The dissertation aimed to examine ethnic minority parents' attendance and session engagement in Parent Training (PT) and their impact on treatment outcome. In study one, we found that African American parent participants were less likely than Non-Hispanic White parents to not attend any session, even after controlling for other baseline variables known to impact attendance. Once ethnic minority parents attended a session, however, their subsequent attendance was not found to be different from Non-Hispanic White parents'. In study two, we found that once ethnic minority parents joined a PT session, their group leaders did not rate their participation differently from Non-Hispanic White participants. Also, leader-rated participation scores at the outset of PT were found to predict later session inattendance and dropouts. Lastly, study three examined how attendance and session engagement may predict treatment outcomes of parenting practices and child behavior problems. The results showed no significant difference between ethnic minority parents' and Non-Hispanic White parents' parenting practices and child behaviors at post-treatment. In addition, results revealed that leader-rated participation at the beginning of PT predicted some of the parenting practice outcomes at post-treatment. This suggests that group leaders may be able to identify parents who are less likely to respond to treatment very early in the course of PT by evaluating their in-session participation, and that session engagement may be a better predictor of treatment outcome than attendance. These findings suggest that the main barrier for ethnic minority parents to benefit from PT appear to be at the recruitment stage, and they participate in similar ways as Non-Hispanic White parents once they successfully attended at least one session. Nonetheless, there was some evidence that leaders can still benefit from increased cultural sensitivity to ethnic minority's disengagement in PT. Clinical implications and limitations are discussed.

This dissertation used observational methods to examine shared-decision making (SDM) as a potential engagement strategy for caregivers of Latinx youth within the context of multiple EBP delivery. Results revealed that community therapists used SDM in most sessions about varied types of decisions, but only at modest levels. We did not find an association between global measurements of SDM and therapeutic bond elements.

Community therapists often adapt evidence-based practices (EBPs) when transported into public systems of care to enhance their fit for the diverse youth and families they serve. Community therapists hold valuable local expertise about what may promote client understanding or engagement in their care contexts, especially when they identify with the communities they serve. This dissertation study employed observational methods to: (1) characterize Augmenting adaptations that community therapists make in sessions of trauma-focused cognitive behavioral therapy (TF-CBT) and factors associated with them; (2) examine associations between Augmenting adaptations and adherence to TF-CBT at the session-level; and (3) examine associations between Augmenting adaptations and client engagement within and across sessions. A sample of 46 community therapists provided 190 TF-CBT session audio recordings delivered to 82 youth (Mean age = 10.30; 67.07% Hispanic/Latine, 21.95% Black, 7.32% Asian American/Pacific Islander, 2.44% White, 1.22% Multiracial). Two observational coding systems were developed and two independent teams of coders were trained to assess the extensiveness of Augmenting adaptations and adherence to TF-CBT (0 = no occurrence, 6 = great extent). Therapist-reported client disengagement and previously observed client engagement behaviors were used to index client engagement outcomes. Multilevel modeling was conducted to investigate the aims. Results indicated that community therapists made Augmenting adaptations in most sessions (n = 119; 62.63%), primarily at modest levels (Mean extensiveness = 2.45; Range = 0–6). Findings revealed session, client, and therapist factors associated with Augmenting adaptations. TF-CBT components were observed in all but two sessions, with acceptable session-level adherence as indicated by the max component score (Mean extensiveness = 4.01, Range = 0–6). No Augmenting adaptations were related to adherence extensiveness. Modify Presentation extensiveness was related to lower odds of therapist-reported client disengagement in a given session, while Integrate extensiveness was related to higher odds of therapist-reported client disengagement. Repeat extensiveness was positively associated with client engagement behaviors. The dissertation data could not support lagged associations between Augmenting adaptations and client engagement in subsequent sessions. While findings suggest meaningful relationships between adaptation and engagement, it is imperative for future work to systematically disentangle the direction of these associations. Implications for EBP practice and implementation within community mental health settings serving structurally minoritized youth and families are discussed.

