Fuerte Program for Newcomer Immigrant Youth

Overview

The present study is a randomized control trial to evaluate the effectiveness of a school-based group prevention program (Fuerte) in two San Francisco Unified School District Public Schools. The program targets newcomer Latinx immigrant youth (five years or less post arrival in the U.S.) who are at risk of experiencing traumatic stress. The Fuerte program focuses on increasing youth's mental health literacy, improving their social functioning, and identifying and connecting at-risk youth to specialty mental health services. The program will be implemented by mental health providers from various county community-based organizations, as well as from the SFUSD Wellness Centers, who already offer mental health services in SFUSD schools.

Full Title of Study: “Fuerte: Evaluating a School-based Prevention Program for Newcomer Immigrant Youth at Risk for Traumatic Stress”

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: Randomized
    • Intervention Model: Parallel Assignment
    • Primary Purpose: Prevention
    • Masking: Single (Investigator)
  • Study Primary Completion Date: December 15, 2023

Detailed Description

Fuerte is a new prevention program that is being introduced into the mental health system of California in order to reduce behavioral health disparities among Latinx newcomer youth. School-based, preventative programming has been proposed to be the frontline for reducing behavioral health access disparities among Latinx newcomer youth. However, very few evidence-based, selective prevention programs exist that have been tailored to ensure cultural relevance for newcomer Latinx youth with limited English proficiency and low health literacy in under-resourced school settings. Like many urban school districts in California, San Francisco Unified School District is an especially relevant setting for the Fuerte program. The district has a high number of newcomer adolescents, with an average of over 500 newcomer adolescents coming into the school district per year, most from Central America and Mexico.

The Fuerte program promotes interagency and community collaboration with the explicit goals of increasing mental health literacy and service access, as it has been largely enacted through a unique collaboration between the San Francisco Unified School District, the San Francisco Department of Public Health, and the Departments of Psychiatry and Pediatrics at the University of California, San Francisco due to their common need for prevention programming for this high-needs population. Much of the curriculum of Fuerte was developed and adapted through feedback from newcomer immigrant youth and their families, as well as providers of the program. In addition, Fuerte's system of care will facilitate the transition to services for these youth to improve their overall functioning, including behavioral health care, medical care, educational, legal, and other social services.

The Fuerte program is designed for youth ages 12 to 18 in the San Francisco Unified School District (SFUSD). In order to optimize the exposure of large number of immigrant youth with limited healthcare providers, Fuerte is designed as a group format, each group comprised of 4-8 participants. This has the additional benefit of fostering a sense of community and normalizing the therapeutic process in a supportive group setting. Participants are recruited through referrals from educators and staff in the Wellness Initiative, health centers that are co-located in schools throughout the district. Group leaders are bilingual behavioral health providers from both the school district and community-based organizations with experience working with newcomer Latinx youth.

Interventions

  • Behavioral: Fuerte
    • Fuerte is a prevention program targeting youth at risk for psychological trauma who are recent immigrants to the United States. The program is evidence-informed using cognitive-behavioral principles and the Attachment, Regulation, and Competency (ARC) model for treating psychological trauma.

Arms, Groups and Cohorts

  • Experimental: Fuerte
    • This group will receive the Fuerte prevention program over the span of six to eight weeks.
  • No Intervention: Delayed waitlist control
    • This group will be the delayed waitlist control group. They will not receive the Fuerte prevention program until the following semester.

Clinical Trial Outcome Measures

Primary Measures

  • Change in linkages to specialty mental health services for at-risk identified youth by the Pediatric Symptom Checklist – 35.
    • Time Frame: Immediately before intervention, immediately after intervention, and 3-months post intervention
    • Percentage of participants needing a specialty mental health referral identified by the PSC-35 (Socred 28 or above) who were effectively linked to services. Pediatric Symptom Checklist for Children – 35 (screener to identify at-risk youth) (3 point symptom scale rating = “Never,” “Sometimes,” or “Often” present and scored 0, 1, and 2, respectively). This measure contains 35 questions, that can be scored for a total maximum score of 70. Higher score indicate more severe symptoms. A higher composite score of 28 or above indicates clinical concern and need for further evaluation.

