Reference List

Culture and Evidence-Based Practice

Bernal, G., Jiménez-Chafey, M. I., & Domenech Rodríguez, M. M. (2009). Cultural adaptation of treatments: A resource for considering culture in evidence-based practice. Professional Psychology: Research and Practice, 40(4), 361-368. doi: 10.1037/a0016401

Abstract: There is a growing interest in whether and how to adapt psychotherapies to take into account the cultural, linguistic, and socioeconomic context of diverse ethnocultural groups. At the root of the debate is the issue of whether evidence-based treatments (EBTs) developed within a particular linguistic and cultural context are appropriate for ethnocultural groups that do not share the same language, cultural values, or both. There is considerable evidence that culture and context influence almost every aspect of the diagnostic and treatment process. Yet, there are concerns about fidelity of interventions, and some have questioned whether tinkering with well-established EBTs is warranted. This study presents arguments in favor of the cultural compatibility and universalistic hypotheses. The study also reviews the available published frameworks for cultural adaptations of EBTs and offer examples from the literature on the process and outcome of different approaches used. Conceptual models for adapting existing interventions and emerging evidence that adapted intervention leads to positive outcomes suggest that there are tools for engaging in evidence-based psychological practices with ethnocultural youth. Recommendations for future directions are provided.

Bernal, G., & Scharron-Del-Rio, M. R. (2001). Are empirically supported treatments valid for ethnic minorities? Toward an alternative approach for treatment research. Cultural Diversity and Ethnic Minority Psychology, 7, 328-342.

Abstract: 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. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (from the journal abstract)

Griner, D., & Smith, T. B. (2006). Culturally adapted mental health interventions: A meta-analytic review. Psychotherapy: Theory, Research, Practice, Training, 43, 531-548.

Abstract: There is a pressing need to enhance the availability and quality of mental health services provided to persons from historically disadvantaged racial and ethnic groups. Many previous authors have advocated that traditional mental health treatments be modified to better match clients' cultural contexts. Numerous studies evaluating culturally adapted interventions have appeared, and the present study used meta-analytic methodology to summarize these data. Across 76 studies the resulting random effects weighted average effect size was d = .45, indicating a moderately strong benefit of culturally adapted interventions. Interventions targeted to a specific cultural group were four times more effective than interventions provided to groups consisting of clients from a variety of cultural backgrounds. Interventions conducted in clients' native language (if other than English) were twice as effective as interventions conducted in English. Recommendations are provided for improving the study of outcomes associated with mental health interventions adapted to the cultural context of the client.

Hall, G. C. N. (2001). Psychotherapy research with ethnic minorities: Empirical, ethical, and conceptual issues. Journal of Consulting and Clinical Psychology, 69, 502-510.

Abstract: There is an increasing demand for psychotherapy among ethnic minority populations. Yet, there is not adequate evidence that empirically supported therapies (ESTs) are effective with ethnic minorities. Ethical guidelines suggest that psychotherapies be modified to become culturally appropriate for ethnic minority persons. Conceptual approaches have identified interdependence, spirituality, and discrimination as considerations for culturally sensitive therapy (CST). However, there is no more empirical support for the efficacy of CSTs than there is for the efficacy of ESTs with ethnic minority populations. The chasm between EST and CST research is a function of differences between methods and researchers in these 2 traditions. Specific recommendations for research collaboration between CST and EST researchers are offered.

Huey, S. J., & Polo, A. J. (2008). Evidence-based psychosocial treatments for ethnic minority youth. Journal of Clinical Child & Adolescent Psychology, 37, 262-301.

Abstract: This article reviews research on evidence-based treatments (EBTs) for ethnic minority youth using criteria from Chambless et al. (1998), Chambless et al. (1996), and Chambless and Hollon (1998). Although no well-established treatments were identified, probably efficacious or possibly efficacious treatments were found for ethnic minority youth with anxiety-related problems, attention-deficit/hyperactivity disorder, depression, conduct problems, substance use problems, trauma-related syndromes, and other clinical problems. In addition, all studies met either Nathan and Gorman's (2002) Type 1 or Type 2 methodological criteria. A brief meta-analysis showed overall treatment effects of medium magnitude (d = .44). Effects were larger when EBTs were compared to no treatment (d = .58) or psychological placebos (d = .51) versus treatment as usual (d = .22). Youth ethnicity (African American, Latino, mixed/other minority), problem type, clinical severity, diagnostic status, and culture-responsive treatment status did not moderate treatment outcome. Most studies had low statistical power and poor representation of less acculturated youth. Few tests of cultural adaptation effects have been conducted in the literature and culturally validated outcome measures are mostly lacking. Recommendations for clinical practice and future research directions are provided.

