malgady hero heroine

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Journal of Consulting and Clinical Psychology1990, Vol. 58, No. 4,469-474 Copyright 1990 by the American Psychological Association,Inc.0022-006X/90/$00.75

Hero/Heroine Modeling for Puerto Rican Adolescents:A Preventive Mental Health InterventionRobert G.MalgadyProgram of Quantitative Studies, New York Universityand Hispanic Research Center, Fordham University

Lloyd H. RoglerHispanic Research Center, Fordham UniversityGiuseppe CostantinoSunset Park Mental Health Center, Brooklyn, New York and Hispanic Research Center, Fordham University

Culturally sensitive treatments of the special mental health needs of high-risk Puerto Rican adoles-cents are lacking. The hero/heroine intervention was based on adult Puerto Rican role models tofoster ethnic identity, self-concept, and adaptive coping behavior. 90nonclinical Puerto Rican 8thand 9th graders were screened for presenting behavior problems in school and randomly assignedto an intervention and a control group. After 19 sessions, the intervention significantly increasedadolescents' ethnic identity and self-concept and reduced anxiety. Treatment outcomes varied as afunction of grade level, sex,an d household composition. Self-concept was negatively affectedamong girls from intact families. The study supports the effectiveness of the culturally sensitivemodality as a preventive mental health intervention for high-risk Puerto Rican adolescents, espe-cially from single-parent families.

Hispanics may be at higher risk of mental disorder than theirnonminority and other minority counterparts, and amongthem, Puerto Ricans in particular reveal a high-risk socioeco-nomic and demographic profile (Rogler, Malgady, & Rodri-guez, 1989). Puerto Ricans are markedly below the nationalmedian income and poverty level, undereducated and under-employed, living in substandard housing, and confronting lin-guistic and cultural barriers (Mann & Salvo, 1985). Psychiatricepidemiological models defining a high-risk population interms of increasedstressand higher prevalenceof symptomatol-og y coincide alarmingly with the social and demographic char-acteristics of the Puerto Rican population (Canino, Barley, &Rogler, 1980). More direct evidence of high-risk status is thetendency of Puerto Ricans to report more psychiatric symp-toms than Whites or Blacks (Malgady, Rogler, & Costantino,1987,1988) and, among Hispanics, more depressive symptomsthan either Mexican-Americans or Cubans (Moscicki, Rae, Re-gier, & Locke, 1987).

Critics of the mental health delivery system have argued thatthe contrast between Anglo and Hispanic cultures creates asociocultural distance between therapist and client that re-quires bridging through culturally sensitive treatment (e.g, Co-hen, 1972; Padilla & Ruiz, 1973; Rogler, Malgady, Costantino,

This research was supported by Grants RO1-MH33711-07 and2RO1-MH30569-12 from the National Institute ofMental Health, Di-vision of Biometryand Applied Sciences, Minority Research Branchto Fordham University's Hispanic Research Center.We gratefully acknowledge the cooperation of the students, princi-pal, and dean of students at Intermediate School 136 in Brooklyn, NewYork and of two anonymous reviewersfo r commentson a draft of thisarticle.

Correspondence concerning this article should be addressed to Rob-ert G. Malgady, Program of Quantitative Studies, 933 Shimkin Hall,Ne w York University, New York, Ne w York 10003.

& Blumenthal, 1987; Ruiz, 1981). Three approaches to culturalsensitivity have been identified: increasing the accessibility ofmental health services to the Hispanic community, selectingtreatment modalities that are most congruent with perceivedcultural traits of Hispanics, and embedding cultural traits di-rectly in treatment modalities (Rogler et al, 1987).

Because of the need for special mental health interventionswith Puerto Ricans, we investigated innovative, culturally sen-sitive treatment modalities for high-risk children and adoles-cents. In an earlier study (Costantino, Malgady, & Rogler, 1985,1986), young Puerto Rican children were treated by "cuento"therapy, a form of story-telling that is based on Puerto Ricanfolktales as a modality. The children discussed and enactedfolktales selected to foster cultural values and adaptive behav-ior. The results of this effort were promising: Children incuento therapy demonstrated increased social judgment andreduced anxiety relative to a control group. In the present study,we developed and evaluated a new treatment modality, hero/heroine modeling, which exposes Puerto Rican adolescents toachievement-oriented adult role models fostering ethnic prideand identity, self-concept, and adaptive behavior for copingwith the stresses of poverty, discrimination, and urban life.

