A Contextual Behavioral Framework for Enhancing Cultural Responsiveness in Behavioral Service Delivery for Latino Families

Abstract

In recent years, the field of behavior analysis has shifted its attention to issues of diversity, social justice, and cultural responsiveness. With various cultural groups in the United States, behavior analytic practitioners increasingly find themselves serving clients of diverse cultural backgrounds. One of the populations that continue to face underrepresentation is Latinos. In the current article, a cultural understanding of the Latino culture is provided to support cultural responsiveness in behavioral service delivery. This article explores the Latino identity of individuals receiving behavioral services, systemic barriers faced by Latinos, the use of acceptance and commitment training for Latino families and clients, and Latino cultural values and their role in behavioral service delivery. Most important, a shift in perspective to account for the barriers perceived by practitioners within the context of Latino cultural values is offered through a contextual behavioral framework, the literature, and the authors’ personal and professional experiences as Latino behavior analysts. Recommendations in the areas of assessment, treatment design, service delivery, and collaboration when working with Latinos are also discussed.

Issues of multiculturalism and cultural responsiveness have been at the forefront of various disciplines in social sciences (e.g., Bernal et al., 2009; Cauce & Domenech-Rodríguez, 2002; Montenegro et al., 2022; Paula et al., 2020). In the behavior-analytic literature, there are emerging yet long overdue efforts to increase practitioners’1 utilization of culturally responsive approaches for Latinos.2 A few efforts in the last decade include examining the effects of English and Spanish as the instructional languages used during discrete trial training (Lang et al., 2011), exploring the consideration of linguistic factors during functional behavioral assessments (Durán et al., 2013; Rispoli et al., 2011), and exploring the impact of disparities in behavioral services for Latinos with disabilities and practitioners who work with this population (Bermudez & Rios, 2020). In recent research, the experiences of Latino families living in Massachusetts accessing and maintaining behavior-analytic services were explored (Rosales et al., 2021) and systemic changes such as increasing diversity among practitioners, enhancing training in culturally related issues, and conducting behavioral research on cultural adaptations were suggested to strengthen access and quality of behavioral services for Latinos (Castro-Hostetler et al., 2021). In addition, the effects of instructive feedback in Spanish on the development of listener skills in English for children with autism spectrum disorder (ASD) were examined when occasioned by discriminative stimuli in Spanish (Jimenez-Gomez et al., 2022).

Despite the work emphasizing Latino consumers of services based on applied behavior analysis (ABA) and the ethical requirements that call for cultural responsiveness and diversity (Behavior Analyst Certification Board [BACB], 2020, 2021), the integration of cultural values to enhance culturally responsive behavioral services for the Latino population has yet to be discussed. Therefore, the focus of the current article will be on Latino families receiving services based on ABA. In particular, the present article will discuss the Latino identity; systemic barriers experienced by Latinos when navigating health-care and social systems; the utilization of acceptance and commitment training (ACT) with Latino families within clinical practice; and Latino cultural values, their implications for treatment adherence, possible perceptions of cultural values as treatment barriers, and how to address treatment barriers through such cultural values. Finally, various recommendations will be provided so that practitioners can begin to enhance collaborative, culturally sensitive, and compassionate relationships with Latino families during behavioral service delivery. In addition to the inclusion of peer-reviewed literature, the current article also encompasses the collective experiences and perspectives of the authors, who were raised in Latin America or raised by parents born in Latin America, and their work with Latino families during the delivery of ABA-based services.

Is it “Latinx/e,” “Latino,” or “Latina?” Which One Is It? La Identidad / A Identidade

For the Latino population, particularly in the United States, the topic of identity has been a nonlinear one, potentially due to uncertainties about the definitions of "Hispanic" and "Latino." Per the Encyclopedia Britannica "Hispanic" refers to people from Spanish-speaking Latin American countries, as well as Caribbean countries/territories and Spain. On the other hand, "Latino" refers to anyone born in Latin America, anyone with Latin American ancestors (regardless of language), or anyone who lives in the United States and has Latin American ancestors. Because Spanish and Portuguese3 are gendered languages, "Latinx" and "Latine" have been proposed to promote gender inclusivity and neutrality. Therefore, practitioners are advised to inquire about how families and clients from this population self-identify (e.g., Hispanic, Latino/a/x/e, Afro-Latino, Central American) rather than assuming how they identify, given that nationality, social position, immigration status, and religion also affect how Latinos identify and, more important, experience the environments they navigate.

Systemic Hurdles Latino Families Face: Las Barreras / As Barreiras

Despite the importance of identity, solely inquiring about how a Latino family or client self-identifies is insufficient to respond in a culturally sensitive manner, just as solely providing instructions is insufficient to develop and shape behavior through behavioral skills training. As the Latino population increases, so will the number of Latino families that seek behavioral services (Castro-Hostetler et al., 2021). According to Castro-Hostetler et al., Latino families continue to experience political, legal, and economic barriers, which point to the ongoing inequalities encountered by this population when accessing health and behavioral services. As part of high-quality provision of culturally responsive behavior-analytic services, it is essential for practitioners to account for Latinos’ experiences with systemic barriers, which may increase awareness and understanding of such barriers and may be directly addressed by practitioners (Castro-Hostetler et al., 2021). Such systemic barriers relate to the diagnostic process, language discrepancies between professionals and families, families’ knowledge about ASD, and practitioners’ level of cultural awareness.

The Diagnostic Process

There are various factors that have been described as barriers that Latino families experience during the diagnostic process, including health-care systemic factors, Latinos’ lack of knowledge about ASD, and family/parental factors (e.g., socioeconomic status and legal status), all of which continue to prolong treatment disparities for Latinos (Bermudez & Rios, 2020). Taken together, these systemic factors likely contribute to Latino children receiving an ASD diagnosis nearly 1 year later than their non-Latino white peers (Magaña et al., 2013), as well as more critical signs and symptoms being observed because of such delayed diagnoses (Constantino et al., 2020; Klin et al., 2020). For a more detailed discussion about these factors, readers are encouraged to review Zuckerman et al. (2014).

Linguistic Discrepancies

Another area that practitioners are urged to account for relates to language discrepancies between professionals and families, which may significantly affect parents/caregivers adequately expressing developmental concerns and behavioral needs (Jimenez-Gomez & Beaulieu, 2022; Zuckerman et al., 2014). Considering the diversity of languages spoken in the United States (U.S. Census Bureau, 2015), linguistic accessibility to information can be ensured in numerous ways. Some ways include increasing the availability of accurate information, educational resources, efforts towards advocacy, and materials in the various dialects and languages spoken by Latino families of individuals with ASD (e.g., Spanish, Portuguese, indigenous languages such as Mam).

In considering the language-related barriers that Latino families face as they access behavioral services, practitioners are highly encouraged to exercise caution if their primary or sole approach to helping alleviate such barriers is to reinforce families’ self-advocacy in their non-native language (i.e., English). Per Baires et al. (2021), if two parties are speaking the same language but come from different cultures, discrepancies in nonvocal verbal behavior (e.g., gestures and facial expressions) and/or vocal verbal behavior (e.g., grammar and semantics) can affect effective communication. As it relates to monolingual Latinos and bilingual Latinos, English listeners may not mediate the reinforcement that is typically delivered by verbal communities of Latino speakers when engaging in self-advocacy. Not only does this speak to differences across cultures when it comes to self-advocacy and the impact it has on obtaining behavioral services, but the importance of practitioners’ roles in delivering culturally responsive and collaborative services is stressed.

Knowledge about ASD

Latino families may also lack adequate or accurate knowledge about ASD. Practitioners must account for this barrier in families’ pursuit of a diagnosis (Rosales et al., 2021; Zuckerman et al., 2014), because familiarity with the signs of ASD is essential for long-term benefits and outcomes (Casillas et al., 2017), including a timely professional assessment (Chaidez et al., 2012). Understanding developmental milestones and the early signs of ASD can help families seek support and make better informed decisions about different treatment options, the expectations of such options, and their frameworks. In addition, Latino families' lack of knowledge regarding service eligibility may prohibit access to the most effective services (Rosales et al., 2021). As reported by Dennison et al. (2019), undocumented families may not seek out behavioral services due to uncertainties regarding eligibility and/or fear of detainment or deportation due to their immigration status.

Cultural Awareness Among Practitioners

Practitioners must also continuously monitor their level of cultural awareness when working with culturally and linguistically diverse families (Beaulieu & Jimenez-Gomez, 2022), such as Latinos. Dennison et al. (2019) highlighted several systemic factors that may contribute to the field’s overall level of cultural awareness. Some of these factors include practitioners’ attitudes and biases regarding culture (e.g., public statements that behavior analysis is inherently free of bias, and that cultural biases derive from the families served and not behavior analysts themselves; Kirby et al., 2022); limited research focusing on bilingualism (Brodhead et al., 2014), and a lack of understanding and empathy related to the impact of sociocultural and socioeconomic stressors that families with cultural and linguistic diverse backgrounds experience (e.g., attributing such stressors to Latino families’ lack of English instead of the lack of linguistically accessible environments, and discounting the emotional hardships of navigating such stressors; Dennison et al., 2019).

An additional factor highlighted by Dennison et al. (2019) includes the challenge for practitioners to analyze their own cultural biases (e.g., a bias that all Latino families are from Mexico and/or speak Spanish; Wright, 2019). Bias within a verbal community may be influenced by verbal rules rather than direct contingencies (Catania, 2013). For example, a colleague saying "Latinos are lazy; that’s why this family never followed my clinical recommendations" during a consultative meeting can function as a rule if it affects how others in the room interact with Latinos. When providing behavioral services, for instance, a practitioner whose behavior is governed by such a rule may be more likely to avoid working with Latino families.

