in the home(“My mother told my son, ‘If your mother spanks you, tellher that I am going to spank her!’ I tell my mother, ‘Don'ttell him that because that is wrong.’ That is why he will notrespect me.”), and the negative influence of older siblingswho themselves misbehave (“Some households … haveteenagers and you know, teenagers these days, they justwant to do whatever they want to do and [the youngerkids] see that, so that's why they're misbehaving”).

Parenting was viewed as a contributing cause of childmisbehavior by all of the focus groups, whereas only one(of the five) key informant held the view that parentingplays a causal role in child misbehavior. This motherargued that problems arise when parents do not to “puttheir foot down and say ‘You're gonna get your buttwhooped.’” She added:

I think that parents should just be on top of their kids all thetime from when they're little. If you take care of them whenthey're little, they'll be good when they get bigger. If you letthemget awaywith everything, or you let them run the streets allthe time, let them go out by themselves, do things by themselveswhen they're not, you know, of age yet to do it, you're makingthem grow up too fast.

All of the other key informants explicitly stated that theydid not believe parenting practices and child misbehavior

to be linked. For example, in response to a query of whetherparenting contributes to children's behavior problems, onemother said, “No, no I don't think so. [All parents] try to putlimits … but sometimes, [children] don't accept that andthey always just want to do what they want to do.”

As noted above, parenting was a common themeduring the focus group discussions. Only one group notedthe importance of building and maintaining a strongparent-child relationship, through giving children posi-tive attention and having meals together as a family. Morecommonly, groups expressed the view that lax parentingleads children to misbehave. “There are a lot of parents …that think that giving a child whatever they want, lettingthem do whatever they want to do, is good. But it'sbad.” In particular, mothers emphasized the need fordiscipline: “Sometimes one does not correct them. Onelets them grow up without rules, without discipline.”Another common view was that parents model negativebehaviors, such as yelling and hitting, that childrenimitate: “Sometimes … they imitate the behaviors theysee … If one is in the habit of responding by yelling, thechildren too are going to respond that way,” and “Parentswant to deal with everything by hitting. Then, kidsbecome more aggressive. We ourselves make themaggressive if that is how we bring them up.”

At the same time, mothers felt limited in their ability toeffectively raise their children without the use of yellingand hitting. One mother explained,

Children take advantage of this system in which we live, wherechildren are untouchable, where children are not to becorrected, where one has to put up with many things becauseone cannot “overcorrect” them, according to [Americans],which for us is a normal correction.Wedon't want to lose a childfor trying to correct him and lead him down the right path.

368 Calzada et al.

The majority of mothers reported that their childrenhad been told to call the police if they were spanked bytheir parents. Such disempowerment was viewed asultimately contributing to child misbehavior.

Acceptability of Evidence-Based Parenting StrategiesTable 4 presents participant views on the acceptability

of evidence-based parenting strategies for each keyinformant and focus group. There was universal accep-tance of parent-child play, the use of praise and privilegesas rewards for good behavior, and the elimination ofharsh verbal discipline (conversely, the use of a firm butmatter-of-fact tone of voice). Mothers easily recognizedthe importance of playing with their children, eventhough this was not common practice in their familiesand communities. “My mother didn't do that with us.With me, for example, when my mother was raising me,she was working, and would get home to cook, to clean.”

Mothers described commonly giving praise and privi-leges, as well, but praise was often used to “boost children'sself-esteem” and privileges were not always contingent ongood behavior (“[I give it to them whether] they behave orthey misbehave”). Moreover, most key informants andseveral mothers in the focus groups were opposed to theuse of material rewards for good behavior, arguing that itwas ineffective, and like “wasting my money” because,“The child does not needmaterial things. The child needslove.” Mothers expressed disagreement with the utility ofthis strategy: “If you [the psychologist] are tellingme to buyhim a toy, then you are not helping me,” and concernabout its feasibility, given their financial situations: “ThenI, as a parent, am going to be obligated and sometimes, Ido not have that option.” Several mothers described howthey had unequivocally told their children that they wouldget material goods only when there was money available

Table 4Acceptability of Common Evidence-Based Parenting Strategies for L

Key Informants (KI; n=5)

KI1 KI2 KI3 KI4* KI5*

POSITIVE STRATEGIESParent-child play • • • • xPraise/Privileges as rewards • • • • •Material rewards x x x x •

DISCIPLINARY STRATEGIESSelective Ignoring at home • x x • xSelective Ignoring in public • x x • xTime-out • x • x •Loss of privileges (response cost) • x • x •Eliminate spanking x x x x x

Note. * interview/focus group conducted in English. • = strategy viewed aconsensus. % agreed = % agreed on strategy as acceptable.

for their purchase, “I will buy you what I can and when Ican buy it,” and not under any other circumstance.