Huey, S. J., Jr., Tilley, J. L., Jones, E. O., & Smith, C. A. (2014). The contribution of cultural competence to evidence-based care for ethnically diverse populations. Annual Review of Clinical Psychology, 10, 305-338. doi: 10.1146/annurev-clinpsy-032813-153729.

Abstract: Despite compelling arguments for the dissemination of evidence-based treatments (EBTs), questions regarding their relevance to ethnically diverse populations remain. This review summarizes what is known about psychotherapy effects with ethnic minorities, with a particular focus on the role of cultural competence when implementing EBTs. Specifically, we address three questions: (a) does psychotherapy work with ethnic minorities, (b) do psychotherapy effects differ by ethnicity, and (c) does cultural tailoring enhance treatment effects? The evidence suggests that psychotherapy is generally effective with ethnic minorities, and treatment effects are fairly robust across cultural groups and problem areas. However, evidence for cultural competence is mixed. Ethnic minority-focused treatments frequently incorporate culturally tailored strategies, and these tailored treatments are mostly efficacious; yet support for cultural competence as a useful supplement to standard treatment remains equivocal at best. We also discuss research limitations, areas for future research, and clinical implications.

Lau, A. S. (2006). Making the case for selective and directed cultural adaptations of evidence-based treatments: Examples from parent training. Clinical Psychology: Science and Practice, 13, 295-310.

Abstract: With prevailing concerns about the generalizability of evidence-based treatments (EBTs) in real-world practice settings, there has been increased attention to the potential of cultural adaptations of treatments to ensure fit with diverse consumer populations. However, it could also be argued that there has been insufficient dissemination and evaluation of our existing EBTs with minority populations to warrant and guide adaptation efforts. This article discusses a framework (a) for identifying instances where cultural adaptation of EBTs may be most indicated, and (b) for using research to direct the development of treatment adaptations to ensure community engagement and the contextual relevance of treatment content. Ongoing work in the area of parent training is highlighted to illustrate key issues and recommendations.

Miranda, J., Azocar, F., Organista, K. C., Munoz, R. F., & Lieberman, A. (1996). Recruiting and retaining low-income Latinos in psychotherapy research. Journal of Consulting and Clinical Psychology, 64, 868-874.

Abstract: This article offers suggestions for recruiting and retaining low-income Latinos in treatment studies. Because Latinos under use traditional mental health services, places such as medical centers or churches with large Latino constituents are suggested as useful alternative sources. To keep Latinos in research protocols, providing culturally sensitive treatments are necessary. Culturally sensitive treatments should incorporate families as part of recruitment efforts, particularly older men in the family. In addition, showing respect is an important aspect of traditional Latino culture that includes using formal titles and taking time to listen carefully. Finally, traditional Latinos tend to like interactions with others that are more warm and personal than is generally part of a research atmosphere. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (from the journal abstract)

Miranda, J., Bernal, G., Lau, A., Kohn, L., Hwang, W., & LaFramboise, T. (2005). State of the science on psychosocial interventions for ethnic minorities. Annual Review of Clinical Psychology, 1, 113-142.