Of critical importance to the lives of Puerto Rican adoles-cents is the integrity of adult role models within the anomicsocial environmentof inner-city life. In 1980, for example,44 %of New York City's Puerto Rican households were female-headed (Mann & Salvo, 1985). This signifies not just the ab-sence of a singular male parent but the absence ofall patternsofsocial interaction enmeshing the father role. Puerto Rican ado-lescents in such families lack comprehensive parental role mod-elswith whom to identify and, therefore, may be denied adap-tive values and behaviors to emulate as they mature towardadulthood. Thus, the hero/heroine modeling intervention usesbiographical stories about prominent Puerto Rican historicalfigures as a therapeutic vehiclenot only to bridge a culturalgap

469


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470 R. MALGADY, L. ROGLER, AND G. COSTANTINOexperienced by adolescents, but also to provide for their needfor adaptive role models.

MethodParticipants

All Puerto Rican eighth an d ninth graders (N = 418) at a publicschool in Brooklyn, Ne w \brk were screened for behavior problems bytheir homeroom teachers using the Conners Teacher Rating Scale(Trites, Blouin,& Laprade, 1982). Students p resenting the most severebehavior problems (below the median teacher ra ting) were solicited forthe study, and 110 who were not undergoing mental health treatmentvolunteered to participate with parental consent. Students were ran-domly assigned to an intervention group (n = 7 0) and a control group( n = 40),' but 9 intervention members (13%) and 1 1 control members(27%) dropped out.The 90 students who completed the study ranged in age from 12 to 1 5years (M = 13.67, SD = 0.79); all were U.S. born and English-domin-ant; 50 were eighth graders (29 male, 21 female) and 40 ninth graders( 1 1 male, 29 female). Seventy-one percent of the students' householdswere female-headed, and 64% were receiving welfare benefits. Em -ployed mothers an d fathers were in the three lowest SE S occupations(menial service and unskilled and semiskilled workers) on theHollingshead Index of Social Position.Intervention

The hero/heroine interve ntion was based on a social learning, mod-eling approach to treatment. The rationale was to expose adolescentsto successful adult role models, often lacking in their ow n environ-ment, w ith whom they could identify by virtue of ethnic an d culturalsimilarity; to focus adolescents' attention, first, on the similarity oftheir own stressful experiences to the models' experiences and the n onhow the models coped adaptively with stress; and to reinforce adoles-cents' behavior that was consistent with the m odels' by discussion andimitative role-playing exercises. The content of the intervention tar-geted cultural conflicts, emphasizing the need for a strong sense ofpersonal and ethnic identity, and ways of overcoming stressful life cir-cumstances. Th e intervention wa s conceived as preventive rather tha nactively therapeutic b ecause although the adolescents were socioecon-omically an d demographically defined as a high-risk population an dwere already experiencing behavior problems in school, they were no tdiagnosed as psychiatrically disordered. The target outcomes of theintervention were to increase ethnic identity and self-concept and toreduce stress and its symptom s. In this sense, the intervention did no ttarget specific DSM-IH-R disorders of childhood and adolescence b utrather presumed antecedents of psychopathology.A panel of Puerto Rican psychologists, educators, and sociologistsan d a specialist in Puerto Ric an literature and history selected "he-roic" role models for the intervention on the basis of their significantachievements and adaptivecoping to overcome adversities such as pov-erty, sickness, and prejudice. Biographies w ere compiled on nine maleand nine female models in diverse areas of achievement (e.g., sports,education, art, and politics), sampling Puerto Rican history from the16th century to the present time.The intervention sessions were conducted in small groups of 3-5students led by a schoolteacher and a graduate psychology intern(under supervision of Robert G . Malgady, Lloyd H. Rogler, and Giu-seppe C ostantino). After rapport wa s established, each group memberread aloud a portion of the biography, and the group leaders analyzedselected anecdotes taken from the biography, identifying the source ofstress and the behavior reflecting ethnic pride, positive self-concept,an d adaptive coping strengths. The grou p leaders then asked a series of