From a functional contextual approach, biases are not inherently negative, but rather their impact or outcome on the person's behavior and its surrounding environment (Kanter et al., 2020). Biases become problematic when they reduce sensitivity to direct contact with contingencies (e.g., a practitioner is unable to satisfactorily work with Latino families because of the rule that they are lazy). Rules, like cultural biases, may be maintained by the consequences of engaging in the behavior stated in the rule (i.e., avoid working with Latino families because they are lazy) or because of a limited tacting repertoire which permits interpreting events due to personal, social, and cultural histories rather than describing events as they are.

Harmful biases and rules affect the well-being of Latino families in numerous ways. Therefore, practitioners are urged to overtly acknowledge the harm and presence of such behavioral phenomena. Although research indicates that a little over a quarter of board certified assistant behavior analysts (BCaBAs), board certified behavior analysts (BCBAs), and doctoral level BCBAs (BCBA-Ds) reported receiving some academic and applied training in compassionate care and therapeutic relationship skills (LeBlanc, Taylor, & Marchese, 2020b), conveying empathy and compassion towards Latino families may strengthen treatment adherence, allow for better treatment outcomes, improve acceptability of services (Rohrer et al., 2021; Taylor et al., 2018), and set the foundation for meaningful rapport. These efforts may be enhanced through a contextual behavioral framework, such as acceptance and commitment training.

Can Acceptance and Commitment Training Be an Effective Approach for Latino Families? Los Eventos Privados / Os Eventos Privados

Acceptance and commitment training (ACT; Hayes et al., 1999) is a contemporary, contextual, behavioral, and scientific approach rooted in the philosophy of functional contextualism (Hayes et al., 2013) and relational frame theory (Hayes et al., 2001). Said differently, ACT is a contextual behavioral approach rooted in behavior analysis that uses language-based interventions to address issues of human well-being and performance. ACT is explicitly focused on decreasing psychological inflexibility, which is conceptualized as a pattern of behavior characterized by rigid responses and experiential avoidance of thoughts and emotions (i.e., private events), resulting in detachment from personal values and increased difficulty in interacting with the present moment (Hayes et al., 2011). This rigid and avoidant way of responding can also lead to increased dissatisfaction with life and feelings of discomfort.

An alternative functional class to psychological inflexibility is psychological flexibility. Psychological flexibility is defined as a behavioral repertoire that brings one into contact with new and broader sources of reinforcement when responding to changing contingencies in contextually sensitive and flexible ways (Ming et al., 2023). ACT fosters psychological flexibility by addressing six core repertoires including present moment awareness, acceptance, defusion, self-as-context, committed actions, and values (Luoma et al., 2007). As a result, ACT helps individuals live a life that is guided by awareness and openness, while engaging in behaviors that are aligned with what they care about most (Bond et al., 2006).

Psychological flexibility has been found to be associated with increased levels of responsiveness and parental adjustment (Evans et al., 2012). In addition, ACT has demonstrated empirical and clinical effectiveness in decreasing self-reported levels of stress, depression, and anxiety for parents/caregivers of children with varying difficulties (see Byrne et al., 2021 for a systematic review on the use of ACT to support parents/caregivers). Therefore, ACT has the potential to help Latino parents/caregivers manage a range of difficulties, such as navigating systemic barriers in health-care and social systems, by addressing experiential avoidance (i.e., unwillingness to experience aversive thoughts and emotions) and cognitive fusion (i.e., “fusing” private events to an experience), which fall under the purview of psychological inflexibility (Coyne et al., 2011). For instance, a Latino parent/caregiver may have identified the value of being a “parent that does whatever it takes” for their child, but consistently cancels diagnostic appointments for their child because of linguistic discrepancies. To move away from this past aversive experience, rumination on the future, and unhelpful behavior pattern, ACT can assist the Latino parent/caregiver in identifying and acting in alignment with behaviors that will get them closer to what is important in the present moment (e.g., identifying medical professionals who speak their language and securing an interpreter).

In considering the empirical support and clinical significance of ACT, it is vital to be aware that as expressed by Fung (2014), ACT is a Western adoption of Buddhism, meaning Western values and principles likely guided the formation of ACT. Although authors of this article have integrated ACT with Latino clients and parents/caregivers during behavioral services by focusing on the identification of values, orienting the individual to the present moment, and helping the individual detach from unhelpful private behavior, challenges are likely to arise. In particular, many ACT protocols use sophisticated terms (which decreases accessibility for individuals with a limited verbal repertoire), require that written materials be completed (which is not inclusive for individuals who do not write), and are frequently written in English (which is inaccessible for non-English speakers and can contribute to linguistic discrepancies). Moreover, if ACT was founded on Western values, it may be culturally biased instead of culturally sensitive (Hayes et al., 2011; Pasillas & Masuda, 2014). Although practitioners who utilize ACT with Latino families may encounter such challenges, they provide opportunities for researchers and practitioners to further enhance culturally responsive behavioral service delivery.

The work of ACT with families of children with ASD has been emerging, yet the work with Latino families of children with ASD is minimal. To date, there are only a handful of scholarly works focused on using ACT with this population. For instance, Cañón et al. (2023) replicated Blackledge and Hayes’s (2006) procedures with Latino families of children with ASD. In particular, Cañón conducted a 14-hr workshop in Spanish to assist parents in gaining distance from unhelpful private events and fostering a healthier relationship with these private events while clarifying personal values and engaging in behavior change. This study included various self-reported pre- and postmeasures and suggested a decrease in depression, anxiety, and psychological inflexibility/experiential avoidance.

Thereafter, Baires et al. (in press) culturally adapted ACT for Spanish-speaking Latino parents of autistic children/children with ASD by integrating sociocultural factors (e.g., historical background, acculturation levels, educational and literacy levels) and Latino cultural values (e.g., familism and religion/spirituality) in the metaphors, exercises, and activities used. This was done to evaluate the effects on parents’ statements of psychological flexibility and inflexibility, and their self-reported scores across a variety of areas related to psychological flexibility (e.g., automatic thoughts, mindful attention and awareness, thought suppression). Results suggested an increase in statements of psychological flexibility and statistically significant difference (i.e., increase) in thought suppression following culturally adapted ACT.

It is not surprising that the behavior-analytic community increasingly recognized the importance of shaping cultural awareness and responsiveness during behavioral service delivery following the discussion initiated by Fong et al. (2016). Although findings from Cañón et al. (2023) and Baires et al. (in press) begin to empirically address this matter, additional work is necessary given that Latinos are an underserved and underrepresented population in the behavior-analytic literature (Brodhead et al., 2014; Jones et al., 2020; Li et al., 2017; Severini et al., 2018). To practice cultural awareness and responsiveness, especially from the contextual behavioral perspective underlying ACT, practitioners must exhibit a flexible repertoire, which involves flexibly interacting with (i.e., “talking and thinking about”) personal and professional experiences in context sensitive ways (Ming et al., 2023). Per Ming et al., strengthening flexible repertoires can foster meaningful and purposeful connections, and increase behavioral persistence, even in adverse contexts.

Practitioners may begin to respond to others’ behavior in a more contextually sensitive manner when working from the lens of ACT. In particular, ACT can assist practitioners in identifying the persistent, systemic barriers that Latinos can face when securing behavioral services, and considering situational, historical, and cultural contexts of behavior. Further, as suggested by Rosales et al. (2021), considering sociodemographic aspects, such as income, language proficiency and immigration status, are also necessary when working with Latinos, which is also in alignment with a contextual behavioral framework. In not continuously assessing these contexts, analyses of behavior are naturally insufficient and can lead to misunderstanding behavior. For instance, if cultural values are not considered when analyzing behavior, practitioners may observe culturally relevant behavior (e.g., a Latino parent/caregiver canceling a session to attend a family gathering) as potentially problematic (i.e., observed as a barrier in treatment). This may consequently decrease opportunities for practitioners to take a compassionate and culturally sensitive stance with themselves and the individuals they work with.

What Do Latinos Care About? Los Valores / Os Valores

Communities are preserved and strengthened when cultural practices are maintained across generations. At the community level, cultural practices refer to the distinctive topographies and functions of behavior emitted by members of a group. In other words, culture can be defined as the behavior of a particular group that is maintained as a result of social reinforcement (Skinner, 1984). Culture can also be defined as a set of actions and beliefs that are characterized by a group of individuals and maintained across generations of that group (Sugai et al., 2012). Regardless of which definition is utilized, the role of social contingencies in the emergence, shaping, and maintenance of behavior is emphasized.

When working with Latino families, practitioners may observe families engage in behaviors that seem to interfere with behavioral services and address such behavior without examining all variables, including the cultural context. For instance, families may follow a curandera’s (traditional Latin American native healer) recommendations to use homemade remedies for challenging behavior or cancel sessions because an extended family member needs help with something seemingly simple. Being knowledgeable about cultural values and other sociocultural aspects (e.g., historical background, community support, familial environment, socioeconomic status, immigration history) of an individual or family might allow for practitioners to take perspective and respond in compassionate ways during the provision of behavioral services. Considering the theoretical framework of behavior analysis, an individual behaves (both covertly and overtly) due to an ongoing history of interacting with internal and external environments. However, behavior cannot be completely understood without considering the context in which the behavior occurs, which is consistent with the principles of behavior analysis. Here, context refers to an ever-changing sequence of events that influence behavior (Hayes et al., 2012) and can include one’s history, culture, health, memories, social relationships, work, family, therapists, and more.