Abstract: According to a recent report of the Surgeon General (U.S. Department of Health and Human Services 1999), a range of treatments exist for most mental disorders, and the efficacy of those treatments is well documented. However, a supplement to that report (U.S. Department of Health and Human Services 2001) notes that minorities are largely missing from the efficacy studies that make up the evidence base for treatments. Because of this omission, questions arise as to whether it is appropriate to advocate for providing evidence-based care for minority populations. Do efficacious treatments generalize to minority populations? Should we adapt care for each cultural group? Does poverty affect outcomes of care? If we were better able to encourage ethnic minorities to enter care, would outcomes be similar to those found for majority patients? New data have become available regarding the impact of mental health interventions on ethnic minorities. Although data are not available to answer each question posed above, we examine what is known about outcomes of mental health treatments for ethnic minorities and begin to answer these important questions about providing care to our growing and diverse ethnic minority populations. Outcomes of mental health care are obtained through two types of research, efficacy and effectiveness studies. Efficacy studies, or randomized, controlled trials, are useful in identifying the outcomes that are likely to be associated with precisely defined care provided by experts. These studies identify the impact of interventions on outcomes, such as decreases in psychiatric symptoms and remission of syndromes. The goal of efficacy studies is to determine whether or not an intervention works for a specific syndrome. Thus, the populations studied need to meet criteria for that syndrome and be relatively free of comorbid disorders. Furthermore, highly trained, specialized clinicians provide the care under carefully specified conditions. To date, these studies have predominantly been conducted in nonminority populations; well-controlled efficacy studies examining outcomes of mental health care for minorities are rarely available. In fact, in an analysis conducted for the report of the Surgeon General entitled "Mental Health: Culture, Race and Ethnicity" (U.S. Department of Health and Human Services 2001), it was found that of 9266 participants involved in the efficacy studies forming the major treatment guidelines for bipolar disorder, schizophrenia, depression, and attention deficit/hyperactivity disorder (ADHD), only 561 Black, 99 Latino, 11 Asian American/Pacific Islanders, and zero American Indians/Alaskan Natives were included. Few of these studies had the power necessary to examine the impact of care on specific minorities. In this chapter, we examine available data from treatment outcome studies with minorities. Effectiveness studies are also important when thinking about outcomes of psychosocial interventions because these studies help evaluate outcomes of care given in real-world settings. Once an intervention is found to be efficacious, effectiveness studies then determine how they work within more diverse (both in terms of diagnosis and comorbidities) populations and when given by less-specialized clinicians. Clinicians in effectiveness studies are more likely to be generalists working in clinical settings. Outcomes often include factors such as whether or not care is sought, length of care, and adequacy of interventions. In addition, because of generally larger sample sizes, some of these trials are able to examine outcomes associated with not only symptom reduction, but also with functioning, quality of life, and cost effectiveness of care. Newer studies tend to include more diverse samples and a few have specifically included a minority sample. Again, we examine data available for minorities and compare outcomes with nonminority samples.

Whaley, A. L., & Davis, K. E. (2007). Cultural competence and evidence-based practice in mental health services: A complementary perspective. American Psychologist, 62, 563-574.

Abstract: The need for cultural competence and the need for evidence-based practice in mental health services are major issues in contemporary discourse, especially in the psychological treatment of people of color. Although these 2 paradigms are complementary in nature, there is little cross-fertilization in the psychological literature. The present article illustrates the complementary nature of these 2 paradigms. A main point of convergence is related to the development of culturally adapted interventions in the move from efficacy research to effectiveness studies. The implications of cultural adaptations of empirically supported treatments for mental health services in terms of research and practice with ethnic/racial minority populations are discussed. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (from the journal abstract)

Wilson, S. J., Lipsey, M. W., & Soydan, H. (2003). Are mainstream programs for juvenile delinquency less effective with minority than majority youth? A meta-analysis of outcomes research. Research on Social Work Practice, 13, 3-26.

Abstract: Objective: A meta-analysis was undertaken to synthesize research results about the effectiveness of mainstream service programs for minority juvenile delinquents relative to White delinquents. The analysis addresses the question of whether mainstream interventions that are not culturally tailored for minority youth have positive outcomes on their subsequent antisocial behavior, academic performance, peer relations, behavior problems, and other outcomes. In addition, outcomes were compared with those for White samples receiving the same interventions to identify any differences in the responsiveness of minority and majority youth. Method: 305 studies were selected from a large meta-analytic database in which the participant samples were either predominantly (60% or more) minority or White youth. Effect sizes and more than 150 study descriptors were coded from these studies and analyzed using standard meta-analytic techniques.

Results: The results showed positive overall intervention effects with ethnic minority respondents on their delinquent behavior, school participation, peer relations, academic achievement, behavior problems, psychological adjustment, and attitudes. Overall, service programs were equally effective for minority and White delinquents. Although there were slight differences in effectiveness for different service types between minority and majority youth, none of these differences was statistically significant. Conclusions: The use of mainstream service programs for ethnic minority juvenile delinquents without cultural tailoring is supported by these findings.

