Any parent who has struggled with bedtime, carpool schedules, child care, naps, or temper tantrums knows that raising kids can be stressful.
But the amount and intensity of parental stress has reached the point of a public health crisis, affecting a third of all parents. In late August, U.S. Surgeon General Dr. Vivek Murthy, who is also a dad, issued an advisory that parents’ mental health is in jeopardy. It is the same type of statement that the Surgeon General’s office issued decades ago that was the first official warning to the public about the dangers of smoking.
Immigrant parents face an even higher risk. The Surgeon General’s report outlines the common causes of stress: basic needs, screen time, loneliness, packed schedules, said Jaime Ballard, a University of Minnesota researcher who focuses on mental health, parenting, and immigrant families.
“Immigrant parents face all of these plus more,” she said.
A new program in Minnesota is working with immigrant parents to help them cope with the challenging behavior of their children. Called Empowered Generations, the support program is designed for parents of children ages 3-8. After a pilot program showed promising results last year, including a 20% decrease in child behavioral problems after eight weeks, researchers received additional funding from the National Institutes of Health this summer to expand the program.
Ballard and Christopher J. Mehus, another University of Minnesota researcher who focuses on highly stressed families, developed the program as an evidence-based method to address both stressors common to all parents and specific concerns of immigrant parents. They launched the pilot with 16 therapists, half of whom are immigrants or have expertise in immigrant families.
“We found it led to an increase in parents’ confidence, and they report decreased stress,” Ballard said.
Veronica Rivera Arteaga understands these challenges personally and professionally. Arteaga serves as a therapist for Empowered Generations. She’s also a mom who arrived in the U.S. from Mexico in 2007.
“You add that barrier, that challenge of arriving to a new state and a new country, where maybe you can’t read the signs in the streets, you don’t know how to take a bus or rent an apartment,” Arteaga said. “Immigrant parents are out of their window of tolerance most of the time … the level of stress in immigrants is high and affects their ability to make good decisions and relax.”
Stressors common to immigrant parents go beyond logistics, Arteaga and other therapists in the program noted. Challenges vary depending on country of origin, but share many similarities, including:
- Coming from a culture that does not talk about stress and depression.
- Acculturation gaps: Kids are often more attuned to American culture while parents and grandparents are operating from home country culture.
- Discrimination and racism in the U.S.
- Stigma of mental health conditions in home country.
- PTSD from the actual journey/migration experience.
- Living in poverty.
Parental stress can impact children as well: Children of parents with mental health conditions may have a higher chance of themselves developing mental health conditions such as depression and anxiety.
This intergenerational trauma must be interrupted, said Chansophal Mak, one of the newly recruited therapists. But parental stress has been overlooked. For example, when Cambodians came to the U.S. in the 1980s, they were screened for mental health, but there was no followup from the screening.
“They still live with PTSD, and it is showing in their parenting,” she said.
How it works
Mehus had been casting about for the best way to reach parents in need of help; he landed on primary care doctors as the gateway to the program.
“Primary care doctors are a trusted source of information in a non-stigmatizing setting,” he said.
And, the vast majority of parents take their young children to the doctor, so it’s a good way to connect with parents.
For the pilot project, doctors attended training to spot parents who might benefit from the program. That usually means any parent who brings up something of moderate concern about a child’s behavior, whether it be a 3-year-old’s frequent tantrums or getting an older child to go to school. The doctor talks to the family about language preferences and cultural expectations for the sessions. A therapist that best matches the parents’ preferences then reaches out to the family. If the family agrees that the program might help, they set up six sessions that can be online or in person.
Sessions are based on simple, teachable interventions that have been shown to make a difference, Ballard said.
In the first session, therapists encourage parents to talk about their strengths and their children’s strengths.
“We focus on building a relationship,” said Maria Angelica Keller Flores, one of the therapists. “Parents are amazed to talk about the strengths of their child, because they usually talk about misbehaviors. And then we talk about their strengths as a parent and they feel validated.”
In subsequent sessions, the focus turns to effective ways to give directions to young children.
In many cases, parents may be doing something else and give their child a command such as, “Hey, pick up your things,” said Flores, “and then the parents are getting mad if the kid is not doing that.”
Instead, the parent could look the child in the eye, and say, “Can you please do this?” she said. “Just giving that direction clearly, when a kid is listening, makes such a huge difference.”
It’s hard for parents to believe at first, but very simple changes can have a big impact, the therapists said. And parents often notice results from the very first session, they said.
“The minute that we slowed down and got to their level and did the actions that she told us to do, our cooperation with our two girls at that point literally skyrocketed,” one parent said in a focus group after finishing the program. “We were just mind-blown just in that first week with those little things, how much it helped us, just something that simple.”
Therapists also stage role-playing exercises with the parents.
“Usually that’s a very important moment for parents,” Arteaga said. “They suddenly realize that they’re so busy working or cleaning that they hadn’t paused and connected with their child. That’s where I get the most feedback. They say, ‘Now I remember how it was to be a little one.’”
After six weeks, Arteaga is usually surprised by the amount the parents have changed. They’ve changed the tone and methods of communication, as well as how they discipline their children.
Parents often seem equally surprised, she said: “It’s working!!!” they’ll tell her. They report smoother bedtimes, more efficient transitions, willingness to follow safety protocols. “They are pretty happy, and the kids are too because they see that their parents are relaxing,” Arteaga said.
Why it works
Research and anecdotal evidence has shown that the intervention works for any parent. Flores, for example, reports positive results from working with parents of races that don’t match her own.
But when immigrant parents are paired with therapists from the same or similar home country, the chances for success increase, the researchers and therapists believe.
Just removing the language barrier is huge, Arteaga said. It’s too hard to express the nuances of parenting through an interpreter, she said.
“It’s my tone, the way that I’m moving, it’s how we communicate, how we connect,” she said.
Many families don’t feel as comfortable talking to therapists who they perceive as an authority figure, Mak said. “They don’t feel safe to talk about problems, so they are superficial and friendly … They like to talk about their migration stories — they are storytellers — and they are not going to tell anyone if they don’t feel comfortable.”
Inherent understanding between a parent and therapist who share the same cultural background can be vitally important, Flores said. For example, traditional punishments in most Latino countries are different from American customs, she said. And people who come from countries with violence are often focused on survival.
“In Cambodia, traditional parenting is fear-based and harsh,” Mak said. “We went through a lot of civil war and genocide so parents want to make sure their children are alive. … They don’t have time to reflect on parenting practices.”
Therapists from the same culture can also ease concerns about stigma. In many cultures, the term “mental health” has extremely negative connotations, Mak said. “They don’t want to be identified as being crazy. They don’t know that mental health is emotional health … and that family relationships can be affected by individual mental health.”
In addition to perceived decreased stress in parents, the pilot program found a 10% decrease in sadness and anxiety among the children.
Over the next four years, Empowered Generations plans to train 60 therapists and 200 doctors in Minnesota. Ultimately, they hope the program will become a national model.
“That is a driving force behind this work,” Ballard said, “hoping that if we can show this model works and connects families with support that helps kids thrive, that other states will adopt it as well.”
Help for parents:
If you’re a parent, therapist, or doctor interested in learning more about Empowered Generations, contact the Knowledge for Parents Team at kfp@umn.edu.
