Evidence Based Practice and Cultural Competency
As the juvenile justice field nationwide increasingly adopts the use of evidence-based practices, local practitioners are grappling with whether these programs are culturally appropriate for their communities—that is, whether they are “culturally competent.” This concern, combined with the significant underuse of mental health services by youth of color, particularly Latino youth, makes cultural competency a priority behavioral health issue.
“We need to learn how to adapt for communities of color,” said James Bell executive director of the Haywood Burns Institute. “What we’re trying to do is figure out how to encourage promising practices, get them considered in debates, have some meetings of the individuals between evidence based practice people and people in the community that are skeptical. People won’t take advantage of these programs if they don’t think it will work for them.”
An enlightening conversation on the issue of cultural competency took place during a convening this past summer of organizations that make up the Models for Change National Resource Bank (NRB). Members of the NRB and the Models for Change Action Networks participated in a roundtable discussion led by Bell on the importance of developing culturally appropriate and effective evidence based practices.
Maricela Garcia of the National Council for La Raza stated during the convening that practitioners working with different races and ethnicities must be sensitive to the ethnicities of the communities in which they are working. Specifically, practitioners must recognize the communication and lifestyle differences. She said there’s a difference between communicating with Latinos on the West Coast and the East Coast, for example, and that Mexican culture is not the same as Dominican.
“Even if there are great evidence-based practices, if a community is not engaged, the pushback is going to be certain,” said Garcia. “They are not going to believe something is good just because someone says it’s a new idea.”
Researching Variances in Outcomes for Different Communities
Dr. Phillippe Cunningham professor in the Department of Psychiatry and Behavioral Sciences at the Medical University of South Carolina, in Charleston, S.C. said one argument for utilizing more culturally competent care is the low retention rate of some ethnic groups; for a variety of reasons, many drop out of programs prematurely and as a result, they don’t receive a full dosage of treatment. A 2007 MacArthur Foundation-funded needs assessment and data tracking study in Benton-Franklin Counties in Washington State replicated this national finding. Latino youth who were referred to mental health services from probation departments were much less likely to show up for appointments or come back after attending once. People like Dr. Cunningham are trying to determine why this is.
“Our reasoning is, maybe we’re doing something wrong, or whoever’s providing the service doesn’t truly have competency. Or maybe it’s how the treatment is being delivered. Maybe, speaking metaphorically, the pill needs to be modified to help the medicine go down.”
“Clearly, we haven’t done a good job understanding and treating many ethnic populations,” said Cunningham. “Part of the problem is we are only now beginning to develop culturally relevant or competent practices in this area.”
While cultural adaptation frameworks for evidence-based practices exist, they can be time-consuming and require significant resources, according to physicians Sarah Walker and Eric Trupin of the Department of Psychiatry and Behavioral Sciences at the University of Washington School of Medicine. The University of Washington’s Cultural Enhancement model, developed as part of part of the strategy to address disproportionate minority contact and mental health issues in Washington State’s Models for Change program, focuses on surface-level adaptations that do not affect core components, requires fewer resources than other published adaptation frameworks and has promising, preliminary outcomes. The toolkit will be published in the late fall.
Do Adaptations Compromise Fidelity to Evidence Based Practices?
Practitioners and researchers debate the extent to which evidence-based practices created and studied for particular communities can be adapted for others. If one makes too many adaptations, is it no longer what was originally studied and found to be effective?
“Rarely in social movements are debates settled; and if they do get settled, a new debate begins,” said Bell. “What’s starting to happen is the conversation isn’t polar and oppositional anymore; we’re starting to see more collaboration. Meetings like the one MacArthur held this summer help this conversation happen.”
Participants in the summer convening also want to see a federal policy component added to the discussion, as well as increased funding to support future research and development. With the continued dedication and insight of Models for Change participants and support around the nation, this conversation can turn into action.
Photo courtest of Photostock: http://www.freedigitalphotos.net/images/view_photog.php?photogid=2125