Cultural References for Specific Practices

Beasley, L. O., Silovsky, J. F., Owora, A., Burris, L., Hecht, D., DeMoraes-Huffine, P., ... & Tolma, E. (2014). Mixed-methods feasibility study on the cultural adaptation of a child abuse prevention model. Child Abuse & Neglect, 38(9), 1496-1507. doi: 10.1016/j.chiabu.2014.04.017

Abstract: The current study utilized mixed-methods analyses to examine the process of adapting a home-based parenting program for a local Latino community. The study examined the:(a) acceptability and cultural congruence of the adapted SafeCare protocol, (b) adherence to the core components of SafeCare while adapting to local community culture, and (c)social validity of the new model in addressing SafeCare target areas (parenting, home safety, and child health). Participants were Latino mothers and eight providers. After training in the adapted model, providers demonstrated improved knowledge and skills. All providers reached national certification standards for SafeCare, demonstrating fidelity to the core components of the original model. Positive consumer–provider relationships were developed as reflected by the results on the Working Alliance (collaboration between caregivers and parents). Themes from the integrated results of the social validity measures and individual interviews with parents were perceived benefits of the program on targeted areas and cultural congruency of the approach. Recommendations are to consider using adaptation guidelines as outlined to promote local culturally congruent practices.

Calzada, E. J., Basil, S., & Fernandez, Y. (2013). What Latina mothers think of evidence-based parenting practices: A qualitative study of treatment acceptability. Cognitive and Behavioral Practice, 20(3), 362-374. doi: 10.1016/j.cbpra.2012.08.004

Abstract: Parent training has great potential to alter the developmental trajectories of young Latino children with or at risk for behavior problems. However, traditional parent training programs may seem culturally irrelevant or inappropriate to Latino parents as they promote practices that are based on white, middle class standards. The current study of treatment acceptability used focus group and key informant interviewing methodology to investigate Latina mothers’ views on the causes of young children's misbehavior and the acceptability of evidence-based parenting strategies. The sample consisted of Spanish- and English-speaking Latina mothers of 3- to 6-year-olds recruited from day-care centers and preschools in New York City. Focus groups were conducted with 34 mothers, and key informant interviews with 5 mothers whose children had behavior problems. Results showed that the most commonly viewed causes of child misbehavior were child temperament, fighting in the home, and negative peer influence. Mothers found some evidence-based parenting strategies acceptable (e.g., the use of praise, social rewards) and others objectionable (e.g., selective ignoring in pubic situations, the elimination of spanking). For some strategies, there was little consensus on its acceptability (e.g., time-out). Taken together, results highlight the critical need for aligning parent and clinician goals at the outset of treatment, and of including a strong psychoeducational component in parent training programs because not all of its components are consistent with Latino cultural norms and beliefs.

Chaffin, M., Bard, D., Bigfoot, D. S., & Maher, E. J. (2012). Is a structured, manualized, evidence-based treatment protocol culturally competent and equivalently effective among American Indian parents in child welfare? Child Maltreatment, 17(3), 242-252. doi: 10.1177/1077559512457239

Abstract: In a statewide implementation, the manualized SafeCare home–based model was effective in reducing child welfare recidivism and producing high client satisfaction. Concerns about the effectiveness and acceptability of structured, manualized models with American Indians have been raised in the literature, but have rarely been directly tested. This study tests recidivism reduction equivalency and acceptability among American Indian parents. A subpopulation of 354 American Indian parents was drawn from a larger trial that compared services with versus without modules of the SafeCare model. Outcomes were 6-year recidivism, pre/post/follow-up measures of depression and child abuse potential, and posttreatment consumer ratings of working alliance, service satisfaction, and cultural competency. Recidivism reduction among American Indian parents was found to be equivalent for cases falling within customary SafeCare inclusion criteria. When extended to cases outside customary inclusion boundaries, there was no apparent recidivism advantage or disadvantage. Contrary to concerns, SafeCare had higher consumer ratings of cultural competency, working alliance, service quality, and service benefit. Findings support using SafeCare with American Indians parents who meet customary SafeCare inclusion criteria. Findings do not support concerns in the literature that a manualized, structured, evidence-based model might be less effective or culturally unacceptable for American Indians.

Cohen, J. A., Deblinger, E., Mannarino, A. P., & De Arellano, M. A. (2001). The importance of culture in treating abused and neglected children: An empirical review. Child Maltreatment, 6, 148-157.

