The Comprehensive Asian Preschool Services Program

The Comprehensive Asian Preschool Services program (CAPS) is a culturally focused behavioral health intervention that targets mostly Chinese, monolingual immigrant families with young children who are enrolled in one of four preschool programs in the Chinatown and Tenderloin neighborhoods of San Francisco. CAPS was one of 12 sites funded nationally by the Starting Early Starting Smart (SESS) initiative, a public-private partnership of the Substance Abuse and Mental Health Services Administration and the Marguerite Casey Foundation. The goal of SESS was to test the effectiveness of integrating behavioral health services into early-childhood and primary health care settings to foster healthy child development among underserved families at risk of substance abuse and mental health problems.

Implemented in 1997 under the direction of the third author, CAPS was a community-based collaboration among three nonprofit organizations with a long history of service to the Chinese immigrant community in San Francisco: Asian American Recovery Services, Wu Yee Children's Services, and Chinatown Child Development Center.

A key component of the CAPS intervention is an integrated family services team for individualized service planning. The team includes teachers and classroom staff, a licensed mental health professional, and a bilingual family advocate who provides outreach, support, and referral services to families. In addition, on-site mental health consultation and services are provided by a bilingual mental health professional on an ongoing basis. Parenting education and support is also a key component, including a structured parenting curriculum and monthly parent support meetings. The eight-week parenting curriculum addresses intergenerational conflict in immigrant families and was developed by Professor Yu-Wen Ying at the University of California at Berkeley. In addition, recreational family events and activities are organized with parental involvement to promote a supportive community for families, many of whom are recent immigrants who do not have extended families in the United States.

A profile of families that participated in the CAPS evaluation revealed that housing is substandard and overcrowded and that parents work at multiple, stressful, low-wage, low-skill jobs in the garment, restaurant, and hotel industries, with few or no health care benefits. Many live in single-occupancy hotels without bathrooms, refrigerators, or cooking facilities. Forty-one percent of caregivers and 10 percent of children lacked health insurance at intake. Immigrant families experience considerable stress adjusting to their lives in the United States, and children are particularly vulnerable to conflicts between cultural norms at home and those encountered at school, especially in the transition to kindergarten. Caregivers may be at a loss as to how to best support and promote healthy child development in a bicultural context or how to obtain needed services for themselves and for their children. Thus a major goal of CAPS is to link families to culturally appropriate services in the community.

The SESS program, and the CAPS program in particular, has demonstrated outcome effectiveness in terms of increasing service linkage and access to culturally appropriate mental health services as well as to other comprehensive services for families, caregivers, and children. CAPS has also had a positive impact on parental and child health and well-being, family functioning, and child behavior at home and in the classroom, as indicated by preliminary evaluations of the intervention that used an equivalent comparison group over a one-year period.

Of the 284 families captured in the service logs in our intervention sites, 97 percent had received individualized case management services, 83 percent had attended a parenting education or support group, 51 percent had at least one home visit by their family advocate, 31 percent had received on-site mental health services or consultation, and 27 percent had documented service planning and coordination services on their behalf. These figures most likely underestimate true service activity.

During the same period, 271 referrals were made to culturally specific community-based services for 119 families in one of our four intervention sites, including referrals for behavioral health services (a major focus of the SESS initiative), referrals for physical and dental health services, and referrals to address basic needs, such as housing, food, public assistance, employment, legal referrals, and children's services.

Thus the CAPS program embodies an innovative service integration approach to working with immigrant communities that are underserved and at risk of behavioral health problems and links these families to culturally specific behavioral health and comprehensive support services. In addition, CAPS empowers parents to be advocates for their children in the school setting by teaching them to work effectively as partners with teachers and to seek out appropriate mental health services to address the needs of their families.