As a population, Latinos have socially maintained behavior specific to their group. These socially maintained behaviors can relate to cultural values of personalism and sympathy, familism, defined gender roles, and present/past time orientation. Although other racial, ethnic, and cultural groups may maintain the same or similar values, it is pertinent that practitioners familiarize themselves with how different culturally and linguistically diverse populations express such values (i.e., the specific behavior that members emit in alignment with those values). Understanding Latino cultural values is critical to enhancing the therapeutic relationship and promoting treatment adherence. Moreover, being aware of these values allows for practitioners to provide services that can be culturally appropriate and individualized to increase successful outcomes (Neely et al., 2019; Slim & Celiberti, 2021).

The following sections describe and behaviorally define the aforementioned Latino cultural values, provide examples of how Latino families may behave in alignment with each value, discuss implications that each value has on treatment adherence, explore how practitioners may perceive each value as a barrier that interferes with treatment, and how each value can be viewed in the context of addressing real or perceived treatment barriers. With an emphasis on the authors’ experiences of working with Latino families and supervising early career practitioners who work with such families, readers are invited to begin enhancing their cultural responsiveness by shifting any perceived barriers to using Latino cultural values to guide effective treatment.

Personalism and Sympathy

As values that can serve as the foundation for Latino culture, personalism (i.e., friendliness) and sympathy are oriented to relationships and getting along with others (Magaña, 2020; Zea et al., 1994). Personalism is often observed through actions that might make the other person feel appreciated and welcome (Añez et al., 2005), whereas sympathy refers to “kindness” and emphasizes politeness and pleasantness even in the face of stress (Zea et al., 1994). In behavioral terms, personalism can be conceptualized as the mediation of reinforcement to express appreciation or friendliness. In Latin America, sympathy refers to an "intrinsic" characteristic of a person who engages in emotive and polite expressions of caring and generosity toward others. Thus, sympathy as a value might be behaviorally described as spontaneous demonstrations of affection that elicit a pleasant response from others.

Physical space is a pertinent component involved in personalism. During exchanges with others, Latinos may prefer to be closer in space than individuals from other cultures, and expect gestures, such as a hand on the shoulder (Barker et al., 2010; Davis et al., 2019). If there is a large distance between Latinos and someone else during a verbal exchange, Latinos may perceive the other person as distant and disinterested (Antshel, 2002). During difficult situations or important conversations, physical contact and closeness can help provide ease for Latino families of autistic individuals/individuals with ASD.

Interpersonal relationships, which are based on personalism and can include sympathy, are also highly regarded in the Latino culture. These relationships can be conveyed through loyalty, honesty, generosity, hospitality, and willingness towards others (Hernández et al., 2010). For some Latino families, maintaining interpersonal relationships is essential because it is their only source of social, emotional, economic, legal, and intellectual support during their migration process. Thus, interpersonal relations hold great significance for Latinos, in that they are valued more than time (i.e., keeping appointments) and individual achievements, which is likely to contrast with values of individualism.

Implications of Personalism and Sympathy on Treatment Adherence

According to Añez et al. (2005) and Flores (2000), a practitioner's failure to exhibit warmth and personalism to a Latino family and/or client might have a detrimental impact on the satisfaction with behavioral services. For example, if a practitioner’s neutral or businesslike affect is perceived as negative and “cold,” Latino families may become distant. Furthermore, if a practitioner appears distant or stressed for time, the Latino parent/caregiver may express hostility and dissatisfaction with treatment. These actions have an impact on the therapeutic relationship and can influence the likelihood of parents/caregivers following through on treatment suggestions. It is therefore recommended that practitioners keep this in mind, as research has demonstrated that a poor parent–practitioner relationship can be associated with lower utilization of ASD services (Parish et al., 2012) and retention of services. As stressed by Beaulieu and Jimenez-Gomez (2022), being aware of one’s learning histories, the cultural groups of which one is a part, the cultural variables that affect one’s behavior, and the differences between oneself and others in relation to these areas is one of the dimensions in self-assessment. If it is the case that practitioners work with a Latino family who value personalism and sympathy, have a more businesslike affect, and are aware of that, then they are likely to consider this cultural incongruence and engage in behavior that aligns with personalism and sympathy to ideally enhance treatment adherence.

Personalism and sympathy, however, can influence parents’/caregivers’ expectations of the parent–practitioner relationship. In particular, there is a cultural expectation that respectful listening and caring interactions are demonstrated between practitioners and the family so that a foundation of trust and rapport can be built (Añez et al., 2005; Mogro-Wilson et al., 2016). A benefit of fostering a positive relationship is that Latino families feel much closer when they engage in conversation. For example, as authors of the current article, we have found that when we have fostered “formal friendliness,” parents/caregivers have been more likely to voice their concerns and genuinely participate in services. Taking time to build and foster collaboration around those interactions may seem unrelated but can ultimately improve the quality and effectiveness of services (Fong et al., 2017; LeBlanc, Sellers, & Alai, 2020a; Taylor et al., 2018).

How Personalism and Sympathy May Look Like as a Treatment Barrier in the Work with Latino Families

Different ways in which personalism and sympathy can be perceived as a treatment barrier include a Latino parent/caregiver standing near the practitioner and engaging in small talk or conversations that appear unrelated to the provision of ABA-based services. For instance, authors of the current article have frequently had a Latino parent/caregiver ask them about what part of Latin America they or their family is from, which has led to conversations related to travel, customs, and more. In addition, we as authors have observed that Latino parents/caregivers share their excitement about the activities the family engaged in over the weekend (e.g., birthdays and family gatherings), while engaging in physical touch (e.g., placing a hand on a shoulder and giving a hug to say goodbye). To practitioners who are unfamiliar with the values of personalism and sympathy, the close proximity and use of physical contact may be perceived as Latinos not valuing personal space, whereas the frequent small talk may be perceived as Latinos postponing the beginning of sessions or not prioritizing behavioral services (i.e., behavior maintained by escape or avoidance).

Latinos may also express their hospitality and generosity through food. It is not uncommon for practitioners providing in-home services to be gifted with food by Latino families as a token of their appreciation for the interpersonal relationship and for Latino families to persist with the gifting of food after practitioners have declined the offer, which has been frequently experienced by authors of the current article. This may be perceived as Latino families wanting to become friends with practitioners and/or expecting practitioners to return a favor (Bailey & Burch, 2016). Although Bailey and Burch (2016), who are widely known for their work in behavior-analytic ethics, acknowledge that declining a gift is rude in some cultures, they advise that practitioners have families sign a “Declaration of Professional Practice” (Bailey & Burch, 2011, p. 261), which describes the “culture” of behavior analysis and outlines the expectations of ethical behavioral services from the onset. Considering the values of personalism and sympathy, Latinos are likely to view the Declaration of Professional Practice as “cold” or businesslike instead of warm and welcoming, which can significantly harm rapport. In addition, this interferes with practitioners practicing cultural humility and creating an environment that is centered about the family’s culture instead of the field’s culture.

Latinos also foster respectful listening and do not tend to communicate in a “matter-of-fact” way, which practitioners can perceive as Latinos lacking empowerment and self-advocacy. For instance, if concerns about their children have been dismissed or normalized by practitioners (Zuckerman et al., 2014), Latino parents/caregivers may not question practitioners’ decisions (e.g., a nonevidence-based treatment or less hours offered for services). Moreover, even when tasks or expectations are challenging or unclear, Latinos may avoid confronting or disagreeing with practitioners to avoid interpersonal conflict. For example, a Latino parent/caregiver may be eager to please the practitioner and promise to collect data for the following week despite knowing that they will be unable to because of a community event they will attend. In some cases, a Latino parent/caregiver may not directly ask for help or ask follow-up questions if expectations are unclear, as they may feel uncomfortable asking directly and assertively. Even if practitioners perceive the lack of assertive communication as a treatment barrier, the Latino family’s learning history and current maintaining contingencies (i.e., behavior may be maintained by escaping and/or avoiding interpersonal conflict) should be accounted for.

Using Personalism and Sympathy as the Context to Address Treatment Barriers

Building and maintaining rapport is an ongoing process during the provision of behavioral services across all stages (i.e., from assessment to discharge). As a result, having personalism and sympathy serve as the foundation of the therapeutic relationship can allow for the integration of other Latino values, which are described below. From our experiences as practitioners, creating a welcoming environment for Latino families can include engaging in conversations that are casual, and in some cases, unrelated to the provision of services. Creating these environments allows Latino families to share both outcomes and challenges they may be experiencing with their loved ones who are receiving behavioral services. For instance, a Latino family may share that they are struggling with implementing a behavior intervention plan; using personalism and sympathy can encourage families to be honest and transparent because the practitioner is not seen as a practitioner, but as a human.

For practitioners, being knowledgeable about values of personalism and sympathy can assist in addressing treatment barriers, improving self-awareness, and strengthening relationship building skills. For instance, practitioners can begin to recognize instances when a Latino family is not comfortable expressing their disagreement with behavioral services and can work in unison with the family to make modifications. Although repertoires associated with personalism and sympathy can be considered intricate skills to expand, the use of behavioral technology can aid in their development. For instance, Cañón and Gould (2021) evaluated the effects of verbal instructions, clicker training, and role-play on practitioners’ relationship building skills, such as mindful reflecting, asking questions with curiosity, and appreciating. In addition to the study’s efficient, noninvasive, and socially significant methods, the study of Cañón and Gould can serve as a model for increasing personalism and sympathy in practitioners.