There was considerable discussion surrounding the ideaof selective ignoring as a parenting strategy. Severalmothers had successfully used ignoring in response totheir children's tantrums; in many cases, this was describedas theonly optionmothers hadwhen their childrenbecameupset after asking for something that themothers could notafford to buy for them. In other cases, mothers stated thatthey could not bear to watch their children upset if theycould help it: “I don't like children to go through that. It'swrong,” and, “I will end up crying myself!” Moreover,mothers rejected the idea of ignoring a child who is upsetbecause it limited parent-child communication: “You haveto communicate so your child learns,” and “I don't thinkyou should ignore a child no matter what the situation is.You should just listen to them.”

Most commonly, however, ignoring mild misbehaviorssuch as whining or tantrums was viewed as so passive that itwas considered neglectful: “I would ask him what's wrongwith him and try to comfort him. I wouldn't just ignore himand act like nothing's going on.” Mothers speculated that,“something is hurting him, he wants something, is hungry,or something is going on with him. Probably his stomach ishurting him, for example,” or even, “it could be one of theirsneakers that is too tight, and they don't want to express that[directly].”Mothers also expressed fears that their commu-nities would judge them for not being able to control theirchildren (“In the street, I find that people look at that as achild being spoiled”) and would be impatient with them fornot simply spanking the child in response to his tantrum:

[People will say] “You need to beat that child. That child isgoing to walk all over you.” And you know, I wouldn't strikeup an argument [against that] ’cause everybody's just going tosay, “You don't understand what it is to raise kids.”

atina Key Informants and Focus Groups

Focus Groups (FG; n=34)

% agreed FG1* FG2 FG3 FG4 FG5 % agreed

80% • • • • • 100%100% • • • • • 100%20% x • x • ~ 40%

40% x • x x ~ 20%40% x x x x x 060% ~ ~ ~ ~ • 20%60% • • • • • 100%

0 x x x x x 0

s acceptable; x = strategy viewed as objectionable; ~ = no group

369Latino Views of Parenting Practices

Alternately, mothers feared that the authorities wouldassume they were hurting their children if they witnesseda child throwing a tantrum in public: “They are going tothink you hit the child, and you did something to thechild.”

Most mothers reported a high level of acceptance ofloss of privileges as a form of discipline:

If you punish your child in that way, he is going to thinkabout doing it again, because he likes his toys, his videogames, watching television. If you use a punishment like thathe is going to say, “Well, now I won't do it again because I willlose that.”

Two of the key informant participants, however, didnot find loss of privileges acceptable, in both casesbecause they believed that preschool-aged children arenot old enough to understand such contingencies(“maybe when they are six or seven [years old]”).

No key informant or focus group participant ex-pressed agreement with the goal of eliminating spankingand relying exclusively on nonphysical discipline strat-egies such as loss of privileges. Spanking was describedas universally acceptable within the Latino culture, asreflected in the following comment: “[Kids] need a littlepants down, butt cheek out, and four fingers on thebehind. That's what they need.” Mothers repeatedlyemphasized that spanking was necessary in order tosuccessfully raise children (“They'd all be criminals ifyou don't”), although several mothers indicated thatthey were open to alternate strategies to use in additionto spanking. Mothers often referenced the way in whichthey themselves were raised, explaining that physicalpunishment (e.g., kneeling on rice, being hit with aswitch, phone cord or stick, or most commonly, beinghit without the use of an object) was the sole disciplinestrategy used in their families and communities. Aclear theme that emerged from both focus groups andinterviews was the challenge of disciplining children in asociety that discourages the use of spanking. In onegroup, when a mother described her reliance onspanking as a discipline strategy, another interjected,“Remember this is being videotaped!” The mistrust andthe disempowerment that resulted from the perceivedthreat of authorities was brought up in all of the focusgroups. One mother said, in reference to her blond,light-skinned child, “Even if I do this [presses her fingersonto the table], it leaves a mark. So that I don't leave amark, I can't hit him.”

The concept of time-out was largely unfamiliar tomothers (“Nobody that I know would know what time-outis.”), though some had been exposed to the strategythrough their child's school (“It's the teachers who use it.Not really the parents. The parents don't even know thatterm.”). Some mothers had misconceptions about the

strategy, as illustrated in the story of this focus groupparticipant:

I love the idea. I do that. Just yesterday, my husband put mydaughter [in time-out] because she didn't want to put on hercoat. He put her in her stroller and told her, “I don't want tospank you. I don't want to yell at you.” He put her in thestroller. And he gave her milk, put her feet up. And she wassuper comfortable, but she knew that she was in trouble andshe understood. [Time-out] is very useful.

When time-out, as used in parent training programs, wasexplained to mothers, reactions varied widely and many ofthe focus groups failed to reach consensus about itsacceptability. Some mothers objected outright, “I wouldn'tlike to see him there, sitting, alone, quietly.” Some believedthat their extended family and community members wouldsee it as “an abuse of the child” and would think themotherwas “crazy.” Two of the key informants were familiar withtime-out and believed it to be ineffective (“I don't think[my daughter] understood”). Some mothers said they hadno specific objection to time-out but they simply preferredother punishments, like loss of privileges. Others wereenthusiastic about the idea, explaining, “It works great!Where our children are in school, they use it … and athome, the kids will say, “Mommy, not the ugly chair, no!”Another mother explained, “I see it as useful. Because thenI won't mistreat my child, you see?”

