Dr. Kate Merrill and her Chicago area community partners talk about how "Floreciendo," a sexual and reproductive health workshop for Latina teens and their female caregivers, is creating healthier bodies, minds and relationships.
Kate Merrill, PhD
Assistant Professor
Center for Dissemination and Implementation Science
Department of Medicine, University of Illinois College of Medicine
Centro Romero
The Kedzie Center
The LoSAH Center of Hope
Corazon Community Services
Gads Hill Center
Girls in the Game
Center for Clinical and Translational Science 2024 Pilot Projects
Learn how you can get involved in translational research at ccts.uic.edu.
The University of Illinois Chicago Center for Clinical and Translational Science is supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant UL1TR002003. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
0:00 Corin Mora:
I've had the privilege of serving as a team facilitator twice. Each time, it never fails that I experience a rush of emotions towards the participants. This topic is very taboo in our culture. I am 19 years old, and my mother has never discussed anything related to sex or contraception with me. During the workshop, I am glad some caregivers are willing to learn with their teen along the way.
0:26 Voice Over (VO), Lauren Rieger:
Welcome to Collaborative Endeavors, a podcast about how experts from different areas of research come together to tackle big health challenges, leading to better therapies and healthier communities.
In this episode, we meet the team behind “Floreciendo,” a sexual and reproductive health workshop for Latina teens and their female caregivers. This project is spearheaded by Dr. Kate Merrill, an assistant professor in the Center for Dissemination and Implementation Science within the University of Illinois Chicago’s Department of Medicine. Her work focuses on issues of sexual and reproductive health, HIV, intimate partner violence and mental health among young people and their families in the Chicagoland area and sub-Saharan Africa. Also contributing to this episode are representatives from two of the Floreciendo community organization collaborators, Centro Romero and The LoSAH Center of Hope, as well as mothers and teens who have participated in the program. They will talk about the challenges they saw in their communities, their experiences implementing Floreciendo within their organizations, and early indications of positive impact the program is having on Latina teens and their female caregivers.
Dr. Merrill gave some background on what prompted the project.
1:40 Dr. Merrill
We know that Latina teens have disproportionately higher rates of STIs, and they're more likely to engage in risky sexual behavior compared to their white counterparts. It really is an issue that's founded in health disparities, and that's largely what sparked this project, with a specific focus on Latina teens. A lot of the challenges that Latina teens face, it relates to specific issues in Latina culture that they may be facing, where a lot of these topics tend to be taboo in Latina families. They're not really able to talk about these things with their parents, for example. But we know that parents- and mothers in particular- are really valuable resources for their for their teens with addressing sexual health related issues, so we were trying to bring in the family aspect through this project to really encourage teens and their mothers to be able to talk about these kinds of things, and we wanted to develop a program that could be delivered through community organizations as being a really great resource for teens that would go beyond the information that they might be getting in schools and meet them at these organizations where there are trusted facilitators who are part of their communities, who they could really connect with as mentors through the project. In terms of where the idea for the project came from, about four and a half years ago, I was I had a conversation with one of my colleagues at the time, Dr. Angela Sedeño, who's the executive director of the Kedzie Center, which is a community-funded mental health center based in Albany Park. We were talking about sexual and reproductive health issues in the community, she noted that she had just seen in a report that there were high rates of unplanned pregnancy among teens in the area of Albany Park specifically. I shared with her a little bit about an intervention called IMARA, which is a mother-daughter sexual health intervention that was originally designed for black families, and it was designed by my mentor, Dr. Geri Donnenberg, who, until recently, was based here at UIC. And so, Angela was really interested to hear about the IMARA project, and she asked if we could adapt it for Latinas because that's the population the Kenzie Center primarily serves. So, that kind of launched the initial project idea. And then soon after that, I connected with Susi Salgado at Centro Romero, who also expressed real interest in this mother daughter approach towards supporting Latina teens with their sexual and reproductive health. She and Centro played a key role in the project's conception, and we ended up getting a K99/R grant from the NICHD to fund the project. So right now, we are a little more than three years into the five year grant that we got.
5:06 VO:
As Dr. Merrill mentioned, there are several organizations that have played a pivotal role in the adaptation, implementation, and assessment of Floreciendo. Here is Gisel Romero, a licensed clinical social worker at the LoSAH Center of Hope, a “sister center” to the Kedzie Center.
5:26 Gisel Romero:
The Kedzie Center community mental health centers are funded by the neighborhoods. Because we're funded by the neighborhoods, we are tasked with meeting the mental health needs of our neighborhoods. Being a part of Floreciendo has been amazing, because we get to really put this out there in our neighborhoods and offer it to our Latino teens, to our Latina caregivers, and really have this opportunity to engage in in this needed conversation.