Familism

Familism is one of the most salient values in the Latino culture. Familism is defined as the commitment to provide the needed emotional and tangible social support to nuclear and extended family members via solidarity, loyalty, and reciprocity (Calzada et al., 2013; Roseberry-McKibbin, 2014). In behavioral terms, familism is described as the mutual provision of social (e.g., attention, information, affection, respect, compassion) and tangible reinforcement to promote the cohesion of nuclear and extended family members. Not only is familism prevalent among the Latino community in general, but it also has a tremendous influence on parenting approaches and goal attainment. Familism involves two types of social support: structural and behavioral (Calzada et al., 2013). Structural familism relates to the physical proximity to family members. For example, if Latino families have relatives living outside of the United States, they may frequently travel to see them. Also, rather than utilizing residential facilities, assisted living, or nursing homes, Latino families may prefer to care for family members who require extensive care (e.g., grandparents or individuals with disabilities). Structural familism may also encompass the involvement of multiple family members in personal and medical decision-making processes, such as considering potential treatments for a loved one with ASD. As a result, several family members are likely to be present during assessments, evaluations, treatment, and in the home.

As an alternative, behavioral familism refers to behavior that is influenced by the values and expectations of the family and involves respecting and obeying authority figures (e.g., grandparents). In particular, behavioral familism may be seen by being helpful, generous, and loyal, and engaging in laborious work to benefit the family (Antshel, 2002). In addition, Latinos are more likely to prioritize the needs and priorities of others over their own (i.e., collectivism), which closely aligns with familism. For instance, a Latino parent/caregiver may postpone the purchase of supplies for their child's in-home ABA-based treatments (e.g., small table, chair, preferred stimuli) to assist their relatives in paying a bill.

Implications of Familism on Treatment Adherence

In behavioral services, taking familism into account can have a substantial impact on treatment adherence in a variety of ways. To name a few, involving close family members in treatment design and implementation (Antshel, 2002) will help to generalize service outcomes across people, contexts, and stimuli. Moreover, as Wolf (1978) describes, the aims, procedures, and results of behavioral services must be evaluated by society to establish social validity. Because of the amount of social significance and value of familism to prioritize the needs of others when appropriate, having support of goals, procedures, and consequences from numerous Latino family members may enhance treatment adherence overall. In other words, Latinos may adhere to treatment delivery for a loved one because it is a way to support the family and express love for them. In addition, for practitioners, integrating familism in behavioral services may lead to numerous opportunities for assessing interobserver agreement and treatment integrity.

How Familism May Look Like as a Treatment Barrier in the Work with Latino Families

Working with culturally and linguistically diverse families can be challenging for practitioners if their values differ from the family’s. Familism is a Latino value that practitioners may struggle to understand because the behaviors that maintain familism may conflict with therapeutic goals that promote autonomy. This value is typically observed when someone engages in behavior that functions to provide support to family members, relatives, friends, and neighbors. For example, we (the authors) have frequently observed that Latino parents/caregivers complete certain chores/tasks (e.g., laundry and cooking) for their children through adulthood (particularly males) or for Latino adults to still live with their parents/caregivers. It is also possible that Latino families have several family members present during sessions and seek and follow the advice of other family members (e.g., senior family members) regarding parenting methods or treatment recommendations before cooperating with professionals (Sue et al., 2019), which has also been observed by authors of the current article.

Familism may also be evident when Latinos frequently cancel their ABA-based sessions to accommodate family members who are visiting from abroad to celebrate family events (e.g., seasonal holidays) or to take care of a sick friend or relative. Another area where familism is observed is in the work of self-care with parents/caregivers. There may be difficulties in formulating specific goals in alignment with self-care because Latino parents/caregivers may be more concerned with the overall well-being of the family rather than their own well-being. For a practitioner, these behaviors may be seen as maintaining inappropriate dependency, despite such actions occurring in alignment with familism.

Using Familism as the Context to Address Treatment Barriers

There are several ways that familism can guide practitioners in addressing treatment barriers. If practitioners provide in-home services to a Latino family that is composed of multiple extended family members, such family members can be included in programs, behavioral protocols, and goals, which can create several naturally available opportunities for maintenance and generalization. As Latino practitioners, we (the authors) have found this approach to enhance the delivery of behavioral services and maintain and strengthen interpersonal relationships among family members. In relation to addressing self-care for Latino parents/caregivers, familism can be integrated by addressing self-care for the collective family as opposed to one individual. For instance, strategies for improving self-care can include other family members and close relatives living in the home (e.g., going for a walk as a family) instead of focusing on one person (i.e., the parent/caregiver going for a walk by themselves).

Practitioners can also use the natural context where a connection between a family member and client naturally occurs, so that behavioral targets can be integrated without requiring the family member to shift from the natural routine for the sake of actively carrying out the behavioral intervention. If the most common context for an interaction is the kitchen, for instance, there may be opportunities for the client to assist their grandparent in cooking a preferred traditional dish that is of interest for the client. With this, the likelihood of reinforcing exchanges between the client and their grandparent is not only increased, but cooperation and self-help goals are also addressed. Integrating these modifications can strengthen culturally responsive interventions and interconnectedness between multiple family members. Finally, and in general, practitioners are highly encouraged to expand their definitions of “parent” to “caregiver,” which is defined as someone who directly cares for others (Merriam-Webster.com). Others including grandparents, family friends, older siblings, aunts, uncles, and neighbors, often help care for Latino autistic individuals/Latino individuals with ASD. Considering their vital role in the Latino client’s life may strengthen the design, provision, and longevity of services. In our personal and professional experiences, we (the authors) have expanded our definitions of “parent” to include “caregiver” by including such individuals when conducting initial assessments, creating programs and intervention plans, and so forth.

Defined Gender Roles

Another common cultural value within the Latino community relates to defined gender roles, such as machismo/chauvinism (Zuckerman et al., 2014) and marianismo/marianism. Machismo/Chauvinism can be characterized by strong or aggressive “masculine” pride. Traditional orientations of the Latino culture tend to reinforce machismo/chauvinism when emitted by men but not women (e.g., financially providing for the family; Lindinger-Sternart, 2014; Mahalik et al., 2003). In addition, behaviors such as seeking help are often associated with vulnerability and weakness and seen in opposition of machismo/chauvinism (Pederson & Vogel, 2007), despite the value including related characteristics such as honor, respect, dignity, and value for the family (Arciniega et al., 2008). Machismo/Chauvinism can be behaviorally defined as behaviors displayed by men that align with biased instances of physical or emotional strength (e.g., withholding tears during times of sadness), pride (e.g., financially providing for one's family), honor (e.g., engaging in a behavior because the person indicated that he was going to do it, even though conditions have changed), dominance of women (e.g., asking a female partner not to work and instead clean the house), and respect (e.g., demanding that children comply with all demands without question). It is vital to highlight that if such acts are emitted by women, they are likely to result in punishment and/or extinction.

Marianismo/Marianism differs from behaviors that maintain machismo/chauvinism, which are expected from women, particularly mother figures. Marianismo/Marianism can be characterized by “feminine” traits of harmony, spirituality, modesty, virtue, and submission (Piña-Watson et al., 2014). In particular, Latinas may be expected to maintain spirituality in the home, provide emotional support to other members of the household, secure health-care services for their children (e.g., ABA), and teach their native language to their children. Moreover, it may be expected that Latina women take responsibility for the completion of domestic tasks (e.g., cleaning, cooking), be present during health-care appointments (e.g., medical or behavioral), and not express feelings of anger or frustration. Marianismo/Marianism can be defined behaviorally as behaviors exhibited by women that align with biased instances of harmony (e.g., helping to reconcile different perspectives without evoking an argument), spirituality (e.g., attending spiritual or religious services), modesty (e.g., wearing appropriate attire that does not stand out in comparison to other women), virtue (e.g., not engaging in premarital sexual relations), and submission (e.g., avoiding interpersonal conflicts by yielding her position about a problem). It is vital to highlight that if such acts are emitted by men, they are likely to result in punishment and/or extinction.

Traditional Latino families are hierarchical in form, with special authority given to parents, older family members, and men. Within this type of family structure, gender roles are also clearly delineated. The father figure is typically the primary authority figure, whereas older children are expected to care for and protect their younger siblings when the mother or other “mother-like” figures (e.g., grandmother and aunt) are unable to. In addition, gender roles can guide expectations in Latino homes for both adults and children. For example, it is common to see Latino fathers working outside of the home to financially support the household. On the other hand, Latina mothers may often take on the responsibility of caring for the children by attending parent–teacher conferences, participating in parent training during ABA-based services, and providing support for their children in addition to maintaining the household.

Considering this, practitioners are advised to note that defined gender roles may be seen more in traditionally oriented Latino families. Deviations from traditional gender roles may be seen in Latino families that are acculturated, which speaks to the intersection of adapting to the dominant culture while maintaining practices and values of the original culture (Berry, 2005), or families that are assimilated, which speaks to one’s adoption of the dominant culture’s beliefs, values, and practices (Kawaga-Singer, 2012). As supported by the research of Vasquez (2014), masculine and feminine ideals have been found to shift for second-generation Latino families, which suggests that gender roles are not fixed values. Therefore, as with any Latino cultural value, practitioners must remain aware that how a value overtly presents itself will differ given the family’s level of acculturation or assimilation.

Implications of Defined Gender Roles on Treatment Adherence

In relation to treatment recommendations, authors of the current article have observed that treatment adherence may be higher with mother figures than father figures in a Latino household that maintains traditional defined gender roles. Given the cultural expectation for women to secure and be present during healthcare services for their children, they may be more likely to collect data, implement treatment recommendations, and more. However, challenges may arise with father figures if the cultural expectation is for them to financially support the family and teach their sons to be “the man of the house.” To help alleviate such challenges, Antshel (2002) recommends encouraging extended family members (e.g., fathers, uncles, grandfathers) to share child rearing responsibilities. Doing so in this culturally sensitive manner can help increase father figures’ participation in behavioral services, including adherence to treatment.

If a Latino family is patriarchal in nature, where father figures have a strong presence, then they can influence the treatment adherence of other family members and behavioral services in general. As a result, practitioners are advised to consider soliciting the insights and feedback of such individuals if the house is patriarchal in nature. Although mother figures may be the key behavior change agents, major decisions related to behavioral services (i.e., continuation and/or termination of services) may fall under the purview of father figures. Therefore, it is essential that practitioners foster rapport with mother and father figures in a Latino household.