Previous research suggests that child behavioral phenotypes such as behavioral inhibition and aspects of parental control behavior may be shaped by culturally-informed socialization goals. Specifically, in accord with collectivistic values for interpersonal harmony and self-discipline, East Asian parents tend to support children's behavioral inhibition (BI; Chen & French, 2008) and utilize more parental control strategies such as encouragement of moderate emotional expressivity and restrictiveness (P. Wu et al., 2002). In contrast, parents from Western contexts tend to view BI as an indicator of anxiety (Rosenbaum et al., 1993; Schwartz, Snidman, & Kagan, 1999; Turner, Beidel, & Wolff, 1996) and avoid using parental control methods for fear of intruding on a child's autonomy (e.g., Chao & Tseng, 2002).

Thus, child behavioral inhibition may be associated with other child dispositions such as cognitive control and negative affectivity in distinct ways depending on the cultural context. Likewise, parental control may have different motivational determinants depending on cultural context. In particular, the role of possible evocative effects of child developmental factors such as behavioral difficulties, self-regulation, and cognitive control should be understood within cultural context. In order to better understand the nature of cultural differences in parental control, it is useful to examine a population in which developmental challenges may shape parent orientation toward control. Thus, while Paper 1 focuses on cultural differences in typically developing children and their parents, Paper 2 examines how parenting may shift to non-normative cultural practices in response to more challenging child behaviors as displayed by internationally adopted children.

In Paper 1 we examined whether BI and parental control were differentially related to children's temperament in a sample of 45 Asian American (AA) and European American (EA) preschoolers. Results indicated that AA parents endorsed more parental control (restrictiveness, encouragement of modesty) than EA parents. However, there were no ethnic differences in BI, cognitive control, or negative affectivity. Furthermore, analyses revealed that for AA families, BI was positively correlated with a measure of cognitive control; however, this association was not significant for EA children. This finding is consistent with the notion that BI is a heterogeneous phenotype in which AA children may be intentionally utilizing their cognitive control abilities to display withdrawal from novel situations (Xu et al., 2007). In addition, among AA children, there was no significant relationship between parental control and cognitive control, whereas this relationship was negative for EA families. This suggests that while parental control may be normative in AA families and not closely tied to children's cognitive control, there may be a different process in EA families. While the direction of influence is not clear, it may be that when EA children struggle with cognitive control, EA parents move outside of their culturally normative approach and utilize more parental control.

In Paper 2 we continued to explore evocative models of development in a sample of 64 preschoolers. We examined the interaction of parental ethnicity (EA, AA) and adoption status (adopted, nonadopted) on parental control and the explanatory effects of child factors (behavioral inhibition, anxiety, and cognitive control). Results indicated that adopted children displayed higher behavioral inhibition and lower parent reported cognitive control. As predicted, cultural differences in parental control emerged among the parents who did not adopt, but there was cultural similarity among the parents who adopted. Furthermore, we found that variation in behavioral inhibition and cognitive control partially explained adoption status by ethnicity interaction effects on parental control.

Taken together, these findings help elucidate the complicated reciprocal influences that flow between a child, their parents, and the larger culture.

This study investigated whether cultural factors and aspects of a stressor determined Vietnamese American and European American adolescents’ coping responses. Between- and within-person differences in the link between coping tendencies and patterns and psychological adjustment were also examined. It was hypothesized that individual and stressor-related factors would differentially determine adolescents’ coping responses. Moreover, it was predicted that support seeking would be more adaptive for females than males and that avoidant coping would be less detrimental for Vietnamese American adolescents than for European American adolescents as these coping strategies are more aligned with the ways in which they have been socialized. It was also expected that adolescents with more variability in their patterns of coping and more overall deployment of coping strategies would be better adjusted than those with less coping variability and lower coping average levels, respectively.

