Strengthening Attachment In the Context of Migration: A Community-Engaged Adaptation and Pilot Study of the Confiar Intervention

Background. Confía en Mí, Confío en Ti (CEM) is an eight-session manualized group intervention, delivered by community health navigators to mothers and adolescents (10-17 years). The goal of CEM is to reduce mental health symptoms and improve attachment security in Latino mothers and their adolescents. Although CEM shows promise in Latino families (see Borelli, 2021), the intervention does not address the unique experiences of immigrant mothers and adolescents from Latin America who have faced migration trauma and acculturative stress. Method. Using Community-Based Participatory Research methods, researchers engaged an established community advisory board to adapt CEM. The adapted intervention, named CONFIAR (CONFIanza, Inclusión, Apoyo y Resiliencia), includes two additional sessions that focus on challenges related to migration (e.g., separation, ambiguous loss) and acculturation stress (e.g., legal uncertainty, adjustment). The feasibility and acceptability of CONFIAR was explored in a pilot study with four mothers and nine youth. Participants were recruited from a long-term shelter that provides housing and case management to new immigrants in Texas. CONFIAR was delivered by community health navigators in three separate but simultaneous groups (mothers, older adolescents 17-14 years, and younger adolescents 13-11 years) twice a week for five weeks. Self-report measures were collected on maternal mental health (Brief Symptom Inventory, PTSD Checklist) and internalizing and externalizing symptoms in adolescents (Child Behavior Checklist). Qualitative interviews assessed feasibility, acceptability, and preliminary effects of CONFIAR on the mother-adolescent relationship. Results. Maternal mental health (depression, anxiety, and externalizing) improved from pretest (M = 44.30) to posttest (M = 26.00) demonstrating a large effect size (d = 1.21). Maternal PTSD symptoms improved from pretest (M =41) to posttest (M = 26.3), with a moderate effect size (d = 0.59). Adolescent’s internalizing symptoms decreased from pretest (M = 10.10) to posttest (M = 6.00), yielding a large effect size (d = 2.37). Adolescent’s externalizing symptoms decreased from pretest (M = 9.44) to posttest (M = 6.11), with a large effect size (d = 1.78). Interviews revealed high levels of acceptability and feasibility, as described by one mother, “We were sad when [the group] ended because we had a friendship where we talked about things. We got things out that we had hidden. I opened my heart [to the worker]. I talked to her about a lot of things. Something I haven’t been able to do with anyone else.” (02M). Participants also identified CONFIAR as helpful in strengthening family relationships, highlighted by one 10-year-old, “[the group] helped [my mom] reflect and it helped to forget the past. Now [my mom] doesn’t cry anymore.” (04M01Y) Conclusion. Findings provide preliminary evidence supporting the feasibility, acceptability, and preliminary effects of CONFIAR for recent immigrant mothers and adolescents from Latin America. Improvements in maternal and adolescent mental health, coupled with large effect sizes across key outcomes, suggest that culturally grounded, attachment-based interventions delivered by community health navigators can promote family well-being and resilience. Qualitative findings further underscore the intervention’s relevance and impact in strengthening communication, trust, and emotional connection between mothers and their adolescents in the post-migration context.