How Defined Gender Roles May Look Like as a Treatment Barrier in the Work with Latino Families

There may be a prominent dichotomy between how non-Latino identifying practitioners and Latino families view defined gender roles, especially if practitioners analyze seminal texts in behavior analysis from a multicultural feminist lens (Wolpert, 2005), work to dismantle sexism in the field (Baires & Koch, 2019), examine intersectional feminism theory from a behavior-analytic lens (DeFelice & Diller, 2019), and establish/attend conferences that highlight the accomplishments of women in behavior analysis (Sundberg et al., 2019). This dichotomy may be more apparent when considering differing levels of acculturation and assimilation. When working with Latino families who are more traditional in their gender roles, the practitioner may face difficulties in taking a flexible approach to multiple aspects of behavioral treatment. For example, Latino men may be expected to financially support the household (Ojeda et al., 2016) instead of attending parent training sessions. For a practitioner who is unaware of the defined gender roles in the Latino community, this may be perceived as inequitable and/or sexist if the expectation is solely for women to attend parent training sessions.

Additional challenges related to defined gender roles can also be seen. For example, a Latino father may not wish to obtain ABA-based services for his son, as this may result in his son being perceived as different from his peers and not being able to carry out the role of a “man” in the future (e.g., being the breadwinner or marrying someone of the opposite sex and having a large family). In such cases, treatment adherence is predicted to be low or nonexistent. Moreover, practitioners may perceive this as Latino fathers not seeing the ultimate benefit of their child, when, contextually, the Latino father is behaving in accordance with the values his culture has maintained and transmitted across generations.

A common experience in our practice as authors is that fathers work all day and come home with the intention of relaxing and spending quality time with their children. Sometimes, quality time involves creating a reinforcing environment (i.e., noncontingently providing preferred foods, toys, or activities) even when the client exhibits challenging behaviors that are currently being targeted for reduction during sessions. This might lead to lower treatment fidelity, disagreements between parents/caregivers, and discouragement for mothers who are the likely behavior change agents attempting to maintain contingencies outlined in the behavior intervention plan. If practitioners were to approach this situation, it is advised to do so in a culturally sensitive manner, as Latino men may not feel comfortable interacting with practitioners or other professionals because of their lack of authority in such situations (Antshel, 2002). For example, one could set aside time to explain to the father figure that his child's actions (i.e., challenging behavior) may be acceptable in the framework of a game but may be troublesome in other situations. Then, the practitioner can provide concrete examples of how these behaviors can affect their child's socialization and offer alternative behaviors in the game with the father figure. To maintain values of personalism and familism, it is advised to discuss this topic with the father figure at a later time instead of interfering with the game in the moment.

Another way in which dichotomous gender roles can be perceived as treatment barriers in the work with Latino families relates to how goals centered around autonomy are not often emphasized, compared to how such goals are prioritized in non-Latino cultures. In particular, Latino parents/caregivers may often select goals that are gender-specific within the culture and align with family responsibilities, given what has been reinforced by the verbal community. For example, learning how to clean up one’s bedroom, do one’s laundry, and cook for oneself may be deemed appropriate and socially significant for daughters, but not for sons. Moreover, there may be the expectation for daughters to have more responsibilities (e.g., run errands and help prepare meals), “set the example” for their siblings (i.e., marianismo/marianism), or take care of their siblings when parents/caregivers cannot, especially if such daughters are the oldest.

Using Defined Gender Roles as the Context to Address Treatment Barriers

As suggested by Sue et al. (2019), practitioners are advised to highlight the varying expectations for gender roles between the Latino culture and U.S. culture. In other words, defined gender roles as a “treatment barrier” can be approached by collaborating with a Latino parent/caregiver to explore the differences and similarities between what is expected of their child in terms of gender in the United States versus Latin America and find an equilibrium. Here, practitioners can also take advantage of the opportunity to learn from and alongside the parent/caregiver.

Practitioners should be cautious when inadvertently imposing personal views in terms of gender roles unless the Latino individual expresses interest in understanding different perspectives. Because practitioners have an ethical obligation to involve clients and stakeholders in every aspect of service delivery (BACB, 2020), they are encouraged to create bridges between their personal and clinical perspectives, and the perspectives of the Latino family they are supporting. This can be done by helping those family members who are not typically involved in behavioral services (because they are working or caring for the family as defined by gender roles or current living circumstances) understand the implications of the client not receiving the support that is being sought out, which is commonly a result of receiving a diagnosis. For instance, a conflict may occur between the family and practitioner, wherein the practitioner insists on meeting with both parents/caregivers, despite the mother/mother figure being the primary caregiver involved in services and the father/father figure having limited availability. In such cases, authors of the current article have found it helpful to involve the parent/caregiver with limited availability by capturing naturally occurring interactions with the client to help create meaningful learning opportunities.

In general, the importance of defined gender roles can be flexibly integrated in assessment and treatment. In conjunction with assessments (e.g., Vineland Adaptive Behavior Scales; Sparrow et al., 2016), practitioners are encouraged to assess a Latino client's skill set based on the family’s gender expectations. The results of this culturally sensitive approach to conducting assessments will allow for a discussion about how gender-based skills can be expanded and look across various life domains. For instance, in the case of Latino parents/caregivers expecting their son to be “strong,” authors of the current article have explained how strength is not only related to physical dominance but to engaging in skills independently across various developmental domains (e.g., hygiene, relationship building, coping skills, communication). During behavioral services, practitioners can then describe how developing these skills more closely aligns with the characteristics of “strength” and independence.

As authors who identify as Latino/a, it has been challenging not to impose our values of gender equality in our work with Latino families. However, having an ongoing awareness of personal biases and actions towards a more culturally responsive approach in behavioral services (Beaulieu & Jimenez-Gomez, 2022) is extremely beneficial in such situations. Moreover, sharing these self-observations with colleagues who have similar ethnic and cultural values may be fruitful in enhancing personal and professional growth, and considering cultural values during behavioral services.

Past and Present Time Orientation

A focus on the past, present, and future is determined culturally, that is, by the contingencies of reinforcement and punishment established by groups in a social context (Fong et al., 2016). Like many other collectivistic cultures, Latinos are focused on past time orientation (i.e., preserving cultural traditions) and present time orientation (i.e., meeting current needs), whereas individualistic cultures place more emphasis on future time orientation (Healy et al., 2004). In behavioral terms, a focus on past time orientation can be defined as engaging in behavior that maintains cultural traditions across generations (e.g., holidays, dishes, language) or behaviors that are controlled by environmental events of the past that are coherent with traditional or cultural practices. Meanwhile, a focus on present time orientation can be defined as engaging in behavior that results in alleviating immediate needs or behavior that is controlled by environmental events in the present.

The Latino population's focus on present time orientation is closely related to the learning history of encountering several impediments to social mobility. According to Zea et al. (1994), families from lower socioeconomic groups tend to prioritize immediate, daily needs that have higher relevance for subsistence. For instance, if a Latino family is experiencing financial problems and has unmet basic needs (e.g., adequate housing, health care, fair work remuneration), these pressing issues will take priority over securing or attending behavioral services for their child with ASD, even when attending such services could result in more desirable conditions in the future.

Latino families’ emphasis on their immediate needs may be tied to religious practices and spirituality, because they may rely on religion or spirituality to overcome current difficulties. This connection between time orientation and spirituality can be observed through families’ expression of spiritual beliefs. For instance, Latino families may see their autistic child/child with ASD as part of their fate (e.g., “God gave me this child for a reason,” “My child is the way he/she/they is/are,” “I do not want to change my child into someone they are not”) or a result of God’s will (i.e., a blessing or punishment) for them to endure. However, Latino parents/caregivers may also use nonevidence-based alternatives and be guided by spiritual beliefs to help their children “get better.” For instance, they may prefer to follow spiritual advice even when it conflicts with advice given by practitioners (e.g., using herbal or home-based remedies or treatments, different diets, or even “miraculous” practices). In a qualitative study conducted by Lopez et al. (2019), Latina mothers reported that their family members thought ASD could be healed or cured with alternative healing methods. Other ways include regularly praying and attending religious gatherings, sometimes “at the expense” of behavioral services.

Implications of Past and Present Time Orientation on Treatment Adherence

Depending on the family or client’s level of acculturation or assimilation, a focus on past time orientation can enhance behavioral services if cultural traditions are integrated and preserved in services, which can support treatment adherence. For instance, authors of the present article have modified services to account for a cultural holiday (i.e., Día de los Reyes Magos/Three Kings Day) that was important to a Mexican family. In particular, one of the authors encouraged traditional foods (e.g., rosca de reyes/king’s cake, which is a baked good that resembles a crown, has various dried and candied fruit to symbolize jewels on a crown, and contains a small hidden figure inside to represent a newly born Jesus) and customs (e.g., everyone cutting their own slice of the baked good to find the small hidden figure, which results in that person hosting a party for the family the following month) when the holiday was observed. A celebration of this cultural holiday provided an opportunity to assess generalization and maintenance of the skills being targeted during behavioral services. Though, more important, such celebration served as an opportunity to preserve the Latino family and client’s cultural tradition.