Even though the majority of mothers were unfamiliarwith time-out (until it was explained to them), there was aclear openness to trying it with the support of a therapist.In fact, in every focus group and in four of the fiveindividual interviews, mothers stated that they woulddefer to a mental health professional regardless of theirown norms, values and beliefs. “If it is the advice of apsychologist, that is for the benefit of the child, even if ithurts, one [as a mother] has to do it.” Several mothersdescribed their need for professional support:

My ears are always open because I'm trying to be good. I'mtrying to be a good role model, you know, for my kids. Sowhatever you may tell me, if I'm doing anything wrong,anything right, I'll appreciate it.

For some, support was especially important because ofthe challenges of raising children in a new culturalcontext: “We're trying to do the best for our kids, but wedon't know. We were raised different,” and one in whichthey were isolated: “I do need that help. I don't have like alot of friends and stuff. It's only like me, by myself. I'mtrying to learn everything … but I don't have a lot ofpeople that I know to tell me.”

Discussion

The current study of social validity addressed thetreatment acceptability of parent training programs with

370 Calzada et al.

Latina mothers of young children ages 3 to 6. Using focusgroup and key informant interviewing methodology, thisstudy provided an in-depth examination of mothers’ viewsof the causes of young children's misbehavior and theacceptability of evidence-based parenting strategies. Thisresearch is useful in understanding the potential barriersto engagement and retention of Latino families in parenttraining programs and, ultimately, in addressing mentalhealth disparities.

In this somewhat heterogeneous (i.e., Spanish- andEnglish-speaking, from various countries of origin)sample of Latina mothers, there were differing opinionsabout many of the issues presented. One exception wasthe universal objection to the elimination of spanking as adiscipline strategy. Among both focus group participantsand key informants (whose children were identified ashaving behavior problems), spanking was described as aprimary discipline strategy used by Latino families andwas viewed as necessary for raising well-behaved children.This idea was rooted in the strong belief that parentingthat is not strict enough leads directly to child defiance.The empirical literature is inconclusive on the effects ofnormative spanking on young children's development(Baumrind, Larzelere, & Cowan, 2002; but see Gershoff,2002) but participant mothers struggled with messagesfrom mainstream American society that spanking is anunacceptable form of discipline (Dumas et al., 2010), andfelt both judged and disempowered.

Given the prevalence of spanking as described byparticipant mothers, and the fear that spanking is con-demned by U.S. American culture, it seems essential forservice providers to assure Latino parents that the use ofnormative spanking is not a reportable offence. A directconversation about the clinicians’ responsibilities as amandated reporter to child welfare agencies, and of thecircumstances under which clinicians judge children to bein danger (or not), will help to dispel misconceptions andbuild trust. Clinicians should also recognize any biases theyhave related to the use of normative spanking and be awareof the ways in which theymay (directly or indirectly) conveyjudgment of a parent who chooses to spank.

Other commonly cited causes for the developmentof behavior problems included negative peer influences(i.e., imitating defiant and aggressive classmates), difficultchild temperament and fighting in thehome.These findingssuggest that Latino parents may not be drawn to mentalhealth services that treat child behavior problems bytargeting parenting practices, and that clinicians may needto emphasize different aspects of the intervention to engagethem in parent training programs. For example, cliniciansmay help parents see how parent training programs addressthe needs of children with difficult temperaments or thoseexposed to stress (e.g., fighting in the home) and negativeoutside influences. It could also be useful to frame a parent

training program in terms of biculturalism, or supportingparents in finding strategies that are both consistent withtheir strict approach and acceptable within mainstreamU.S.American society. Past studies on the cultural adaptation ofparent training programs for Latino families have found itbeneficial to reframe services to be aligned with culturallyspecific goals and issues (Martinez & Eddy, 2005; McCabe,Yeh, Garland, Lau, & Chavez, 2005). Thus, careful atten-tion to the way in which parent training programs arenamed and advertised could increase the service utilizationof Latino families.

In addition to the use of spanking, the other strategyfor which there was total consensus was the use of praise.Mothers agreed with rewarding good behavior with praise,other social rewards and privileges. They also noted theadded benefit of building children's self-esteem. Mostmothers found parent-child playtime acceptable as well.These findings are consistent with past studies that havefoundhigh levels of self-reported use of praise and playtimeamong Latina mothers of preschoolers (Calzada & Eyberg,2002), and high acceptance of positive parenting practicesamong parents more generally (Jones et al., 1998; Kazdin,1980a, 1980b).