questions of the group members designed to focus attention on themodel's concerns, feelings, obstacles faced, and the resources used tosurmo unt them . The ensuing discussion prompted mem bers to volun-teer similar experiences from their ow n lives, which were comparedwith those of the model through another series of questions (e.g., Theperson faced poverty. How have you faced this problem?) in order toreinforce identification with the model. The discussion evok ed exam-ples of positive an d negative experiences, feelings, and behaviors; thegroup leaders intervened to verbally reinforce mem bers' self-reportedbehavior that was consistent wit h the model's and explored alternativesto reports of behavior they judged as maladaptive. Sessions ended withunstructured role playing in which mem bers enacted an open-endedskit that was based on the story they discussed. The group leadersclosed the session by verba lly reinforcing adaptive resolutions of theskit's conflict or seeking alternativ es to m aladaptive resolutions.Procedure

An introductory intervention session wa s conducted to present anoverview of the history of Puerto Rico and some of the famo us peoplethe m embers would b e learning about. T he intervention was portrayedas an educational program about famo us men and women in the his-tory of Puerto Rico. Eighteen 90-min modeling sessions were con-ducted in the school on a weekly basis, with a male or female biographypresented alternately. One group leader was male and one female ineach intervention session. Regardless of students' sex, they were ex -posed to ma le and female biographies, as opposed to same-sex model-ing, because a significant degree of diversity would have been lost bycreating separate male and female intervention protocols. The se-quence of biographies wa s arranged chronologically in order to pro-vide historic continuity to the intervention.Eight 90-min control group meetings were conducted for compara-bility with the intervention grou p and to maintain student interest inorder to min im ize attrition at the posttest. The control group also metin small groups with a psychology intern and a teacher (one male an don e female) leading grou p discussions of curren t events, school activi-ties, an d topics of student interest. Control group m eetings were heldat the testing sessions and on a m onth ly basis between testings.Students w ere paid $7 per session for their participation. Differentgroup leaders conducted the interven tion and control grou p sessions.The students in both groups were formed into single-sex groups be -cause pilot work indicated that groups of mixed-sex adolescents weredistracted by members of the opposite sex and were more likely tomisbehave, resulting in interference with the intervention. By conduct-ing single-sex group sessions, the leaders were better abie to managestudents' behavior an d focus their attention on the biography, discus-sion, an d role-playing th em es at hand.The comparabili ty of the intervention an d control groups is shownin Table 1 . Th e students in the two groups were distributed v ery simi-larly by grade level, age, father presence/absence in the household, andwelfare status. H owever, a notable source of discrepancy was amou ntof contact. There were more than twice as ma ny intervention sessionsas control sessions, and the attendance rate wa s much higher in thecontrol group (M = 84%) than in the intervention group (M = 68%).Outcome M easures

In order to assess the effects of the intervention, participants werepretested and posttested with a battery of instruments to measure1 By design, the intervention and control groups had unequal sam-ples sizes to accommodate the participating public school officialswho wanted as man y students as possible to participate in the interven-tion.


