A Telenovela-based Adaptation of Manualized Transdiagnostic Scalable Mental Health Interventions for Displaced Spanish-Speaking Populations Globally
Alesha Cid-Vega, M.A.
Adam Brown, Ph.D.
Karina Gonzalez Perez, B.A.
Migration & Mental Health
Migration trends
Hispanic and Spanish-speaking Latinx communities account for 50% of the total immigrant population in the US (Budiman et al., 2020).
Migration Stressors
Legal status, family separation, financial hardship, language barriers, acculturation, reduced social support (Grafft et al., 2022).
Global and Internal Displacement
The Caribbean and Latin America have doubled their migrant populations in the last decade. (Selee et al., 2023).
Mental Health
Traumatic stress and exposure to violence in the home country or while fleeing, are highly prevalent.
High rates of depression & anxiety (Schiess-Jokanovic et al., 2021; Grafft et al., 2022).
Global Mental Health & Capacity Building
Non-specialist providers can safely and effectively deliver low intensity MH interventions.
The World Health Organization has developed a series of MHPSS task-sharing interventions
This approach also targets:
Cultural relevance
These can be culturally and contextually adapted.
However, gaps in participant engagement, benefit retention, sustainability and ensuring cultural relevance remain a work in progress in the context of scalable mental health interventions (McBride et al., 2021).
Community-delivered support has shown to increase engagement & access to care.
Stepped Models
Capacity building are different levels of care promotes prevention, appropriate intervention and referral processes.
Problem Management Plus (PM+)
Transdiagnostic intervention for adults facing adversity and experiencing common mental health problems based in Cognitive Behavioral Therapy.
It teaches four key strategies:
Managing Stress
Deep slow breathing.
Get Going, Keep Doing
Breaking cycles of inactivity.
Staying well
Managing Problems
Breaking down big problems into small actionable steps
Strengthening
Social Support
Connecting to others in difficult times.
Self Help Plus (SH+)
Transdiagnostic intervention for adults experiencing stress based on the Acceptance and Commitment Therapy Framework. It teaches five key strategies:
Unhooking
From negative thoughts.
Making Space
For difficult emotions.
Grounding
Being kind
To one self and others.
Acting on your values
& values-guided problem solving
Entertainment education
By depicting relatable characters facing similar issues as the viewers, EE encourages viewers to engage in behavioral changes (Sabido, 2021).
● EE was developed in Mexico by Sabido in the 1960s
EE in health fields
● Research has shown the EE improves health literacy and promotes positive health behaviors across diverse populations (Singhal et al., 2012; Jibaja-Weiss et al., 2010; Volk et al., 2008; Booker et al., 2016; Khalil & Rintamaki, 2014)
Global Organizations
● UNICEF, UNESCO, Centers for Disease Control, Johns Hopinks, the World Bank have implemented and conducted research on EE in their interventions (Arroyave Cabrera, 2008).
Methods: Phase I
Expert Writers
(10+ years experience in telenovelas for social impact in Mexico & Central America)
● Lead Writing Technical Advisor
● Co-technical advisor 1
● Co-technical advisor 2
Provided:
a) 20h course on telenovela for public health writing AND
b) Wraparound support, editing, & technical advising weekly.
c) Technical meetings w/ research team weekly.
Community Writers (Spain, Venezuela, Mexico, Costa Rica)
● Alesha C. - mental health/creative
● Marianne A.filmmaker/community
● Jose G. - writer/ community
● Karina G. - psych student/ community
Community Writers:
Each person was responsible for writing one storyline for a character with a unique story that represents different migration backgrounds and common narratives.
Each community writer represents the community in different ways and possess lived experience with migration.
Story & Character design
Adela: Mexican, single mother, internal displacement, anxiety, depression, stress.
Lucas: Mexican, childhood adversity, chronic illness.
Luis Alberto: Mexican, family separation, fatherhood,caballellerismo.
Juan Bautista: Mexican, chasing American Dream at all costs, machismo.
Mayra: Venezuelan migrant, middle age issues, entrepreneur, anger & discrimination toward other migrants.
Clara: Colombian migrant, family reunification & return to home country, overcoming mental health stigma. SH+ facilitator.
Xibach: Guatemalan (Mayan) migrant, indigenous identities and culture, human trafficking.
Miguel: Venezuelan migrant, LGBT, physical disability, overcoming trauma. PM+ facilitator.
Cultural elements
selected by community members
Worry dolls (quitapenas) are traditional Mayan dolls (Guatemala and southern Mexico), according to legend, take away children’s worries when you tell them your troubles & place them under your pillow at night
Family, motherhood, community building during resettlement.
Food and restaurants as a way to gather, make a living and share with others from different parts of Latin America, e.g. arepas, soup, tacos.
Salsa, merengue, social dancing as a way to gather, connect & celebrate, present in Caribbean and Latino cultures.
BeatSheet:Mapping the storyline
Methods: Storyline and MH strategies
8 episodes 10-15 min each, with embedded scenes showcasing characters learning and engaging in PM+ & SH+ strategies in the face of adversity. Each episode also contains a 1min summary of the given strategy at the end of it.