It has been suggested that the Latino value of respeto(i.e., an emphasis on respect that calls for unquestioningobedience and deference to adults/elders) may beincongruous with the use of positive reinforcement(Calzada, 2010). In the present study, evidence for thisnotion was found only in relation to the use of materialrewards, which mothers found objectionable becausechildren should not “need” material rewards in order tobehave appropriately. Most social validity studies do notexplicitly examine the acceptability of the use of materialrewards to shape and reinforce positive behavior (forexample, Borrego and colleagues, 2007, examined positivereinforcement in the form of privileges earned) and it ispossible that the current findings reflect the socioeconomicstatus of the mothers more than any underlying culturalbeliefs. Notably, however, Dumas and colleagues (2010)found that physical affection is the most culturally con-gruent form of reinforcement among immigrant Mexicanmothers. It is important for clinicians to be sensitive whendeveloping a token economy system (e.g., a sticker chart)with Latino families and avoid assumptions about theacceptability and feasibility of earningmaterial rewards suchas stickers or small toys. Exploring various types ofreinforcers, especially social rewards, may be critical inestablishing a successful token economy system withinLatino families.

With the exception of some concerns about theage-appropriateness of the strategy, mothers were familiarwith and accepting of loss of privileges as a disciplinestrategy. In fact, consistent with Borrego et al.'s (2007)findings, the present study showed that taking away

371Latino Views of Parenting Practices

privileges and toys was the preferred punishment forcommon child misbehaviors (and spanking was the pre-ferred punishment for more serious but less commonmisbehaviors). In contrast, Latina mothers in this samplewere generally not familiar with time-out, andmany notedits incongruence with traditional Latino discipline. Still,many mothers, particularly those who had seen it usedsuccessfully in the school setting, expressed an opennessto this approach to discipline.

Importantly, few mothers had an accurate understand-ing of time-out (e.g., that children should not receiveattention or any other reinforcer during time-out), and itwas those who had used time-out incorrectly andunsuccessfully who found the strategy most objectionable.While the Borrego et al. study (2007) found that time-outwas highly acceptable with his sample ofMexicanAmericanparents, other studies have found that Latino parents findtime-out unfamiliar (Donovick & Domenech-Rodriguez,2008) or too demanding (Matos, Torres, Santiago, Jurado,& Rodriguez, 2006). It is possible that the acculturationlevel of the parents influences their exposure to andunderstanding of time-out, and knowledge, in turn, isrelated to acceptability (Hobbs, Walle, & Caldwell, 1984).These findings highlight the critical need for a strongpsychoeducational component to parent training pro-grams with Latinos (Matos et al., 2006). It may also beuseful for clinicians to offer less acculturatedLatino parentsa menu of additional disciplinary approaches.

Perhaps the most universally objectionable parentingstrategy was selective ignoring, which was seen as passiveand neglectful. Similarly, McCabe and colleagues (2005)reported that clinic-referred Mexican American familiesfound ignoring misbehaviors too passive, and suggestedteaching parents a more active approach to discipline. Inthe view of many of the Latina mothers in the presentstudy, children who are engaging in mild misbehaviors(e.g., whining, sassing, screaming, tantruming) have emo-tional and sometimes physical needs that mothers shouldattend to through open communication and support; tofail to attend to these needs was deemed bad parenting.Moreover, somemothers believed it was more important tostop a child from experiencing (and displaying) strongnegative emotions than to correct his behavior, per se.

The low acceptability of ignoring, also found in theBorrego et al. study (2007) and consistent with the culturalvalue of respeto (Calzada, 2010), underscores the need forcaution in coaching parents in the use of parentingstrategies that rely on selective ignoring, including differen-tial attention and time-out. Notably, though, studies withnon-Latino White parents have also found ignoring to havelow acceptability (e.g., Calvert & McMahon, 1987), suggest-ing that there may be universal factors (e.g., parents’emotional experience in ignoring) that explain parents’rejection of ignoring as a discipline strategy.

In the present study, selective ignoring was describedas especially objectionable in public situations in whichmothers said they would feel judged by their communitiesfor not adequately disciplining their children (i.e., for beingtoo lenient; McCabe et al., 2005), and fearful of authorities(i.e., the police) who would assume they were hurtingtheir children. One clear instance in which ignoring wasdescribed as necessary and successful was when childrenwere having a tantrum over something they wanted andwhich mothers could not afford to buy for them; in thiscase, mothers felt they had no choice but to ignore a childwho did not respond to their attempts to comfort themwithout giving in to their demands. In general, though, thestrategy of selective ignoringmaybeunappealing forLatinoparents without some form of modification. Cliniciansshould help Latino parents make modifications or identifyalternate effective parenting strategies for use in publicsituations, as children's misbehavior in public has beenfound to be a significant source of stress for parents,especially of children with behavior problems (Donenberg& Baker, 1993; Suarez & Baker, 1997). Proactive strategiesthat help to prevent misbehavior, such as clarifyingexpectations, establishing rules, and explaining conse-quences, may be especially useful and acceptable fordealing with public misbehavior among young Latinochildren.

