Are Empirically Supported Treatments Valid for Ethnic Minorities? Toward an Alternative Approach for Treatment Research

Cultural Diversity and Ethnic Minority Psychology (Impact Factor: 1.36). 12/2001; 7(4):328-42. DOI: 10.1037/1099-9809.7.4.328
Source: PubMed


The psychological community has given considerable attention to the problem of establishing empirically supported treatments (ESTs). The authors argue that a scientific practice that discriminates against some approaches to knowledge undermines the EST's relevance for communities of color. They examine the EST project's contribution to knowledge of effective treatments for ethnic minorities by considering both how knowledge is constructed and the limits of research (e.g., external validity). Alternatives on how to best contribute to treatment research of clinical utility with diverse populations are articulated. An approach for treatment research, derived from an integration of the hypothesis-testing and discovery-oriented research approaches, is presented, and recommendations to advance treatment research with ethnic minority communities are offered.

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Available from: Guillermo Bernal
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    • "Beyond the practice itself, other factors related to culture that are believed to influence Latino client experiences with services may include language of service delivery and ethnicity of the provider (or ethnic match between the client and provider). These are in addition to the cultural competence of an agency, achieved through policies and training in culturally responsive practices that improve communication, reduce value conflicts and enhance client engagement and satisfaction (Bernal and Scharron del Rio, 2001; Barona and Santos de Barona, 2003; McCabe, 2002; Kumpfer et al., 2002; Sue et al., 1994). Clients of Latino ethnicity in particular may face unique linguistic, cultural, attitudinal and socio-political barriers to establishing relationships with providers and engaging in services during the delivery of standardised practices (Bernal et al., 1995; McCabe, 2002; Lau, 2006; Barona and Santos de Barona, 2003). "
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    ABSTRACT: Purpose: The purpose of this paper is to examine the experiences of Latino clients following a naturalistic cultural adaptation made to SafeCare, an evidence-based home visiting intervention designed to address specific linguistic and cultural issues affecting the Latino community during implementation in San Diego County, California. Design/methodology/approach: Hierarchical linear models examined whether Latino clients experienced differences in perceptions of SafeCare delivery, working relationship with the home visitor and satisfaction with services when compared with non-Latino clients and whether language of service delivery and provider-client ethnic match were related to Latino clients' experiences of the intervention. Findings: Overall, across several different dimensions, there was No decrement in experience with SafeCare for Latino clients compared to non-Latino ones, implying that adaptations made locally adequately engaged Latino and Spanish-speaking clients in services without compromising perceived adherence to the programme model. Research limitations/implications: Because this was a non-experimental study, conclusions could not be drawn as to whether the locally adapted SafeCare would fare better in Latino client ratings than SafeCare unadapted. However, the findings are important because they contradict concerns that EBPs may not be relevant to diverse client groups, and support the idea that when adaptations are made, it is possible to maintain adherence at the same level of adherence as when the programme is delivered in its non-adapted form. Originality/value: The study explicitly documents and generates knowledge around an organic adaptation made in a community to an evidence-based intervention for a client group about whom there has been documented concern regarding the relevance of and engagement in services.
    Preview · Article · Dec 2014 · Journal of Children's Services
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    • "Evidence-based treatments (EBTs) refer to " the interventions or techniques (e.g., cognitive– behavioral therapy for depression, exposure therapy for anxiety) that have produced therapeutic change in controlled trials " (Kazdin, 2008, p. 147). Since the majority of " possibly efficacious " EBTs have been developed and tested primarily with White, middle-class, English-speaking women, mental health professionals have questioned their efficacy with ethnic minorities (Bernal & Scharrón-del-Río, 2001;Miranda et al., 2005). Based on a limited number of EBT studies the earlier review concluded that cognitive– behavioral therapy (CBT) and interpersonal therapy (IPT) are effective for African Americans and Latinos (Miranda et al., 2005). "
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    ABSTRACT: Recent meta-analyses and reviews have showed that culturally adapted mental health interventions are more effective for racial and ethnic minorities than traditional unadapted psychotherapy. Despite the advances in providing culturally sensitive mental health services, disparities among racial and ethnic minorities still exist. As a body of literature on culturally sensitive treatments accumulates, there is a need to examine what makes a treatment for specific presenting problems culturally sensitive. This article presents a critical review of existing culturally sensitive treatments for depression because it is one of the most common and debilitating mental disorders. In particular, we examined what treatment modalities were used, what types of adaptations were implemented, and what populations were targeted. The conceptual framework this review uses to categorize existing culturally sensitive treatments includes a top-down, a bottom-up, or an integrative approach. The review reveals that the majority of culturally sensitive treatments for depression employed an evidence-based bottom-up approach, which involved general and practical adaptations, such as translating materials or infusing specific cultural values. Most studies used cognitive-behavioral strategies and included Latinos and African Americans. Recommendations and future directions in interventions and research are discussed to decrease mental health care disparities among ethnic minorities. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
    Full-text · Article · Nov 2014 · Psychological Services
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    • "In order to develop an evidence base for mental health care for minority populations, specific ethnic and cultural issues must be taken into account [1] [2] [3] [4]. The US Surgeon General's report, " Culture, Race, and Ethnicity: A Supplement to Mental Health " and a recent white paper from the National Council of La Raza entitled " Critical Disparities in Latino Mental Health: Transforming Research into Action " [5] [6], points to the need for sub-group specific mental health research that explores the cultural variation and heterogeneity of the Latino population. "
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    ABSTRACT: The Surgeon General's report, "Culture, Race, and Ethnicity: A Supplement to Mental Health," points to the need for subgroup specific mental health research that explores the cultural variation and heterogeneity of the Latino population. Guided by cognitive anthropological theories of culture, we utilized ethnographic interviewing techniques to explore cultural models of depression among foreign-born Mexican (n = 30), Cuban (n = 30), Columbian (n = 30), and island-born Puerto Ricans (n = 30), who represent the largest Latino groups in Florida. Results indicate that Colombian, Cuban, Mexican, and Puerto Rican immigrants showed strong intragroup consensus in their models of depression causality, symptoms, and treatment. We found more agreement than disagreement among all four groups regarding core descriptions of depression, which was largely unexpected but can potentially be explained by their common immigrant experiences. Findings expand our understanding about Latino subgroup similarities and differences in their conceptualization of depression and can be used to inform the adaptation of culturally relevant interventions in order to better serve Latino immigrant communities.
    Full-text · Article · Sep 2011 · Depression research and treatment
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