Episode Plot
1 Adela and Lucas arrive at their destination in Mexico City, only to face an unexpected scare that just might change their path for the better.
2 Adela is doing her best to keep up at El Refugio, learning something new each day while balancing life as a mom, her work responsibilities, and the challenges of being new in town.
3 Adela is trying to figure out how to pay for Lucas’s medical bills while juggling all her other challenges. A call from back home brings a glimmer of hope, just as Mayra makes a decision that will directly impact Adela.
4 Adela faces a major change and, while staying true to her values, finds a way to overcome a challenge. At El Refugio, everyone shares their stories, growing closer. Then, a call from home arrives, one that will change Adela’s life forever.
5 Adela faces life-changing news from home while trying to keep everything together. With support from those around her, she finds strength and shares a heartfelt moment with Luis Alberto
6 Adela is blamed for a tense incident at El Refugio, forced to repay and left in debt. She helps Lucas cope with worry using quitapenas (worry) dolls. As Mayra faces a health scare, Adela learns the power of sharing her struggles.
7 Through community support, Adela, Xibach, Miguel, and Luis Alberto team up to save the restaurant. Clara makes a bold move that shifts its future. Mayra apologizes to Adela, and offers her job back, while Luis Alberto finds himself caught between two worlds.
8 Miguel and Adela share a heartfelt moment, recognizing how much she’s evolved. Luis Alberto makes a difficult choice. Mayra surprises everyone with big news, and an unexpected visitor sparks a celebration
Strategy
SH+ : Grounding .
SH+: Unhooking
PM+: Managing Stress
PM+: Managing Problems
SH+: Acting on your Values
PM+: Get Going, Keep Doing
PM+: Strengthening Social Support
SH+: Being Kind.
SH+: Values-guided Problem Solving & Making Space.
PM+: Staying Well & Imagining the Future.
Quitapenas:EE Mechanisms in Action
● Modeling Healthy Behavior:
○ Clara shows SH+ strategies when protagonist (Adela) goes through adversity, and Miguel teaches PM+ strategies to address practical problems.
○ Characters show navigating adversity through sharing and using PM+ and SH+ strategies, initiating conversations on taboo topics (e.g. migration, suicidality) (SCT).
○ Storylines normalize seeking care, reducing stigma and perceived barriers (HBM).
● Building Emotional Engagement:
○ Narratives enhance perceived susceptibility through relatable challenges.
● Showcasing problem-solving (e.g., seeking support from community resources) builds self-efficacy.
● Shifting Social Norms: Community-focused narratives foster collective action (e.g., open discussions on mental health).
(Demi, 2018)
Methods: Phase II Consultation & Filming
Filming took place In Mexico City over 5 intensive days with a local team of actors and crew from Colombia, Mexico and Venezuela.
Intensive brief training in PM+ & SH+
Ongoing consultation
Trainer provided 2h workshop to actors and crew on the psychoeducation and strategy modules for PM+ and SH+.
1) Community input: Feedback from additional community members on scripts and adaptation.
2) Mental health supervision:
Trainer took role of field executive producer and supervised fidelity of intervention strategy depiction, throughout the filming.
Methods: Phase III Post-Production & pre-implementation
➔ Finalizing post-production: Editing, creating original music and adding subtitles to all episodes.
➔ Outreach materials: Developing website, media kits, and social media content tailored for stakeholders and community partners.
➔ Stakeholder engagement: Ongoing conversations to explore implementation partnerships.
➔ Next steps: Planning a pilot trial and identifying funding opportunities. Click logo for website; password: worrydoll
Media kits
Links for videos
Episode 1:
https://drive.google.com/file/d/17IYrRU82ywW6k-PhX_vjHfoj940sIVN_/view?usp=drive_link
Episode 2:
https://drive.google.com/file/d/1lJ0UpmjbuCxiI3_pdu_PlZ6egUpwyoPR/view?usp=drive_link
Additional slides
Entertainment-Education (EE)
By depicting relatable characters facing similar issues as the viewers, EE encourages viewers to engage in behavioral changes (Sabido, 2021).
● EE developed in Mexico by Sabido in the 1960s.
● General theoretical background:
○ Elaboration Likelihood Model (ELM): given certain conditions and context, individuals are more likely to deeply engage and elaborate about a message if it is presented through attractive outcomes and strong arguments (Petty & Cacioppo, 1984).
○ Social Cognitive Theory (SCT): individuals learn by observing the actions and outcomes of others' behaviors, leading to enhanced awareness, problemsolving capabilities, and decision-making processes (Bandura, 2001).
○ Health Belief Model (HBM): Builds risk perception and enhances selfefficacy by depicting challenges and solutions in ways that audiences can emotionally connect to (Becker, 1974).
Alesha Cid-Vega, MA a.cidvega@miami.edu
Adam Brown, PhD brownad@newschool.edu
Karina Gonzalez Perez, BA gonzalk@newschool.edu Center for Global Mental Health
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