In sum, study findings suggest that Latino parents haveculturally rooted and contextually driven beliefs thatappear to influence their view of the parenting strategiesespoused in evidence-based parent training programs.Nonetheless, Latina mothers in the present studyexpressed a great need for support around parentingissues, an openness to learning new strategies that workwithin a U.S. cultural context, and the willingness to deferto mental health professionals for the sake of theirchildren's healthy development. The openness andseeming trust expressed by participants may have beenspecific to working with a mental health professional whowas both Latina and bilingual (as was their experience inthis project). But they may also have reflected the moti-vation for Latino parents to effectively control theirchildren's disruptive behaviors, such as defiance, whichcan be particularly egregious in Latino culture because ofthe emphasis on interpersonal harmony.

There are clear limitations to the present study thatshould be noted. The inclusion of fathers in studies ofLatino families is critically important, both in light of thekey role that fathers play in child development (Cabrera& Garcia Coll, 2004) and in light of demographic datathat show the high percentage of Latino children who areraised in two-parent homes (U.S. Census Bureau, 2007).The views of other family caregivers, including grandpar-ents, who are intimately involved in childrearing, mustalso be considered (Calzada, 2010; Powell, Zambrana, &

372 Calzada et al.

Silva-Palacios, 1990). Also, while the present sampleincluded Spanish- and English-speaking Latina mothersfrom various ethnic backgrounds, all participants camefrom low-income urban communities, and the presentfindings should not be generalized to Latina mothersliving in rural or suburban communities, or those of highersocioeconomic status. Past studies have found within-ethnicgroup differences in the acceptability of parenting strate-gies based on family income, suggesting that culturalbackground and SES interact to shape acceptance (Heffer& Kelley, 1987).

Moreover, although we aimed to examine treatmentacceptability among parents of children with and withoutbehavior problems, all children had elevated internalizingand/or externalizing scores. Unfortunately, because wedid not collect information on the eligibility of families ateach site, we cannot examine whether participant motherswere representative of the larger community from whichthey were recruited. Given the apparent self-selectionbias among mothers from the community who chose toparticipate, caution must be taken in generalizing findingstomothers of childrenwithout behavior problems.Also, thesample size was small, further limiting the generalizability ofstudy findings and precluding examination of specificsubgroup differences in the present study. As the diversity(in terms of country of origin, language of choice) in thesample may explain some of the divergent views expressedwithin and across groups and interviews, future studiesshould explore these sources of variation as they havesignificant implications for the dissemination of parenttraining programs to the pan-Latino population. Othercharacteristics of the participants, including employmentstatus, marital status, stress, and depression, may havesimilarly influenced mothers’ responses and deservefurther attention. Finally, although every effort was madeto ensure that mothers understood the parenting strategieswell enough to judge their acceptability, it is possiblethat mothers’ perceptions would change if they had theopportunity to further explore the real-life use of thestrategies.

Nonetheless, the present study makes a contribution tothe literature on the treatment acceptability of evidence--based parenting strategies with Latina mothers of youngchildren. The use of a qualitative research approachallowed for an exploration of the underlying views thatcontribute to mothers’ perceptions of a strategy as accept-able or objectionable, and several themes to guide clinicalwork with Latino parents were identified. As mental healthprofessionals charged with serving the Latino populationwith engaging services, it is important to keep culturecentral in the process of parent training programs. Suchefforts would serve to empower Latino parents to raise theirchildren in ways that are both effective and culturallycongruent.

References

Alegria, M., Canino, G., Rios, R., Vera, M., Calderon, J., Rusch, D., &Ortega, A. N. (2002). Mental health care for Latinos: Inequalitiesin use of specialty mental health services among Latinos, AfricanAmericans, and non-LatinoWhites. Psychiatric Services, 53, 1547–1555.http://dx.doi.org/10.1176/appi.ps.53.12.1547

Alegría, M., Mulvaney-Day, N., Woo, M., Torres, M., Gao, S., & Oddo, V.(2007). Correlates of past‐year mental health service use amongLatinos: Results from theNational Latino andAsian American Study.American Journal of Public Health, 97, 76–83. http://dx.doi.org/10.2105/AJPH.2006.087197

American Psychiatry Association (2010). Mental Health Disparities: Hispa-nics/Latinos [Fact Sheet]. Retrieved from. http://www.psych.org/Share/OMNA/Mental-Health-Disparities-Fact-Sheet–Latinos.aspx.

Arnold, D. S., O'Leary, S. G., Wolff, L. S., & Acker, M. M. (1993). TheParenting Scale: A measure of dysfunctional parenting in disciplinesituations. Psychological Assessment, 5, 137–144. http://dx.doi.org/10.1037/1040-3590.5.2.137

Baumrind, D. (1995). Child maltreatment and optimal caregiving in socialcontexts. New York, NY: Garland.

Baumrind, D., Larzelere, R. E., & Cowan, P. (2002). Ordinary physicalpunishment: Is it harmful?CommentonGershoff (2002).PsychologicalBulletin, 128(4), 580–589.