5:52 VO:
Dr. Merrill shared this fun aside.
5:58 Dr. Merrill:
Part of what has been fun is, I worked for my dad's organization as a community organizer in high school, and I was part of the group that was canvassing to establish the mental health center that became The Kedzie Center probably 20, well, 15 years later. It's been a fun connection to be able to then work directly with the Kedzie Center after so many years.
6:30 VO:
Susanna “Susi” Salgado, youth program director at Centro Romero, has played a key role inspiring and advancing this work. Centro Romero has been helping the northeast Chicago immigrant and refugee community achieve self-sufficiency for more than 38 years. Their programming includes youth learning and leadership, family services, adult education and legal services. Here is Susi.
6:57 Susie Salgado:
I've been the youth program director for a little bit more than ten years, but I have been part of Centro Romero's community for 26 years. I was a youth program participant myself, and when I started coming into Centro Romero as a youth program participant, there was a lot of need to have the hard conversations that we were not able to have at home- and that was like 25 years ago. I've noticed that, as a youth program director, our teenagers were not getting the appropriate or accurate information from their peers. This is when Kate approached us and she said, “Oh, this is the proposal. This is what we're trying to do.” And I was like, this is perfect because this is something that we've been trying to address in other ways, like bringing in workshops for our parents and for our youth, but it was not a research study, right? That's why we decided to participate, because we always advocate for our community and want to make sure that they participate, and we take in consideration, also, their cultural background. And the research project was what we were looking for.
8:12 VO:
Licensed marriage and family therapist and certified sex therapist, Sara Vargas, sits on Floreciendo’s Community Advisory Council, which has guided the Floreciendo project since its inception. When commenting on the program’s value, she said, “Conversations around sex and sexual health tend to be quite taboo in the Latine community. By creating a space where Latina teens and their caregivers can talk openly, we start to dismantle the shame and fear around sex and begin to normalize sexual health as part of typical human development.”Gisel, who also serves as a program facilitator at the LoSAH Center of Hope, described what this space and these conversations look like.
8:54 Gisel:
There are four areas ranging from foundations of sexual health to talking about healthy relationships. So there are different section, and we really get to dive deep into these different areas within that two hour period with the caregivers and the teens. At certain points we also split them, so one of us does the workshop with the caregivers. But there are certain pieces which I love. You know, you get to provide privacy for them so they can speak more openly and not have to be so concerned about having to hold back because their teen is there, having to hold back because their mom or their aunt is there. So the teen facilitator will have space with their teens. The caregiver facilitator will have the space with the caregivers, and you really get to dive into the topic. And then we get to come back together to debrief. And it really provides such a beautiful opportunity to get to be authentic and really get to reflect and share and engage with each other in terms of what you got to learn and discuss. I remember when we did the first workshop last summer and getting to experience seeing the first caregivers, the first teens to do the workshop, and then to get their feedback right away. For me, it was just amazing to see. And then at the same time, we who would be facilitators, providing our feedback as well and just how invaluable it is to provide a workshop, and right away, you ask the participants, how was this for you? What do you think we should change? All these different things that really provide more clarity, and in the long term, I think it will better serve the community, because you're getting it directly from community residents, right?
11:03 [Sound clip from interview with program mothers, in Spanish]
11:20 VO:
Those are the voices of two mothers whose daughters participate in Floreciendo. They provide some of the most powerful testaments to Floreciendo’s value. Their commentary, which was in Spanish, was translated by a study team member. I’ll try to do it justice in English. One mother said, "I feel like it was very intense what happened at Floreciendo. There were things that my daughter wouldn’t have dared to say, but she said it at the workshop. I was made aware of things that I may not have been made aware of previously. So everything that happened that day and everything we could talk about made our relationship closer. There was more trust after the workshop. It was like opening something… not so much about sexual things but more sentimental- like how she felt.”
Said another mother, “Our parents never told us anything. I had look up information and results on my own, and I made errors many times. I don’t want my daughter to make many errors, I want to teach her. But I know there are a lot of people with that fear of teaching them. If you learn with them, you’re not just saying, “Daughter, it’s because you have to learn, but Daughter, I’m going with you, and I’m learning together with you.”
We also were able to hear from former Floreciendo workshop participant and current youth worker at Centro Romero, Corin Mora. Corin has an interesting history with Floreciendo, as she participated in the earliest focus groups for the project and she and several peers from a Centro Romero youth group created the name and logo for the program. Corin talked about how the workshop impacted her then and continues to do so now.