In relation to present time orientation and treatment adherence, being sensitive to a Latino family’s immediate and basic needs can have significant implications. It may be that a Latino family is oriented in the present time and cancels sessions to attend to their basic needs (e.g., medical needs). If practitioners conduct functional analyses to determine the cause of frequent cancellations in such cases, they can connect the family to resources and even consider holding the continuation of behavioral services if possible. Although the latter could affect funding sources and affect progress for the child, supporting the Latino family as they are oriented in the present time “now” can enhance behavioral services later because the practitioner emphasized the family’s immediate needs rather than the provision of behavioral services. In their research examining Latino families’ experiences with autism services (i.e., ABA), Angell et al. (2016) found that one Latino family terminated ABA-based services because they felt the practitioner was pressuring them to not cancel further sessions despite the recent addition of a newborn to the family. In this case, it was likely that treatment integrity and an interpersonal relationship with the family was harmed. Therefore, with a past and present time orientation in mind, practitioners can incorporate this cultural value and perhaps strengthen family members’ participation in and adherence to behavioral services.

How Past and Present Time Orientation May Look Like as a Treatment Barrier in the Work with Latino Families

Past time orientation may be seen through various phases of behavioral services (i.e., from the initial assessment to termination of services). Particularly during the onset of services when behavioral assessments are conducted, Latino parents/caregivers may provide information that is considered “unnecessary,” such as extensive details about their childhood and the client’s, what they think the cause of the client’s diagnosis is, and so forth. This “unnecessary” information may be seen as a treatment barrier, yet such information is in alignment with past time orientation because it informs on traditional and cultural practices that the Latino parent/caregiver finds important to share with the practitioner. As Latino practitioners, we have experienced this in our clinical work and oftentimes had to stay beyond the time allotted by the funding source to conduct the initial evaluation. Despite the extra time not being funded, we recognized the importance of personalism, sympathy, and past time orientation to serve as the foundation for the rapport being built with the family.

In addition, focusing on the present may be observed when Latino families prioritize reducing socioeconomic disparities such as poverty, uncertain/temporary immigration status, long working hours in low-paying jobs, and access to health care (Durkin et al., 2017). As Latino-identifying practitioners, we have observed that when Latino families are under such adverse circumstances, parents/caregivers may be less likely to maintain appointments and/or dedicate time to focus on behavioral services. This may be perceived by some practitioners as a lack of engagement (e.g., “Latino parents do not do what would be beneficial for their child’s future”) or resistance to change (e.g., “Latino families do not follow the treatment procedures”) when attempting to implement “different” or “new” parental practices suggested by practitioners. Moreover, if Latino families are undocumented, they may be less likely to participate in community outings with their children as part of behavioral services. In our experiences, such families may be afraid to leave their homes at risk of being persecuted by immigration officers.

Using Past and Present Time Orientation as the Context to Address Treatment Barriers

It is necessary for practitioners to assess if systemic barriers are present for Latino families by considering their circumstances and the wider context. Practitioners may view Latino families’ disregard of behavioral services as a “lack of consistency” or an “excessive reliance on accommodations,” despite such circumstances being related to other interfering factors that are not typically considered by practitioners (e.g., unmet physical or psychological needs such as sleep, adequate housing, isolation, sense of belonging). In this case, and with the family’s consent, referrals to community organizations and/or charitable culturally sensitive groups could be beneficial for Latino families to explore avenues for additional support at different levels (e.g., community connection, empowerment, financial support).

Another way to address perceived barriers focused on time orientation is to consider Latino families’ traditional religious and spiritual beliefs in a cultural assessment. By doing so, practitioners can identify relevant traditions that may be helpful to integrate into behavioral services (e.g., persistence; patience; acknowledging that life is not easy, but that improvement depends on what we do/practice with the client; resilience; acceptance). Also, practitioners can identify verbal and nonverbal contextual cues to help pinpoint instances in which a Latino parent/caregiver feels powerless (i.e., contacts extinction or punishment) in the face of challenging situations.

In such cases, practitioners could use culturally relevant sayings or culturally relevant dichos as metaphors to help Latino parents/caregivers connect with cultural values and engage with therapeutic goals for their loved one with ASD. For instance, to provide encouragement during challenging times, practitioners can say “Casa de herrero, azadón de palo” in Spanish, “Casa de ferreiro, espeto de pau” in Portuguese, or the equivalent in the language the family speaks, which in English can be understood as someone who has a particular skill set but does not use it when needed, or “Más vale pájaro en mano que cien volando” in Spanish, “Mais vale um pássaro na mão do que dois voando” in Portuguese, or the equivalent in the language spoken by the family, which in English can be understood as someone who “does not have all their ducks in a row” before making a big decision. Authors of this article have used culturally relevant dichos, which Latino parents/caregivers have reported being helpful in taking a different perspective during challenging times or in increasing the value of engaging in a particular response (i.e., augmentals, which are a type of rule governed behavior that can alter the value of events that function as consequences; Törneke et al., 2008). Therefore, practitioners are encouraged to explore dichos used by the Latino parent/caregiver (i.e., culturally relevant dichos), along with the social, cultural, and communicative contexts in which the dichos are used. In other words, when considering the use of sayings or dichos, it is important to note that the same dicho might not be understood similarly across different communities in Latin America due to individual learning history, region, and/or language, which speaks to the importance of culturally responsive approaches in behavior analysis. Along with empathy and compassion, culturally relevant dichos can create opportunities for practitioners to orient Latino parents/caregivers to engage in action in the present moment and potentially contact reinforcement.

Practitioners can also encourage Latino families to observe the impact of their current behavior and the relationship that their behavior’s outcome has with the desired goals. Having specific conversations about well-defined goals that are relevant to the family’s needs and linked to imminent benefits for each family member would allow for Latino parents/caregivers to connect their current actions with their short- and long-term goals. For example, if financial management is being targeted for increase, practitioners can say, “We want Julián to independently buy something from the ice cream truck. If we begin to work on the value of coins, he might be able to independently make small purchases later.”

The previous sections highlighted a few Latino cultural values, their implications on treatment adherence, how they can be perceived as treatment barriers, and how such values can be used to enhance culturally responsive behavioral services. In considering this information, it is important not to overgeneralize these cultural values or how they are demonstrated among Latinos. In other words, because Latinos experience their identities in different ways and in conjunction with other social identities, as previously mentioned, the aforementioned cultural values and/or the accompanying observable and measurable behavior are not likely to be the same across the Latino population. Therefore, practitioners are urged to take a flexible approach in using their knowledge about these cultural values and avoid making generalizations and/or assumptions about a Latino family’s personal values. Moreover, in considering the value of authors’ experiences serving Latino families along with the peer-reviewed literature in the previous sections, continued empirical validation is necessary to identify best practices in integrating Latino cultural values into behavioral service delivery. In other words, the lived experiences of the current authors, as well as other practitioners who have worked with Latino families, can begin to shape areas for future research to promote inclusivity and cultural responsiveness through data-based decisions.

What Can Be Put into Action? Las Recomendaciones / As Recomendações

In addition to the recommendations provided to address perceived challenges associated with each Latino cultural value, there are additional recommendations to consider when cultivating a collaborative, culturally sensitive, and compassionate relationship between practitioners and Latino families. Such recommendations include conducting needs assessments, conducting cultural assessments, cultivating linguistically responsive verbal communities, establishing connections with organizations and professionals outside behavior analysis, considering culturally adapted informational resources, considering psychoeducational and culturally informed interventions, utilizing existing resources in ABA, and collaborating with linguistically diverse practitioners or Hispanic/Latino practitioners.

Conduct Needs Assessments

Practitioners are encouraged to learn about the needs of the Latino families they are serving by conducting a needs assessment. In a study conducted by Iland et al. (2012), obstacles and needs for support were identified for Latina mothers of children with ASD. In particular, the Encuesta de Necesidades Familiares (Family Needs Survey; Bailey Jr & Simeonsson, 1988) was used, which Bailey Jr et al. (1999) found to be appropriate to be administered to Spanish-speaking Latino populations and was translated into Spanish by Iland (2007), as well as the Caring for My Child Survey, which was devised by Iland (2007). Using such needs assessments can help identify what types of services and information are needed, what is important to families (e.g., cultural considerations), and any barriers that Latino families may face when accessing services. From an ACT perspective, practitioners can more sensitively consider the situational context of behavior (e.g., continuous cancellations) if the results of a needs assessment suggest a Latino family does not have their basic needs met. In other words, if a Latino family does not have certain needs met, it can provide the practitioner with some insight as to why the family struggles with remaining in the present moment with behavioral services. In addition, this information may also yield other resources that Latino families are accessing. Descriptions of these needs assessments, as well as information for a more comprehensive needs assessment for Latinos (e.g., Fuger et al., 2013), are included in Table 1.

Table 1.