Bernal, G., & Scharron-Del Rio, M. R. (2001). Are empirically supportedtreatments valid for ethnic minorities? Toward an alternativeapproach for treatment research.Cultural Diversity andEthnicMinorityPsychology, 7, 328–342. http://dx.doi.org/10.1037/1099-9809.7.4.328

Bird, H., Canino, G. J., Davies, M., Zhang, H., Ramirez, R., & Lahey, B. B.(2001). Prevalence and correlates of antisocial behaviors amongthree ethnic groups. Journal of Abnormal Child Psychology, 29, 465–478.http://dx.doi.org/10.1023/A:1012279707372

Borrego, J., Ibanez, E. S., Spendlove, S. J., & Pemberton, J. R. (2007).Treatment acceptability among Mexican American parents.Behavior Therapy, 38, 218–227. http://dx.doi.org/10.1016/j.beth.2006.08.007

Brestan, E. V., & Eyberg, S. M. (1998). Effective psychosocial treat-ments of conduct-disordered children and adolescents: 29 years,82 studies, and 5,272 kids. Journal of Clinical Child Psychology, 27,180–189. http://dx.doi.org/10.1207/s15374424jccp2702_5

Cabrera, N. J., & Garcia Coll, C. (2004). Latino fathers: Unchartedterritory in need of much exploration. In M. E. Lamb (Ed.), Therole of father in child development (4th ed. pp. 447–452). Mahwah, NJ:Erlbaum.

Calvert, S., & McMahon, R. (1987). The treatment acceptability of abehavioral parent training program and its components. BehaviorTherapy, 2, 165–179. http://dx.doi.org/10.1016/S0005-7894(87)80040-0

Calzada, E. (2010). Bringing culture into parent training with Latinos.Cognitive and Behavioral Practice, 17, 167–175. http://dx.doi.org/10.1016/j.cbpra.2010.01.003

Calzada, E., & Eyberg, S. (2002). Self-reported parenting practices inDominican and Puerto Rican mothers of young children. Journalof Clinical Child and Adolescent Psychology, 31, 354–363. http://dx.doi.org/10.1207/S15374424JCCP3103_07

Calzada, E. J., Fernandez, Y., & Cortes, D. E. (2010). Incorporating thecultural value of respeto into a framework of Latino parenting.Cultural Diversity and Ethnic Minority Psychology, 16, 77–86. http://dx.doi.org/10.1037/a0016071

Calzada, E. J., Huang, K. Y., Anicama, C., Fernandez, Y., & Brotman, L.M. (2012). A test of a cultural framework of Latino parenting.Cultural Diversity and Ethnic Minority Psychology, 18, 285.

Centers for Disease Control and Prevention (2008). Youth risk behaviorsurveillance – United States, 2007. (MMWR Report # 57). Retrievedfrom http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5704a1.htm.

Chambless, D. L., & Hollon, S. D. (1998). Defining empiricallysupported therapies. Journal of Consulting and Clinical Psychoogy, 66,7–18. http://dx.doi.org/10.1037/0022-006X.66.1.7

Donovick, M., & Domenech-Rodriguez, M. (2008). Parenting Practicesamong first generation Spanish-speaking Latino families: A

373Latino Views of Parenting Practices

Spanish version of the Alabama Parenting Questionnaire.GraduateStudent Journal of Psychology, 10, 52–63. Retrieved from: http://www.tc.columbia.edu/publications/gsjp/detail.asp?Id=GSJP+Volumes&Info=GSJP%2C+Volume+10+%282008%29

Donenberg, G., & Baker, B. L. (1993). The impact of young children withexternalizing behaviours on their families. Journal of Abnormal ChildPsychology, 21, 179–198. http://dx.doi.org/10.1207/S15374424JCCP3103_10

Dumas, J. E., Arriaga, X., Begle, A. M., & Longoria, Z. (2010). “When willyour program be available in Spanish?”Adapting an early parentingintervention for Latino families. Cognitive and Behavioral Practice, 17,176–187. http://dx.doi.org/10.1016/j.cbpra.2010.01.004

Eyberg, S. (2005). Tailoring and adapting parent-child interactiontherapy to new populations. Education and Treatment of Children,28(2), 197–201. Retrieved from http://vnweb.hwwilsonweb.com.ezproxy.med.nyu.edu/hww/results/results_common.jhtml;hwwilsonid=SWYMVMZVOXBVZQA3DILCFGOADUNGIIV0

Eyberg, S.M., &Robinson, E. A. (1982). Parent-child interaction training:Effects on family functioning. Journal of Clinical Child Psychology, ll,130–137. http://dx.doi.org/10.1080/15374418209533076

Forehand, R., Wells, K. C., & Griest, D. L. (1980). An examination ofthe social validity of a parent training program. Behavior Therapy,11, 488–502. http://dx.doi.org/10.1016/S0005-7894(80)80065-7

Forehand, R., &Kotchick, B. A. (1996).Cultural diversity: Awake-up call forparent training. Behavior Therapy, 27, 187–206. http://dx.doi.org/10.1016/S0005-7894(96)80014-1

Gershoff, E. T. (2002). Corporal punishment by parents and associatedchild behaviors and experiences: A meta-analytic and theoreticalreview. Psychological Bulletin, 128, 539–579.