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HERO/HEROINE MODELING 47 1ethnic identity, self-concept, trait anxiety, and symptom distress. Thesemeasures were chosen for several reasons. First, the models to beemu-lated demonstrated a positive self and ethnic image, and the interven-tion wasspecifically targeted toward enhancing the participants' eth-nic identify and self-concept. Second, because the biographies to bemodeled and the criteria for reinforcing imitative behavior emphasizedadaptive coping with stress, an effect on indicators of stress (anxietyand symptom distress) wasexpected. Third, the instruments selectedhave acceptable reliability with Puerto Rican examinees.Ethnic identity wa s measured by a 17-item version of the Cuellar,Harris, and Jasso (1980) acculturation scale for Mexican-Americans,which was adapted to measure identification with Puerto Rican versusAnglo-American ethnicity. Items composing the scale referred to be-havior an d feelings associated with pride in being Puerto Rican (e.g.,no t proud at all to extreme pride), ethnic affiliation (e.g., Anglo-Ameri-ca n to Puerto Rican), language preference in family, peer, an d mediainteractions (e.g., Englishonly to Spanish only), and ethnic self-classifi-cation (e.g, very American to very Puerto Rican). Items were rated on a5-point scale such that low scores reflected high Puerto Rican identityand high scores, high Anglo identity, whereas intermediate scores re-flected a bicultural identity.Self-concept wa s measured by the 80-item Piers-Harris Self-Con-cept Scale. Items were rated dichotomously ind icating endorsement (ornot) of statements indicative of positive or negative self-concept. Thescale was scored such that high scores reflected a positive self-concept.

Trait anxiety wa s measured by Spielberger's 20-item trait scale of the

Table 1Comparison of Intervention and Control Groups by Grade,Father in Household, Welfare, Age, and Attendance

Group

Table 2Internal Consistency (Alpha) Reliability of Outcome MeasuresOutcome measure No. of items Pretest alpha Posttest alpha

VariableGradeEighthnPercentageNinthnPercentageFather presencePresentnPercentageAbsentnPercentageWelfare

nYesnPercentageNonPercentageAgeMSDTotal sessionsAttendanceMPercentageSD

Intervention( n = 6 1 )

3456274418304370

3862233813.610.631912.93682.27

Control( = 29)

16551345828

2172

2069931

13.790.6486.74840.86

Ethnic identitySelf-conceptTrait anxietySymptom distress17802088

.76.91.89.97.84.93.92.98

State-Trait Anxiety Inventory for Children. Items were rated on a 3-point scale representing frequency with which a given anxiety symp-tom was felt: 0 (hardly ever), 1 (sometimes), 2 ( o f t e n ) , and were scoredsuch that high scores reflected high trait anxiety.Symptom distress wa s measured by the 90-item Symptom CheckList (SCL-90-R; Derogatis, 1983), which is appropriate for adolescentnonpatient populations.2 Symptoms were rated on a 5-point distressscale from 0 (n o symptom distress) to 4 (extreme distress). Th e GlobalSeverity Index, a measure of overall distress across nine symptom di-mensions, was used in the data analysis.Although rawscores on some of the outcome measures can be con-verted to norm-referencedscores, scaled scores were not used in thedata analysis because the norms were not established for Puerto Ricanadolescents. Becauseof occasional missing data on some items, meanitem scores were used in the data analysis.All students were tested in small groups by bilingual psychologystudents before an d after the 19-week intervention period in two 1-hrsessions for each administration. Internal consistency (alpha) reliabil-ity estimates of the pretests and posttests are reported in Table 2. AsTable 2 shows, all instruments demonstrated an acceptable level ofinternal consistency reliability.

ResultsThe data were analyzed by three-way multivariate analysis of

covariance of posttest scores (anxiety, identity, self-concept, dis-tress), with the corresponding pretests serving as the covariates.The independent variable of main interest was treatmentgroup; sex, grade level, and father presence/absence were ofinterest as potential qualifiers of treatment effects. However, afour-way analysis could not be conducted because of small cellsizes. Therefore, 2 three-way analyses were conducted: Treat-ment X Sex x Grade Level and Treatment X Sex X Father Pres-ence/Absence. In both versions of the multivariate analysis,Boxs M test was not significant (ps > .15), indicating that thewithin-group variance-covariance matrices were homoge-neous. Significant multivariate effects were due to Treatment,F(4, 75) = 2.99, p < .025; Treatment XGrade, F(4, 75) = 2.53,p < .05; and Treatment X Sex X Father Presence/Absence, F(4,75) = 3.29, p < .025. The multivariate analysis was followed byunivariate analyses of covariance for each outcome measure.

In each univariate analysis, homogeneity of variance and ofwithin-group regression of posttests on pretests were satisfied(ps > .20). There was no significant main effect of treatment,nor interactions involving treatment, in the analysis of the

2 Tw o items on the SCL-90-R were deleted, at the request of schoolofficials, because of their reference to sexual behavior.


