EMBRace With Grandparents
Condition: Racial Discrimination; Depression; Anxiety; Stress; Trauma, Psychological
MeSH terms: Psychological Trauma
Study type: Interventional

Summary: 
      Research on racial discrimination (RD) continues to show the debilitating toll on mental and
      physical health for adolescents throughout their developmental trajectory, particularly for
      Black Americans. While adolescents may employ emotion-focused behaviors (e.g., overeating,
      etc.) in-the-moment to reduce discriminatory distress, such risk-laden behaviors can result
      in later disparities in their overall health. While this link has been repeatedly established
      in the literature, racially-specific protective mechanisms (e.g., racial socialization; RS)
      have been shown to disrupt the pathway from discrimination to health-related outcomes in
      adolescents. Although informative, the literature on RS has yet to advance our understanding
      of ways to improve upon these protective processes in Black families. Thus, the proposed
      study will further our understanding by aiming to improve RS competency (e.g., skills and
      efficacy) among African American caregivers and youth (ages 10-14) in Detroit, Michigan
      through the Engaging, Managing, and Bonding through Race (EMBRace) intervention.

      The EMBRace intervention facilitates spaces where Black caregivers strengthen and develop
      skills to be attentive to their adolescent's racial trauma while also reducing their own
      stress via racial coping knowledge and RS strategies. Parents and adolescents start each
      session by engaging in separate therapeutic sessions to process experiences of their Black
      identity. They will then join together for a family session that focuses on enhancing
      messages about racial pride, bias preparation, rationales behind promoting distrust, and why
      not engaging in RS practices may be detrimental to youth. EMBRace sessions will take place at
      the University of Michigan Detroit Center and community sites, and will be video recorded to
      improve upon the delivery of therapeutic techniques to the families we serve.
    

Detailed description: 
      Approximately 90% of Black youth report facing or witnessing racial discrimination in their
      proximal (e.g., classroom) and virtual (e.g., social network) environments. The association
      between discrimination and negative mental health outcomes (e.g., more severe and higher
      rates of depression) has been repeatedly established in the literature. Moreover,
      discrimination impairs the way youth cope, and it is this compromised coping that is
      associated with negative psychological, academic, and health outcomes. Further, adolescent
      outcomes may lead to marked health complications and widening disparities in adulthood.
      Within adolescence, families can have a contributing role in the buffering or exacerbation of
      coping processes and behaviors to discriminatory experiences. The majority of Black families
      use racial socialization (RS)-or the verbal and nonverbal communication regarding racial
      matters-to facilitate coping with race. While RS has been shown to disrupt the trajectory
      from discrimination to negative psychological outcomes in some respects, it has also
      contributed to increased youth depressive and anxious symptoms given the wide variety of
      strategies observed in RS communication. Furthermore, less is known about the impact that
      grandparents have in the socialization process of their adolescent grandchildren, even though
      Black grandparents are more likely to rear their grandchildren compared to other races and
      given current trends. To address these gaps, the emergence of a new RS theory and
      accompanying clinical intervention seeks to investigate and improve upon this potentially
      protective cultural process by improving RS competency and enhancing coping processes. The
      Racial Encounter Coping Appraisal and Socialization Theory (RECAST) postulates that
      caregivers' explicit and consistent delivery of psychoeducation-informed, skilled, and
      confident RS practices can reduce caregiver stress and subsequent psychological problems
      experienced by Black youth via greater coping self-efficacy and coping behaviors. The
      Engaging, Managing, and Bonding through Race (EMBRace) intervention is the application of
      RECAST and seeks to improve upon competent RS practices through therapeutic and empirically
      supported strategies. The use of culturally-relevant theory in clinical treatment is vital to
      Black youth's coping with specific (i.e., racial) stressors linked to long-term health and
      wellness outcomes. The empirical investigation of RECAST can also clarify whether aging
      caregivers (e.g., grandparents) develop the same competencies as other primary caregivers for
      an intergenerational exploration of RS practices. Thus, the goal of this study is to test the
      effectiveness of a unique culturally-relevant and family-based intervention developed to
      enhance RS competencies in Black caregivers and reduce negative psychological outcomes for
      adolescent children. Building on the preliminary data that I collected during the
      acceptability pilot testing of the EMBRace intervention in Philadelphia, the proposed study
      will test the mechanism of caregiver RS competency as a moderator of discrimination, coping
      self-efficacy, coping, and adolescent psychological outcomes.

      The specific aims of the study are to:

        1. improve caregiver RS competency, including a decrease in stress;

        2. improve adolescents' self-reported coping strategies through enhanced coping
           self-efficacy; and

        3. decrease adolescents' self-reported psychological problems within the EMBRace treatment
           group.

      By posttest and 6-week follow-up, EMBRace families are hypothesized to:

        1. be rated as and rate themselves as more competent in their RS practices, including less
           stress;

        2. report more satisfactory coping and higher coping self-efficacy scores; and

        3. report less psychological problems relative to pre-test and a control group.

      The success of an EMBRace pilot and subsequent clinical trials can lead to its uptake by
      service agencies and youth-facing organizations to address the pervasive societal problem of
      racial discrimination for Black youth and families. The reduction of psychological harm in
      Black families will have a reverberating impact in various systems (e.g., school, health,
      residential), which can also address the persistent gaps evident in these systems (e.g.,
      achievement, life expectancy, resource). Furthermore, I seek to have a sustainable and
      long-term research agenda in the improvement of patient health given the community-oriented
      nature of EMBRace, which partners with families and organizations and trains clinicians for
      both the improvement of Black family outcomes and the treatment of race-related problems.
    

Intervention name(s): EMBRace Intervention Group; EMBRace Waitlist Group
Intervention type(s): Behavioral; Behavioral
Intervention description(s): The EMBRace intervention will consist of five weekly sessions (weeks 2 - 6) that will be facilitated by EMBRace-trained therapists. Throughout the 8-week intervention, families will be scheduled for 2-hour blocks with sessions being administered to each parent and adolescent for 90 minutes (individually for 30 minutes, 15-minute break, and 45-minutes session with parent and adolescent together). The sessions will cover research-based types of Racial Socialization, including cultural pride, preparation for bias, and attentiveness and balance towards societal racism. Parents and youth will also learn and practice five literacy skills to process and manage the stress of racial encounters including the ability to recognize racial discrimination, accurately appraise the stress of self and others, reduce one's stress, engage instead of avoid, and finally resolve toward healthy outcomes.; The waitlist group will be asked to complete a pretest and posttest while the treatment group goes through the EMBRace intervention. During this time, the waitlist group will not have any additional requirements and will not be given any form of comparative treatments. Upon the completion of the treatment from the intervention group, the waitlist group will be consented for entry into the intervention arm of the study and will follow the procedures for the intervention group above.
Allocation: Randomized
Intervention model: Crossover Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Racial Socialization; Family Functioning; Stress and Coping