Abstract: There is growing evidence that cultural factors may influence symptom development and treatment referral patterns among abused and neglected children. To date, few treatment outcome studies have specifically examined the impact of race, culture, or ethnicity on treatment response among maltreated children. Those that have attempted to include these factors have typically suffered from lack of clarity of the meaning of these terms. This article reviews the available empirical evidence that addresses the influence of culture on symptom formation, treatment-seeking behaviors, treatment preference, and response following child maltreatment. Hypotheses regarding these findings are addressed, and implications for practice, research, and public policy are discussed.

Lyon, A. R., Lau, A. S., McCauley, E., Vander Stoep, A., & Chorpita, B. F. (2014). A case for modular design: Implications for implementing evidence-based interventions with culturally diverse youth. Professional Psychology: Research and Practice, 45(1), 57-66. doi: 10.1037/a0035301

Abstract: Community-based therapists are frequently faced with the complex task of applying existing research knowledge to clients who may differ markedly from those enrolled in controlled outcome studies. The current study examines the utility of modular psychotherapy design as one method of facilitating the flexible delivery of evidence-based mental health services to ethnically and culturally diverse children and families. Modularity complements existing approaches to the provision of culturally sensitive, empirically informed treatment through its ability to balance the prioritization of research evidence and local practitioner cultural knowledge. Specific applications of modular principles to clinical work with diverse youth are highlighted. Special considerations and limitations relevant to modular psychotherapy and the overall mental health services research literature are discussed, as well as the continued importance of individual clinicians’ cultural competence and use of treatment progress monitoring, both of which should be combined with identified treatment modules to support the delivery of high-quality care.

Matos, M., Torres, R., Santiago, R., Jurado, M., & Rodriguez, I. (2006). Adaptation of Parent-Child Interaction Therapy for Puerto Rican families: A preliminary study. Family Process, 45, 205-222.

Abstract: This study examines how Parent-Child Interaction Therapy (PCIT) was adapted for Puerto Rican parents of children aged 4-6 with hyperactivity and other significant behavior problems. Four steps were followed: (1) translation and preliminary adaptation of the treatment manual, (2) application of the treatment to 9 families as part of an exploratory study using repeated measures, (3) treatment revision and refinement, and (4) in-depth interviews with parents (n=15) and clinical psychologists (n=5) from Puerto Rico who provided feedback on treatment process and components. Throughout this process, cultural elements and modifications were recommended to be incorporated into the treatment protocol. Both quantitative and qualitative results suggest that PCIT seems to be an acceptable intervention for this population, with some minor changes. Parents reported a high level of satisfaction, a significant reduction in children's externalizing behavior problems, and reduction of parenting stress and improvement in their parenting practices. Psychologists also evaluated positively the treatment protocol and recommended its use. Results from this study may inform clinicians and researchers who work with Latino families about relevant issues to be considered to promote their participation in behavioral family interventions and to enhance their acceptability and effectiveness.

McCabe, K. M., & Yeh, M. (2009). Parent-Child Interaction Therapy for Mexican Americans: A randomized clinical trial. Journal of Clinical Child & Adolescent Psychology, 38, 753-759.

Abstract: This study compared the effectiveness of a culturally modified version of Parent-Child Interaction Therapy (PCIT), called Guiando a Ninos Activos (GANA), to the effectiveness of standard PCIT and Treatment as Usual (TAU) for young Mexican American children with behavior problems. Fifty-eight Mexican American families whose 3- to 7-year-old child had a clinically significant behavior problem were randomly assigned to GANA, standard PCIT, or TAU. All three treatment approaches produced significant pre-post improvement in conduct problems across a wide variety of parent-report measures. GANA produced results that were significantly superior to TAU across a wide variety of both parent report and observational indices; however, GANA and PCIT did not differ significantly from one another. PCIT was superior to TAU on two of the parent report indices and almost all of the observational indices. There were no significant differences between the three groups on treatment dropout, and families were more satisfied with both GANA and PCIT than with TAU.

McCabe, K. M., Yeh, M., Garland, A. F., Lau, A. S., & Chavez, G. (2005). The GANA Program: A tailoring approach to adapting Parent-Child Interaction Therapy for Mexican Americans. Education and Treatment of Children, 28, 111-129.