Findings showed that females and Vietnamese Americans used more avoidant coping than males and European Americans, respectively, whereas there were no group differences in support seeking. Adolescents who strongly endorsed emotional restraint reported higher levels of avoidant coping and less support seeking. Also, adolescents who strongly valued family obligation tended to use more support-seeking strategies. In terms of aspects of the stressor, adolescents used more avoidant coping for stressors that they perceived as highly stressful. This association was moderated by gender such that females engaged in high levels of support seeking regardless of how stressful they perceived an event. Adolescents also tended to use more avoidant coping for conflict-related stressors. This association was moderated by ethnicity such that Vietnamese American adolescents reported using more avoidance for interpersonal conflicts compared to European American adolescents. For family-related stressors, adolescents engaged in less support seeking.

Between- and within-person differences in the link between coping response and internalizing symptoms showed that more avoidance coping was associated with more distress at both the individual and occasion levels. In contrast, support seeking was associated with less distress at the individual level but not at the occasion level. Despite individual and gender differences in the average use of coping strategies, gender and ethnicity did not moderate the associations between coping strategies and adjustment. Lastly, coping variability did not predict psychological adjustment, but mean levels of coping were related to internalizing symptoms depending upon whether examined at the individual or occasion level.

The strengths of the current study include the simultaneous examination of between- and within-person differences in the link between coping responses and internalizing symptoms. Additionally, this study was the first to exam adolescents’ dispersion of coping strategies employed in conjunction with overall amounts of coping at both the individual and occasion level. Implications for interventions relating to coping skills training were discussed.

Youth and families, particularly those from ethnic minority backgrounds, demonstrate high levels of unmet need (Kataoka, Zhang, & Wells, 2002), and when they do initiate care, they often experience significant barriers to engagement in child mental health services (MHS; Kazdin, 1993; McCabe, 2002; Morrisey-Kane & Prinz, 1999). Active parent participation in child MHS has been associated with improved outcomes compared to individual child treatment (Dowell and Ogles 2010). Yet, parents are often uninvolved in their child's therapy, and this may be a particular problem in school-based mental health services (SBMHS). SBMHS offer the advantage of increasing access to care (Atkins, 2003), but there appears to be an overreliance on individual counseling (Cerio, 1997; Weist, 1997). Psychoeducation, a therapeutic practice used to present factual information about MH problems and treatments, may be a powerful tool for preparing families for treatment, thereby promoting parental engagement in care.

Study 1 examined the unique effect of therapists' use of psychoeducation strategies, over and above use of engagement strategies, on promoting parental engagement among an ethnically diverse sample of 46 families that received community-based child MHS for disruptive behavior problems. Families were randomized to receive treatment in an evidenced-based (a modular manualized treatment, MMT) or usual care (UC) treatment within the same community agencies. An observational coding system was developed to code recorded therapy sessions for therapists' in-session use of psychoeducation and engagement strategies in the early phase of treatment. Findings revealed that psychoeducation strategies employed by therapists early on uniquely predicted later parent attendance in treatment, over and above the use of other engagement strategies. Furthermore, therapists in MMT provided more psychoeducation and other engagement strategies compared to therapists in UC. Finally, treatment condition predicted parent attendance with parents in MMT attending a greater proportion of treatment sessions than parents in UC, and this difference was mediated by therapist's use of psychoeducation strategies.

Study 2 employed a mixed methods approach to investigate patterns of parental participation in a sample of ethnic minority families who received SBMHS. Administrative data on parent involvement was assessed, and a sample of 20 Latino and Chinese American parents of children that received SBMHS were interviewed to assess their level of participation in services and to document therapist implementation of basic psychoeducation practices in care. Findings from quantitative, administrative data suggest that parent participation in SBMHS was quite low. Qualitative interviews suggested that parents were motivated to be involved in their child's services, but encountered barriers to treatment participation, and their participation was often not solicited by therapists. A majority of parents reported that they were uninformed about their child's presenting problems and various aspects of the treatment process, suggesting limited use of even basic psychoeducation by therapists in their child's SBMHS. Together, findings from Study 1 and 2 suggest that there is a major opportunity to implement psychoeducation-based engagement practices upon entry into care to promote parent involvement in child MHS, whether in community clinics or school-based services.

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