Hall, G. C. N. (2001). Psychotherapy research with ethnic minorities:Empirical, ethical, and conceptual issues. Journal of Consulting andClinical Psychology, 69, 502–510. http://dx.doi.org/10.1037/0022-006X.69.3.502

Hart, C. H., Nelson, D. A., Robinson, C. C., Olsen, S. R., & McNeilly-Choque, M. K. (1998). Overt and relational aggression in Russiannursery-school-age children: Parenting style and marital linkages.Developmental Psychology, 34, 687–697. http://dx.doi.org/10.1037/0011649.34.4.687

Heffer, R. W., & Kelley, M. L. (1987). Mothers’ acceptance ofbehavioral interventions for children: The influence of parentrace and income. Behavior Therapy, 2, 153–163.

Hobbs, S. A.,Walle, D. L., &Caldwell,H. S. (1984).Maternal evaluation ofsocial reinforcement and time-out: Effects of brief parent training.Journal of Consulting and Clinical Psychology, 52, 135–136. http://dx.doi.org/10.1037/0022-006X.52.1.135

Ho, J., Yeh, M., McCabe, K., & Lau, A. (2011). Perceptions of theacceptability of parent training among Chinese immigrant parents:Contributions of cultural factors and clinical need. Behavior Therapy,43, 436–449.

Jones, M., Eyberg, S., Adams, C., & Boggs, S. (1998). Treatmentacceptability of behavioral interventions for children: An assessmentby mothers of children with disruptive behavior disorders. Childand Family Behavior Therapy, 20, 15–27. http://dx.doi.org/10.1300/J019v20n04_02

Kazdin, A. E. (1980a). Acceptability of alternative treatments fordeviant child behavior. Journal of Applied Behavior Analysis, 13,259–273. http://dx.doi.org/10.1901/jaba.1980.13-259

Kazdin, A. E. (1980b). Acceptability of time-out from reinforcementprocedures for disruptive child behavior. Behavior Therapy, 11,329–344. http://dx.doi.org/10.1016/S0005-7894(80)80050-5

Kazdin, A. E. (2005). Evidence-based assessment for children andadolescents: Issues in measurement development and clinicalapplication. Journal of Clinical Child and Adolescent Psychology, 34,548–558. http://dx.doi.org/10.1207/s15374424jccp3403_10

Kouyoumdjian, H., Zamboanga, B. L., & Hansen, D. J. (2003). Barriersto community mental health services for Latinos: Treatmentconsiderations. Clinical Psychology: Science and Practice, 10, 394–422.http://dx.doi.org/10.1093/clipsy.bpg041

MacQueen, K. M., McLellan-Lemal, E., Bartholow, K., & Milstein, B.(2008). Team-based codebook development: Structure, process,and agreement. InG.Guest, &K.M.MacQueen (Eds.),Handbook for

team-based qualitative research (pp. 119–135). Lanham, MD: AltaMiraPress.

Martinez, C. R., & Eddy, J. M. (2005). Effects of culturally adaptedparent management training on Latino youth behavioral healthoutcomes. Journal of Consulting and Clinical Psychology, 73, 841–851.http://dx.doi.org/10.1037/0022-006X.73.5.841

Matos, M., Torres, R., Santiago, R., Jurado, M., & Rodriguez, I. (2006).Adaptation of parent child interaction therapy for Puerto Ricanfamilies: A preliminary study. Family Process, 45, 205–222. http://dx.doi.org/10.1111/j.1545-5300.2006.00091.x

McCabe, K. M., Yeh, M., Garland, A. F., Lau, A. S., & Chavez, G. (2005).The GANA program: A tailoring approach to adapting parent-childinteraction therapy for Mexican Americans. Education and Treatmentof Children, 28, 111–129. Retrieved fromhttp://vnweb.hwwilsonweb.com.ezproxy.med.nyu.edu/hww/results/results_common.jhtml;hwwilsonid=SWYMVMZVOXBVZQA3DILCFGOADUNGIIV0

Miller, D. L., & Kelley, M. L. (1992). Treatment acceptability: The effectsof parent gender, marital adjustment, and child behavior. Child& Family Behavior Therapy, 14, 11–23. http://dx.doi.org/10.1300/J019v14n01_02

Parra Cardona, J. R., Domenech-Rodriguez, M., Forgatch, M., Sullivan, C.,Holtrop, K., Escobar-Chew, A. R., …, Bernal, G. (2012). Culturallyadapting an evidence-based parenting intervention for Latinoimmigrants: The need to integrate fidelity and cultural relevance.Family Process, 51, 56–72. http://dx.doi.org/10.1111/j.1545-5300.2011.01386.x

Patterson, G. R. (1982). Coercive family process. Eugene, OR: Castilia.Peters, M. F. (1988). Parenting in Black families with young children: A

historical perspective. In H. P. McAdoo (Ed.), Black families(pp. 211–224). Newbury Park, CA: Sage.