Abstract: The current manuscript describes the process of developing the GANA program, a version of PCIT that has been culturally adapted for Mexican American families. The adaptation process involved combining information from 1) clinical literature on Mexican American families, 2) empirical literature on barriers to treatment access and effectiveness, and 3) qualitative data drawn from focus groups and interviews with Mexican American mothers, fathers, and therapists on how PCIT could be modified to be more culturally effective. Information from these sources was used to generate a list of potential modifications to PCIT, which were then reviewed by a panel of expert therapists and clinical and mental health researchers. The resulting GANA program and ongoing research to evaluate its effectiveness with Mexican American families is described.

Pina, A. A., Silverman, W. K., Fuentes, R. M., Kurtines, W. M., & Weems, C. F. (2003). Exposure-Based Cognitive Behavioral Therapy Treatment for phobic and anxiety disorders: Treatment effects and maintenance for Hispanic/Latino relative to European-American youths. Journal of the American Academy of Child and Adolescent Psychiatry, 42, 1179-1187.

Abstract: Objective: To examine treatment response and maintenance to exposure-based cognitive-behavioral therapy (CBT) for Hispanic/Latino relative to European-American youths with phobic and anxiety disorders. Method: A total of 131 Hispanic/Latino and European-American youths (aged 6-16 years) who participated in two previous clinical trials for phobic and anxiety disorders were compared along diagnostic recovery rates, clinically significant improvement, and youth- and parent-completed questionnaire scores using traditional hypothesis tests, including effect sizes, and statistical equivalence tests. Results: After treatment, Hispanic/Latino and European-American youths responded similarly to exposure-based CBT in their diagnostic recovery rates and questionnaires. Effect sizes for questionnaire data were also more similar than different across the two groups. With regard to treatment maintenance, Hispanic/Latino and European-American youths also responded more similarly than differently, albeit with some variations within specific assessment points in questionnaire data. Conclusions: Exposure-based CBT for phobic and anxiety disorders produced positive treatment gains and maintenance for Hispanic/Latino youths who participated in the trials. The treatment response that can be expected is generally similar (i.e., favorable) and equivalent to that found with European-American youths based on all the available indices of change.

Self-Brown, S., .Frederick, K., Binder, S., Whitaker, D., Lutzker, J., Edwards, A., & Blankenship, J. (2011). Examining the need for cultural adaptations to an evidence-based parent training program targeting the prevention of child maltreatment. Children and Youth Services Review, 33, 1166–1172.

Abstract: Evidence-based behavioral parent training programs (BPTs) have been recommended as a primary prevention strategy for child maltreatment, and use of BPTs is increasing. As these programs are implemented in new contexts and among new populations, the cultural relevance of these programs and need for adaptations or modifications must be considered. The purpose of this study was to assess the types of cultural adaptations that are being made to a widely implemented BPT, SafeCare, by providers working with families involved in the child welfare system, and to explore the need for more systematic adaptations. Eleven SafeCare providers, from six states, participated in individual, semi-structured interviews. Overall, the providers did not recommend systematic adaptations of the model for specific ethnic groups. However, they provided general and specific information regarding SafeCare components that require adaptation on a case-by-case basis, which is likely to be applicable to many BPTs. More research is needed to develop clear guidance about when and how to assess the need for cultural adaptations and how to institute adaptations that improve rather than weaken evidence-based programs. By sharing data and experiences, purveyors can contribute to the body of knowledge about adaptation.

Wood, J. J., Chui, A. W., Hwang, W., Jacobs, J., & Ifekwunigwe, M. (2008). Adapting Cognitive-Behavioral Therapy for Mexican American students with anxiety disorders: Recommendations for school psychologists. School Psychology Quarterly, 23, 1045-3830.

Abstract: Mexican American students are the fastest growing group in U.S. public schools. There is a growing body of research indicating that Mexican American families under utilize mental health services and are more likely to drop out of care prematurely when they do seek help. These findings may indicate that our health care system is not providing ethnic minorities with culturally competent care. Although cognitive-behavioral interventions are considered to be evidence-based treatments for child anxiety disorders, previous protocols have not taken cultural factors into account. This article discusses how to adapt cognitive-behavioral therapy (CBT) for Mexican American students with anxiety disorders. Working within the Psychotherapy Adaptation and Modification Framework (PAMF), this article offers adaptation principles that may guide school psychologists in implementing CBT strategies when working with Mexican American youth and their families. A case study is provided illustrating how cultural modifications of CBT can lead to positive outcomes for Mexican American students. (PsycINFO Database Record (c) 2009 APA, all rights reserved)