12:54 Corin:
Centro Romero is one of the many organizations in Chicago that have participated in the growth of Floreciendo. When I was a high school participant, my peers and I were introduced to Floreciendo as a research project for Latina teens and were asked to create a logo and name for the project. The logo, signifying the growth of an individual, was created by one of my peers, while another peer came up with the name “Floreciendo,” describing the workshop as a flourishing slash growth process. It has been three years since then, and Floreciendo has successfully conducted many workshops, including four at Centro Romero, with one being the pilot group. I've had the privilege of serving as a team facilitator twice. Each time, it never fails that I experience a rush of emotions towards the participants. This topic is very taboo in our culture. I am 19 years old, and my mother has never discussed anything related to sex or contraception with me. During the workshop, I am glad some caregivers are willing to learn with their teen along the way. For this reason, recruitment can be challenging. There are even times when participants mentioned they were hesitant to join us, since it can be an uncomfortable topic. Overall, there is an emphasis on privacy versus learning during the workshop; confidentiality is our goal. We hope that more caregivers and Latina teens join the workshop to connect and grow together as caregivers and teens. It truly is a beautiful, fun and educational experience.
14:32 VO:
As Dr. Merrill detailed earlier, the original K99 grant was to support Latina teens with their sexual and reproductive health through the Floreciendo program. This work used the IMARA program as a template, but IMARA was created to meet the needs of Black teens and their moms. Using a Community Based Participatory Research- or CBPR- approach, Dr. Merrill and the Floreciendo team adapted the program for Latine families.
14:59 Dr. Merrill:
I'm not Latina myself, and you know, I really knew from the beginning that CBPR would be needed to really ensure that we had leadership from organizational staff, the Latina teens, the female caregivers, that they would really be driving forward this project. Ultimately, our goal was really to achieve adoption of the program and sustainability within the community organizations. We really wanted this to be a project that The Kenzie center, Centro Romero, LOSA, but then even our new partners would really feel like- well, this is our program, and we want to continue to implement this, we adapted this ourselves, and this meets our community's needs. From the beginning, we launched a community advisory council that was made up of representatives from our community organizations, a couple of researchers, Latina teens and female caregivers, and then a few other experts who are also working with Latinas. And that council has really been guiding us all the way along. We meet regularly and talk about the project and issues that are coming up related to the study design, eligibility criteria, how we're getting the word out about the program. We've also really used the council to support with interpreting findings. So, we talk about what we're seeing in the data. What does this mean? What are the implications? How should we use what we're learning for the project? So that's kind of been, I would say, a critical aspect of how the partnership looks in practice. And then also, we have expanded our partnerships. In the beginning of the third year of the grant, we brought on Corazon Community Services, which is a community based organization in Cicero, Illinois that serves the Latina community in Cicero. So they came onto the project, as did the Gads Hill Center in Pilsen, and then most recently, we are partnering with Girls in the Game, which supports adolescent girls. As we've grown in terms of our partnerships, we've really maintained this decision to have shared leadership and a lot of our decision making happens through consensus and through discussion and trying to figure out what would work best for serving everyone's needs.
17:39 Susie:
When you make the community participate, you get a better outcome. Although at Centro we're experts on community, we didn't have that research knowledge. And I think that that's where Kate and her team comes in. But also something like, how to address the red flags that we have in the surveys? And what are the proper questions to ask? As Kate mentioned, a lot of the decision making are based on different conversations that we have, and that's really nice to see because it's everybody's ideas, but also everybody's expertise. I think that it's kind of like an octopus. We have different hands, but we all become together to do better for the community and for our youth.
18:31 VO:
Partnering with organizations like Girls in the Game was a strategic move. As the Floreciendo team moved forward with the original grant, the team noted the critical tie between mental health and sexual and reproductive health. In 2024, Dr. Merrill applied for and received pilot funding from the UIC Center for Clinical and Translational Science to integrate a mental health session that incorporates movement into the program.
18:55 Dr. Merrill:
There is a lot of literature on the relationship between mental health and sexual and reproductive health. During the first two years of the K99 grant, we did a lot of formative research to inform how we were going to adapt Floreciendo for Latinas, and we ended up conducting 13 focus group discussions with Latina teens, female caregivers and staff from both of the community organizations. And mental health came up as an issue that was really affecting Latina teens, that it was also very taboo alongside sexual and reproductive health issues, and as something that was perceived to affect Latina teens sexual and reproductive health. And so, we included some content on mental health in the Floreciendo program that's currently running, but we didn’t really have the ability at the time to build our own mental health session. We were really interested in pulling out the mental health content and seeing looking at its effectiveness through an optimization trial design. So we applied for a CCTS pilot grant, which we ended up getting, which is now allowing us to do more formative research to create this mental health session for Floreciendo. We've been really interested in the idea of using some kind of sport or movement or physical activity approach to delivering the content, because there's a lot of interest in that right now in the field, and it seemed to really resonate with what our community partners are already doing so that's kind of what led to current grant.