Recommendations to increase culturally responsive services for Latino families

Recommendation Category	Name	Reference/Contact	Description
Needs Assessment	Family Needs Survey	Bailey Jr and Simeonsson (1988)	A 35-item survey that inquires about parents’/caregivers’ needs for help with information, support, explaining their child’s diagnosis to others, community services, financial needs, and family functioning.
Needs Assessment	Encuesta de Necesidades Familiares	Iland (2007)	A Spanish translation of Bailey Jr and Simeonsson’s (1988) “Family Needs Survey.” A 35-item survey that inquires about Spanish-speaking parents’/caregivers’ needs for help with information, family and social support, financial, explaining their child’s ASD diagnosis to others, childcare, professional support, and community services.
Needs Assessment	Caring for My Child Survey	Iland (2007)	A 22-item survey that can inform on the circumstances or barriers Latina mothers (i.e., Latino parents/caregivers) face when accessing care for their children with autism/autistic children.
Needs Assessment	2013 Greater Kansas City Hispanic Needs Assessment	Fuger et al. (2013); https://www.mattierhodes.org/wp-content/uploads/2014/11/Hispanic-Needs-Assessment-2013-2014_Optimized.pdf	An assessment project that focused on Latinos and employed a framework based on determinants of health, with particular focus on socioeconomic conditions, access to health-care services, availability of quality education, access to housing, other resources for community living, discrimination, and civic engagement within the community.
Cultural Assessment	Culturally Responsive Assessment Questions for CBT+	University of Washington’s Harborview Medical Center (n.d.); https://depts.washington.edu/uwhatc/PDF/TF-%20CBT/pages/1%20Therapist%20Resources/CBT+-Culturally%20Responsive%20Questions.pdf	A series of questions that begin and facilitate discussions with families and clients about cultural variables that may influence treatment engagement, motivation, and participation. Areas include child rearing practices/parenting, gender roles, acculturation migration/immigration history, family/community focus, discrimination experiences, religious/spiritual beliefs and practices, views of mental health and mental health treatment, language, sex/sexual identity/orientation, and general/nonspecific/wrap up.
Linguistically Responsive Resource	Culturally responsive ABA-based research and practice	Jimenez-Gomez and Beaulieu (2022)	Provides several recommendations to increase cultural responsiveness in ABA-based research and practice, including the incorporation of language in functional analyses, providing choices to account for language preference, and translating materials into the language(s) spoken by the client and/or their family.
Linguistically Responsive Resource	Equitable access to ABA-based services for linguistically diverse populations	Kornack et al. (2019)	Highlights ways that equitable ABA-based services can be increased, including the provision of oral interpretation and written translation services, use of billing codes and modifiers for such services, and rate negotiations for such services.
Organization Outside Behavior Analysis	Fiesta Educativa (Educational Party)	https://fiestaeducativa.org/	An organization that provides workshops, an autism parent education program, a community parent resource center, autism conference, annual statewide conference for parents/caregivers and professionals, and opportunities to participate in research to Latino families of individuals with disabilities living in certain counties of California.
Organization Outside Behavior Analysis	Grupo de Autismo Ángeles OC (Group of Autism Angels OC)	https://grupoangelesoc.org/	An organization that provides workshops, familial community outings, support groups, and more for Spanish-speaking individuals with autism and their parents/caregivers residing in Orange County, CA.
Organization Outside Behavior Analysis	Grupo SALTO (Sociedad de Autismo Latina Trabajando con Optimismo)	https://gruposalto.org/	An organization that serves Latino families of children with disabilities, primarily autism, living in the Chicago area of Illinois by providing monthly sessions on various topics; music classes; Tú y Yo (You and I), which is a mentoring program for youth and young adults with autism; social/recreational activities, and Parents Taking Action (PTA; more details provided below about PTA).
Other Professionals Outside Behavior Analysis	Promotores de salud/Promotoras (Community health workers)	https://www.cdc.gov/minorityhealth/promotores/index.html	Community health workers who empower Spanish-speaking communities through education and connections to health and social resources. Promotores de salud/promotoras also create training materials to increase cervical cancer screening among Latinas for a bilingual educational outreach program called AMIGAS (Ayudando a las Mujeres con Información, Guía, y Amor para su Salud; Helping Women with Information, Guidance, and Love for Their Health). More information about AMIGAS is provided below.
Organization/Other Professionals Outside Behavior Analysis	Colaboración, Liderazgo, Abogacía, Servicio, y Educación (CLASE) Community of Practice	https://ieautism.org/latino-community-of-practice/	A program that informs, educates, trains, and empowers community group leaders who primarily serve Latino families with a loved one with disabilities in California’s Inland Empire.
Culturally Adapted Informational Resource	Fotonovelas (Photonovels)*	https://www.cdc.gov/minorityhealth/promotores/index.html;https://www.cdc.gov/cholesterol/docs/fotonovela_cholesterol.pdf (example)	A photonovel (similar to a comic book) used by promotores de salud/promotoras to provide information on health promotion and health education for Latinos.
Psychoeducational and Culturally Informed Intervention	Parents Taking Action (Padres en Acción)*	Magaña et al. (2017)	A psychoeducational and culturally informed parent education intervention that emphasizes the role of language, persons, metaphors, content, concepts, goals, methods, and context in the dissemination of information regarding ASD to Latino families.
Existing Resource in ABA	Self-assessment of one’s culture, beliefs, attitudes, and biases	Beaulieu and Jimenez-Gomez (2022)	Introduces a framework of cultural responsiveness in ABA and provides several activities aimed at promoting self-awareness of one’s culture, beliefs, attitudes, and biases.
Existing Resource in ABA	Verbal instructions, clicker-training, and role-play to increase relationship-building and compassionate care skills	Cañón and Gould (2021)	Provides a behavioral protocol that can be generalized to develop personalism and sympathy in practitioners.
Existing Resource in ABA	Compassionate Collaboration Tool	Rohrer et al. (2021)	Serves as a tool to self-evaluate and monitor one’s compassionate, collaborative behavioral service delivery
Existing Resource in ABA	Cultural responsiveness in ABA research and practice	Jimenez-Gomez and Beaulieu (2022)	Provides actionable guidance on being culturally responsive with intake assessments, goal and treatment selection, descriptive assessments, functional analyses, social validity assessments, treatment integrity, treatment considerations, functional communication training, and programming for generalization.
Existing Resource in ABA	Goal setting with Latino families of children with intellectual and developmental disabilities in the United States and Colombia	Suarez-Balcazar et al. (2022)	Discusses two case studies used with these populations in which goal setting was utilized to increase goal attainment and identify the behavioral and contextual barriers encountered while working towards established goals
Existing Resource in ABA	Culturally sensitive behavior intervention materials	Martinez and Mahoney (2022)	Provides a step-by-step tutorial for developing comprehensible, culturally adapted intervention plans, particularly in training parents of autistic children/children with ASD.
Existing Resource in ABA	Cultural responsiveness curriculum	Mathur and Rodriguez (2021)	A curriculum based on critical race theory (West, 1995) to enhance culturally responsive services for autistic individuals/individuals with ASD from marginalized communities.

*Requires continued research, because there is a lack of empirical support to date

Conduct Cultural Assessments

It is also recommended to conduct a cultural assessment at the beginning of behavioral services to assess the role of common Latino cultural values in a client’s life. In our experiences, when a Latino family engages in culturally significant activities, the practitioner can promote socially significant behavior that will generalize to the client’s natural environment. Therefore, a cultural assessment may assist practitioners in determining the behaviors that a Latino family typically engages in to follow cultural values. Moreover, cultural assessments may inform family members’ expectations regarding behavioral services and how services can be integrated into the family’s cultural practices. For instance, the Culturally Responsive Assessment Questions for CBT+ from the University of Washington’s Harborview Medical Center (n.d.) provides behavior-analytic practitioners with a variety of questions that can be presented during the assessment phase of services. Questions focus on child rearing practices/parenting, acculturation migration/immigration history, discrimination experiences, religious/spiritual beliefs and practices, language, sex/sexual identity/orientation, and more (see Table 1).

Including a cultural assessment during the initial evaluation can not only help maintain cultural practices, preserve language skills, build close relationships among social supports, help Latinos consider advice for critical decisions, and promote access emotional support for Latino families (Sabogal et al., 1987), but practitioners can further individualize behavioral services and be sensitive to the sociocultural context (Hayes & Toarmino, 1995). For example, a cultural assessment can identify upcoming cultural events, which allows practitioners and the Latino family to discuss how to align a social skills program with the nature of the cultural events the family is considering attending. Moreover, conducting cultural assessments can provide practitioners with opportunities to consider the cultural context of the family’s behavior.

Cultivate Linguistically Responsive Verbal Communities

To effectively serve linguistically diverse families, such as Latinos, and remain in compliance with nondiscrimination provisions, practitioners can cultivate linguistically responsive verbal communities by securing an interpreter and/or taking advantage of modern technologies (e.g., translation applications; Castro-Hostetler et al., 2021) as needed. Although more effortful, practitioners can also conduct culturally responsive functional analyses to include languages spoken by the client and their verbal communities, provide choices to account for language preference during behavioral service delivery, and translate materials into the language(s) spoken by the client and/or their family (Jimenez-Gomez & Beaulieu, 2022). From an ACT perspective, language should be considered if it relates to psychological inflexibility. For instance, linguistically diverse individuals may recall particular events more accurately in one language than another (Marian & Kaushanskaya, 2008) or switch languages during particular (aversive) topics, which can suggest experiential avoidance. Therefore, the aforementioned recommendations not only highlight practitioners’ ethical and legal duties to provide equitable access to ABA-based services, regardless of the recipient’s primary language (Kornack et al., 2019), but can assist in cultivating linguistically responsive verbal communities that allow for meaningful communication. Specific linguistically responsive resources can be found in Table 1.

Establish Connections with Organizations and Professionals Outside Behavior Analysis

Practitioners can also establish connections with organizations and other professionals that specifically serve the Latino population, which can be beneficial in building partnerships, establishing a network of unconventional referral sources, and remaining culturally and contextually sensitive. Some of these organizations include Fiesta Educativa (Educational Party), Grupo de Autismo Ángeles OC (Group of Autism Angels OC), and Grupo SALTO (Sociedad de Autismo Latina Trabajando con Optimismo). Table 1 provides information about these organizations, as well as their contact information. Although these organizations are not geographically accessible to all, they demonstrate the types of support available and can encourage practitioners to seek out similar organizations in their areas, which, from an ACT perspective, can foster flexible repertoires to enhance purposeful connections. Furthermore, practitioners are advised to collaborate with other professionals who primarily serve the Latino population, such as promotores de salud/promotoras (community health workers) and the Colaboración, Liderazgo, Abogacía, Servicio y Educación (CLASE) Community of Practice (see Table 1 for additional information and contact information). Although CLASE is not accessible in all states, practitioners can take the opportunity to find such programs and professionals in their areas to enhance culturally responsive behavioral services.