Powell, D. R., Zambrana, R., & Silva-Palacios, V. (1990). Designingculturally responsive parent programs: A comparison of low--income Mexican and Mexican-American mothers’ preferences.Famly Relations, 39, 298–304.

Reynolds, C. R., & Kamphaus, R.W. (1998). BASC: Behavioral assessmentsystem for children. Circle Pines, MN: American Guidance Service.

Roberts, R. E., Alegría, M., Roberts, C. R., & Chen, I. G. (2005). Mentalhealth problems of adolescents as reported by their caregivers: Acomparison of European, African, and Latino Americans. Journalof BehavioralHealth Services&Research, 32, 1–13. http://dx.doi.org/10.1007/BF02287324

Robinson, C. C., Mandleco, B., Olsen, S. F., & Hart, C. H. (1995).Authoritative, authoritarian, and permissive parenting practices:Development of a new measure. Psychological Reports, 77, 819–830.http://dx.doi.org/10.2466/pr0.1995.77.3.819

Rojas-Vilches, A. P., Negy, C., & Reig-Ferrer, A. (2011). Attitudestoward seeking therapy among Puerto Rican and CubanAmerican young adults and their parents. International Journal ofClinical and Health Psychology, 11, 313–341. Retrieved from: http://www.aepc.es/ijchp/articulos_pdf/ijchp-382.pdf

Serketich, W. J., & Dumas, J. E. (1996). The effectiveness of behavioralparent training to modify antisocial behavior in children: Ameta-analysis. Behavior Therapy, 27, 171–186. http://dx.doi.org/10.1016/S0005-7894(96)80013-X

Slaughter, D. T., & McWorter, G. A. (1985). Social origins and earlyfeatures of the scientific study of Black American families andchildren. In M. B. Spencer, G. K. Brookins, & W. R. Allen (Eds.),Beginnings: The social and affective development of Black children(pp. 5–18). Hillsdale, NJ: Erlbaum.

Snyder, H. N., & Sickmund, M. (1999). Juvenile offenders and victims:1999 National Report. Washington, DC: Office of Juvenile Justiceand Delinquency Prevention.

Suarez, L. M., & Baker, B. L. (1997). Child externalizing behavior andparents’ stress: The role of social support. Family Relations, 47,373–381. http://dx.doi.org/10.2307/585097.

U.S. Census Bureau (2007). The American community—Hispanics:2004.(ACS Report 3). Retrieved from. http://www.census.gov/prod/2007pubs/acs-03.pdf.

Webster-Stratton, C. (1989). Systematic comparison of consumersatisfaction of three cost-effective parent training programs forconduct problem children. Behavior Therapy, 20, 103–115. http://dx.doi.org/10.1016/S0005-7894(89)80121-2

374 Calzada et al.

Wolf, M. M. (1978). Social validity: The case for subjective measure-ment or how applied behavior analysis is finding its heart. Journalof Applied Behavior Analysis, 11, 203–214. http://dx.doi.org/10.1901/jaba.1978.11-203

Yeh, M., McCabe, K., Hough, R. L., Lau, A., Fakhry, F., & Garland, A.(2005). Why bother with beliefs? Examining relationships betweenrace/ethnicity, parental beliefs about causes of child problems, andmental health service use. Journal of Consulting and Clinical Psychology,73, 800–807. http://dx.doi.org/10.1037/0022-006X.73.5.800

Zayas, L., & Rojas-Flores, L. (2002). Learning from Latino parents:Combining etic and emic approaches to designing interventions. In J.M. Contreras, K. A. Kerns, & A.M.Neal-Barnett (Eds.), Latino childrenand families in the United States (pp. 233–252). Westport, CT: Praeger.

Zea, M., Asner-Self, K., Birman, D., & Buki, L. (2003). The AbbreviatedMultidimensional Acculturation Scale: Empirical validation with twoLatino/Latina samples.Cultural Diversity andEthnicMinorityPsychology,9, 107–126. http://dx.doi.org/10.1037/1099-9809.9.2.107

Sevan Basil is now at Adelphi University. Yenny Fernandez is now atHunterCollege.Acknowledgments. This study was supported by a subcontract fromNIMH (P30 MH068579-04).The authors wish to thank Luis Zayas, Ph.D., Enola Proctor, Ph.D., andJoaquin Borrego, Ph.D., for their support of this work. The authorsalso wish to thank the collaborating school sites and participantfamilies who made this work possible.

Address correspondence to Esther J. Calzada, Ph.D., New YorkUniversity Child Study Center, 215 Lexington Avenue, 13th Floor,New York, NY 10016; e-mail: Esther.calzada@nyumc.org.

Received: December 23, 2011Accepted: August 30, 2012Available online 14 September 2012