Secondary Measures

  • Change in social connectedness measured by Los Angeles Family and Neighborhood Survey
    • Time Frame: Immediately before intervention, immediately after intervention, and 3-months post intervention
    • Change in social contentedness factors experienced by participants in school and neighborhood. -Neighborhood and School Relationships measure (items measuring friendships in school and community taken from items from the Los Angeles Family and Neighborhood Survey) Items B1-B5. Not scored on a composite score. Answer options are “Most,” “Some,” “None,” for B2 and B3, “Yes,” “No” for B4 and “Yes,”sometimes yes and sometimes no,” and “no” for B5.
  • Change in perceived experience with discrimination measured by the Negative Immigrant Community Experience Scale (NICE)
    • Time Frame: Immediately before intervention, immediately after intervention, and 3-months post intervention
    • Negative Immigrant Community Experience (NICE) scale. 7-point Likert scale (1 = Strongly disagree, 7 = Strongly agree). 8 items. Max score of 54. High scores reflect a strong negative experiences of discrimination or negative perceptions of the discrimination.
  • Change in Perceived language ability pressures measured by the Negative Immigrant Community Experience Scale (NICE)
    • Time Frame: Immediately before intervention, immediately after intervention, and 3-months post intervention
    • Negative Immigrant Community Experience (NICE) scale. 7-point Likert scale (1 = Strongly disagree, 7 = Strongly agree). 7 items. Max score of 42. High scores reflect a strong negative experiences of language ability pressure or negative perceptions of language ability pressure.
  • Change in Perceived negative community climate measured by the Negative Immigrant Community Experience Scale (NICE)
    • Time Frame: Immediately before intervention, immediately after intervention, and 3-months post intervention
    • Negative Immigrant Community Experience (NICE) scale. 7-point Likert scale (1 = Strongly disagree, 7 = Strongly agree). 12 items. Max score of 84. High scores reflect a strong negative experiences within the community climate or negative perceptions of the community climate context.
  • Change in Benevolent Childhood Experiences
    • Time Frame: Immediately before intervention, immediately after intervention, and 3-months post intervention
    • The Benevolent Childhood Experiences questionnaire uses 10 items with yes or no answers that assess the presence of 10 benevolent childhood experiences. Participants select the age 0-18 years old of when each of these protective factors have been present in childhood. Each yes” answer is scored as 1, and the possible score range is 0-10. Higher scores reflect greater numbers of favorable experiences.

Participating in This Clinical Trial

Inclusion Criteria

  • SFUSD High School student
  • 12 to 18 years old
  • Recent Immigrant to the US (within five years of enrollment date)
  • Country of origin is from Spanish-speaking Latin American countries
  • Have not completed a Fuerte group in the past

Exclusion Criteria

Participant does not speak Spanish as a primary language, i.e., their primary language is an indigenous dialect/language.

Gender Eligibility: All

Minimum Age: 12 Years

Maximum Age: 18 Years

Are Healthy Volunteers Accepted: Accepts Healthy Volunteers

Investigator Details

  • Lead Sponsor
    • University of California, San Francisco
  • Collaborator
    • San Francisco Department of Public Health
  • Provider of Information About this Clinical Study
    • Sponsor
  • Overall Official(s)
    • William Martinez, PhD, Principal Investigator, University of California, San Francisco
  • Overall Contact(s)
    • William Martinez, PhD, (628) 206-2306, william.martinez@ucsf.edu

References

Brabeck KM, Lykes MB, Hunter C. The psychosocial impact of detention and deportation on U.S. migrant children and families. Am J Orthopsychiatry. 2014 Sep;84(5):496-505. doi: 10.1037/ort0000011. Epub 2014 Aug 11. Review.

Perreira KM, Ornelas I. Painful Passages: Traumatic Experiences and Post-Traumatic Stress among Immigrant Latino Adolescents and their Primary Caregivers. Int Migr Rev. 2013 Dec;47(4). doi: 10.1111/imre.12050.

Sawyer CB, Márquez J. Senseless Violence Against Central American Unaccompanied Minors: Historical Background and Call for Help. J Psychol. 2017 Jan 2;151(1):69-75. doi: 10.1080/00223980.2016.1226743. Epub 2016 Sep 23.

Jorm AF. Mental health literacy: empowering the community to take action for better mental health. Am Psychol. 2012 Apr;67(3):231-43. doi: 10.1037/a0025957. Epub 2011 Oct 31.

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