Consider Culturally Adapted Informational Resources

The use of culturally adapted informational resources, such as fotonovelas (photonovels; see Table 1 for additional information and an example), which consist of images and simplified Spanish in the form of a comic book (U.S. Department of Health & Human Services, 2019), can also be considered to promote cultural responsiveness. This resource may be particularly helpful if Latino families are focused on past time orientation and would benefit from present moment awareness to identify learning opportunities for the autistic individual/individual with ASD. Fotonovelas are commonly used by promotores de salud/promotoras to provide information on promoting health and health education for Latinos. Practitioners can consider using fotonovelas as informational resources collateral to the basic principles of behavior (e.g., functions of behavior, antecedent-behavior-consequence model), behavioral intervention plans, and more. However, caution is advised with their use, as fotonovelas may be similar to social stories, which to date, do not demonstrate empirical support (Leaf et al., 2015; Leaf et al., 2020; Reynhout & Carter, 2011; Styles, 2011).

Consider Psychoeducational and Culturally Informed Interventions

It is also recommended that components of psychoeducational and culturally informed parent education interventions be considered within behavioral services. Explicitly focused on Latino parents of children with ASD, Magaña et al. (2017) created Parents Taking Action (Padres en Acción) to address disparities for this population. Using the Ecological Validity Framework (Bernal et al., 1995; Bernal et al., 2009), which outlines eight dimensions to incorporate in intervention and materials for the Latino population, Magaña et al. (2017) emphasized the role of language, persons, metaphors, content, concepts, goals, methods, and context in the parent education intervention (because a detailed review of these dimensions is outside the scope of the current article, it is advised to review Magaña et al., 2017). From an ACT perspective, such intervention can promote present moment awareness, values, and committed actions in a culturally and contextually sensitive manner. Moreover, Parents Taking Action (Padres en Acción) uses a community-based approach by creating an advisory board that consisted of Magaña et al., Latino parents of children with ASD/autistic children, a pediatrician and social worker who frequently work with this population, staff from a community-based organization, and an educational consultant who had previously created materials for Spanish-speaking families.

Following the advisory board’s creation of 14 modules, a promotor de salud/promotora conducted several 2-hr in-home visits to provide parents with information about ASD, advocacy, navigating health-care and social systems, and evidence-based interventions, and to teach parents about various strategies to enhance their child’s communication, social, and play skills, and decrease challenging behavior (Magaña et al., 2017). Given the consideration of sociocultural factors, involvement of community members, and accessible written content, Parents Taking Action (Padres en Acción) may serve as a resource to connect Latino families to and for practitioners to collaborate with. Moreover, it may serve as a model for practitioners to integrate community members, cultural values, language, and so on into ABA-based services. However, practitioners are advised that additional research and empirical support are needed before considering such interventions.

Utilize Existing Resources in ABA

As previously discussed, there are various resources in the behavior-analytic literature that focus on culturally responsive approaches. Together with the information presented in the current article, practitioners can enhance their flexible repertoires in context sensitive ways by individualizing these resources to meet the needs of Latino families. Perhaps one of the most fundamental resources is presented by Beaulieu and Jimenez-Gomez (2022) who informed on various actions that practitioners can continuously engage in to self-assess personal culture, beliefs, attitudes, and biases, because, like any other member of a verbal community, practitioners are subjected to stereotypes and may engage in acts that are verbally controlled by harmful rules or biases. To remain culturally humble, identify possible biases towards Latinos, and engage in incompatible conditional discriminations that can challenge harmful biases, it is recommended that practitioners frequently engage in self-awareness and reflection focused on their learning histories, the cultural contingencies that affect their behavior, and any differences between themselves and Latinos (Beaulieu & Jimenez-Gomez, 2022; Fong et al., 2016). Because self-awareness entails describing one's own behavior in social contexts (Skinner, 1974), taking part in peer discussions, mentorship meetings, and conferences pertaining to diverse clients can also help ameliorate personal stereotypes and biases (Fong et al., 2016; Tervalon & Murray-García, 1998). In addition, increasing interactions with the Latino community and educating oneself about Latino cultural practices is another potentially effective strategy to reduce biases (e.g., Corrigan & O’Shaughnessy, 2007). Practitioners must remain open to exploring their beliefs, attitudes, and/or biases that arise when working with Latinos and other culturally and linguistically diverse populations. Engaging in self-assessment can be unpleasant but it is particularly important if the practitioner’s culture or primary language differs from that of the families they serve, as there can be several implications for services, rapport, and progress.

Practitioners can also enhance their relationship-building and compassionate care skills through the protocol provided by Cañón and Gould (2021), which consisted of verbal instructions, clicker-training, and role-play. When serving Latino families and clients, practitioners can follow this protocol to particularly increase their personalism and sympathy skills. Also, practitioners may consider consulting the Compassionate Collaboration Tool devised by Rohrer et al. (2021) to self-evaluate and monitor one’s compassionate, collaborative behavioral service delivery. Furthermore, practitioners can consult the work of Jimenez-Gomez and Beaulieu (2022), which provided actionable guidance on many areas in behavior-analytic research and practice that can be strengthened from a culturally responsive approach. Some areas include intake assessments to collect demographic data and monitor the provision of services and their outcomes, descriptive assessments to gather information about a client’s culture, and treatment integrity as a possible indicator of culturally sensitive behavioral services. Practitioners may also consider consulting the work of Suarez-Balcazar et al. (2022) who utilized goal setting to increase goal attainment of Latino families in the United States and Colombia, and to identify the behavioral and contextual barriers they experienced while working towards their goals.

Lastly, literature is available on creating culturally responsive intervention materials and curricula for autistic individuals/individuals with ASD. To create comprehensible and culturally sensitive behavior intervention materials for parents/caregivers of children with ASD, practitioners can utilize Martinez and Mahoney’s (2022) step-by-step tutorial. In line with the value of familism for Latino families, practitioners can include several members of the family when creating such intervention plans. The work of Mathur and Rodriguez (2021) can also be used to create a culturally responsive curriculum for autistic individuals/individuals with ASD from marginalized communities. Guided by the tenets of critical race theory (West, 1995), Mathur and Rodriguez specify several target behaviors that practitioners can emit, such as writing treatment goals that are culturally appropriate (as informed by the client/family), forming relationships with other professionals to strengthen interdisciplinary services (e.g., speech and language pathologists), and supporting clients/families in building their advocacy skills. For Latinos, practitioners can form relationships with promotores de salud/promotoras and support the emergence of advocacy skills by establishing rapport built on collaboration, personalism, and sympathy. Additional information for these scholarly resources is presented in Table 1.

Collaborate with Linguistically Diverse or Hispanic/Latino Practitioners

Finally, practitioners can increase collaboration efforts with other practitioners in the field, particularly those that are linguistically diverse and/or identify as Hispanic or Latino. Collaborating with Hispanic/Latino practitioners or practitioners who speak languages spoken by Latinos can serve as an opportunity to better support Latino families, while collaborating with and learning from such colleagues that have experience working with this population. However, practitioners are highly advised to exercise caution with this recommendation and examine any assumptions and biases, as solely and/or repeatedly consulting with these colleagues can be seen as tokenism, or the false appearance of inclusion by including a small number of individuals from a historically marginalized community (Jackson et al., 1995), and/or a microaggression, regardless of the intention behind the consultation (i.e., to enhance culturally responsive services). Moreover, with 26.33% of registered behavior technicians (RBTs) and 20.58% of BCaBAs identifying as Hispanic/Latinx as of January 4, 2023 (BACB, n.d.), BCBAs and BCBA-Ds are encouraged to particularly consider the perspectives of Hispanic/Latinx RBTs and BCaBAs, as they deliver behavior-analytic services and closely work with families.

A Summary: Continuando a Fortalecer la Sensibilidad Cultural con la Población Latina / Continuando a Fortalecer a Sensibilidade Cultural com a População Latina

The current article explored the Latino identity; continuous systemic barriers faced by this population in health-care and social systems; the utility of ACT with Latinos; Latino cultural values, their implications on treatment adherence, how they can be perceived as treatment barriers by practitioners, and how such values can be used to address treatment barriers; and a series of recommendations to enhance culturally responsive behavioral services for Latinos using a contextual behavioral framework. Although this information can assist practitioners in being more culturally aware and sensitive when working with Latino families, it should not be generalized to the entire Latino population. Like any other community, Latinos are diverse within themselves and have rich learning histories that are informed by many other social variables (e.g., gender identity, social position, education level, religion, immigration status). Therefore, it cannot be stressed enough that with every family and person having different experiences, practitioners must consider the role of language, culture, and systemic barriers in assessment and treatment (Fong et al., 2016; Zuckerman et al., 2014); collaborate with parents/caregivers and clients in the design of individualized services (Fong et al., 2017; LeBlanc, Sellers, & Alai, 2020a; Taylor et al., 2018); continuously self-assess their values, biases, and culture (Beaulieu & Jimenez-Gomez, 2022; Fong et al., 2016); commit to ongoing practices of cultural humility (Wright, 2019); and engage in those practices together with functional analysis (Hayes & Toarmino, 1995). As suggested by Wright (2019), to develop cultural humility, self-reflection practices are essential to provide culturally responsive services to culturally and linguistically diverse populations, such as the Latino community. Therefore, we must continuously look within and beyond the field to strengthen culturally sensitive services for all.

Funding

No funding was received to assist with the preparation of this manuscript.

Data Availability

Data sharing is not applicable to this manuscript, as no datasets were generated or analyzed.

Declarations

Competing Interests

The authors have no relevant financial or non-financial interests to disclose.

Ethics Approval

This manuscript does not contain any studies with human participants or animals performed by any of the authors.

Informed Consent

Informed consent is not applicable to this manuscript, as studies with human participants or animals were not performed by any of the authors.