20:38 VO:
Susi talked about how the staff at Centro Romero observed the way families come together to support their teens in sports, including both male and female parents. It is an opportunity for children and caregivers to come together and communicate- as well as an opportunity to promote mental health, resiliency and healthy emotional expression- all within the safe space play creates. Dr. Merrill explained how their research over time will be able to look at whether the program influences teens’ mental health and if so, whether that in turn has positive effects on their sexual and reproductive health.
21:15 Dr. Merrill:
Our primary outcome is reducing risky sexual behavior among the teens. We're going to have a chance to include this mental health session and then look at, does the mental health session support their mental health, their mental well-being, their mental health literacy? And then, does that then help with reducing their risky sexual behavior? So, it's something that we will have a chance to test through the research study, but it does build on some things that we heard during the focus group discussions. For example, here was a Latina teen in one of the focus groups who had talked about how if someone's feeling depressed, if they're feeling really anxious, they might be more likely to engage in a sexual act that they don't want, or drink alcohol and then that maybe leads them to engage in risky sex. So the research design that we have chosen will hopefully allow us to really test some of you these relationships. Part of what we're doing with the study design is we are using a framework called the Multiphase Optimization Strategy Framework that allows us to test the effectiveness of different components of the intervention. The goal is to end up with a mental health session that we can integrate into Floreciendo and to test as part of that next grant, which will be a fully powered optimization trial using the MOST framework and but then, you know, so that's kind of the next step in the research process. Through an optimization trial, it will allow us to see whether all four sessions that we currently are running, and the mental health session will be a fifth session, whether they all are effective and necessary, whether they're contributing to that desired outcomes of the project or not. After that next grant, we'll be able to see should we keep all five sessions? Should we actually remove a couple sessions that aren't doing what we want them to do? And then we'll end up with an optimized version of Floreciendo that can be tested in a randomized control trial. There are a few stages of the research still ahead, but hopefully we'll end up with this program that community organizations will want to keep implementing. We've really been trying to do to plan for the adoption sustainability from the beginning of the project, which is kind of something that, in implementation science, people are realizing you have to do at the beginning if you're going to be able to sustain things over time.
23:51 VO:
Susie and Gisel shared what they find most rewarding about providing the Floreciendo program to their Latina community, as well as how partnering with a research team has opened up new opportunities within their organizations.
24:06 Susi:
I think that the impact that we've seen to date is that there's a lot of communication within the program participants about sexual reproductive health. The good thing is that they're having the right information, right? Because our goal as organization is that later on, when they're deciding to be sexually active, they are making the wiser decisions with the information. And then our youth are feeling more comfortable in addressing those conversations as well. It will be nice to have a group of moms here at Centro. I think that's what we're trying to also do with other programs at the organization, so it also has opened different opportunities for us, as well.
24:50 Gisel:
It's really amazing to see from the beginning when the caregivers and teens first start the workshop and seeing how it really just opens up communication and makes things that can be or have been seen to be uncomfortable topics to discuss- they just bring it out in a way that it feels not so difficult. It provides a normalcy. Just seeing that progression by the end of a workshop, how the curriculum really allows for that mutual conversation, understanding the experience of teens, understanding the experience of caregivers, the fears that they have around sex, right, and the fears they have with each other, as a social worker, it's just lovely to see that. It really pushes into the relationship and just opening up those difficult topics.
25:54 Voice Over:
Collaborative Endeavors is produced by me, Lauren Rieger, on behalf of the Center for Clinical and Translational Science (AKA the CCTS) at the University of Illinois Chicago. To learn more about the team behind Floreciendo, visit the links in our show notes. The CCTS is supported by the National Institutes of Health’s National Center for Advancing Translational Science through their Clinical and Translational Science Award. Opinions expressed by guests of the show are their own and do not necessarily represent the views of myself, the CCTS or our funding agencies. You can find more episodes of Collaborative Endeavors on Apple Podcasts, Spotify, Pandora, Amazon Music & YouTube. While we do not monetize this podcast, we do love positive feedback! If you like what you hear, go ahead and give us a 5 star rating to help spread the word. To learn more about how you can work with the CCTS to make a positive impact on the health and wellbeing of our community, visit ccts.UIC.edu or follow us on X @UIC_CCTS.