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47 2 R. MALGADY, L. R OGL E R , AND G. COSTANTINOTable 3Adjusted Posttest Ethnic Identity an d Self-Concept M e an s andStandard Deviations of Intervention an d Control Groups as aFunction of Sex and Father Presence in Household

Father present Father absentOutcome group Male Female Male FemaleIdentityInterventionMSDControlMSDSelf-conceptInterventionA tSDControlMSD

2.190.362.150.410.730.140.720.18

2.150.272.510.460.670.170.850.17

2.140.462.610.480.730.130.670.17

2.100.472.190.280.760.130.680.16

symptom distress.3 A significant m ain effect of treatment wa sfound on ethnic identity, F= (\ , 81) = 3.96, p < .05. The inter-vention group had significantly greater Puerto Rican identity(M = 2.14) than the control group (M = 2.36). The mean differ-ence between groups represented a moderate standardized ef-fect size (Cohen, 1977) of 0.54 SD units (pooled within-groupSD = 0.41). Another covariance analysis conducted on a globalrating of pride in being Puerto R ican, from 1 (not at all proud)to 5 (extremely proud), revealed a significant main effect oftreatment, F(l, 81) = 4.23, p < .05, and a significant Treat-ment X Grade interaction, F([, 81 ) = 4.36, p < .05. O verall, thetwo groups had high m ean ratings, but the intervention groupexpressed significantly more pride (M = 4.75) than the controlgroup (M = 4.48), corresponding to a moderate effect size of0.45 SD units (SD = 0.60). Tests of simple main effects indi-cated no significant difference at Grade 8, F(l , 81) < 1, and asignificant difference at Grade 9, F(l, 81) = 12.19, p < .001. Themean rating of the intervention group (4.81) wa s significantlyhigher than the m ean of the control group (4.23), which corre-sponded to a large-effect size of 0.97 SD units.The analysis of trait anx iety revealed a significant Treat-ment X Grade interaction, .F(l, 81) = 4.37, p < .05. Tests ofsimple main effects within grade levels revealed no significantdifference between th e intervention and control groups atGrade 9, F(l , 81) < 1, and a significant difference at Grade 8,F(l, 81) = 4.98, p < .05. At Grade 8, the intervention grou p hadsignificantly lower trait anxiety (M = 0.54) than the controlgroup (M = 0.65), representing a small-to-moderate effect sizeof 0.39 SD units (SD = 0.28).The significant multivariate Treatment X Sex X Father Pres-ence/Absence interaction was evident in the univariate analysesof ethn ic identity, F(l, 81) = 4.14, p < .05, an d self-concept, F(\,81 ) = 5.96, p < .025. Table 3 shows the ethnic identity an dself-concept means and standard deviations of the treatmentgroups as a func tion of sex and father presence.Tests of simple interaction effects revealed significant two-way (Treatment X Sex) interaction effects within father-present

an d father-absent fam ilies for ethnic identity and self-concept(.01 < all ps < .05), except for father-absent families in theself-concept analysis. These interactions are illustrated in Fig-ures 1 and 2.Analysis of simple m ain effects on ethnic identity indicatedthat treatment was not significant for girls in father-absent fami-lies nor for boys in father-present families, Fs(l, 81 ) < 1. How-ever, there was a strong treatment effect for boys in father-ab-sent families, F(l, 81) = 14.34, p < .001, and for girls in father-present families, F(l, 81 ) = 11.91, p < .001. Figure 1 shows thatth e intervention group had greater Puerto Rican identity, corre-sponding to a large effect size of 1.15 SD units in the father-ab-sent grou p (boys only) and 0.87 SD units in the father-presentgroup (girls only).Analysis of simple main effects on self-concept revealed asignificant treatment effect for boys, F(l, 81) = 4.01, p < .05,an d girls, F(l , 81) = 5.44, p < .025, in father-absent fam ilies,and for girls in father-present families, F(l , 81 ) = 14.06, p

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