Why is Culture Important? Defacto System Striking disparities for people of color in Promises and Challenges of Evidence-Based • Diffused Child mental health services despite having Practices for Latino Youth and Families Mental Health similar community rates of mental disorders. Services Other Sectors Improving Systems of Care for Latino Youth and Families: Growing People of color have less access to mental Effective and Evidence-Based Strategies for Engagement and Treatment health care than do whites (European July 21-23, 2004 • Unclear Pathways American). Miami, Florida to Care Mario Hernandez, Ph.D. Louis de la Parte Florida Mental Health Institute Mental Health: A Report of the Surgeon General (U.S. Department of Health and Human Services [DHHS], 1999) Evidence-Based Programs and Cultural Basic Assumption Why is Culture Important? Competence: What we know and do not know Culture is an important variable in People of color are less likely to receive We know more about effective practices and determining how people (consumers, staff & needed care and when they receive it, it is programs than what is reflected through providers) see and interpret (know) the more likely to be poor in quality. research done using randomized control trials. world around them and the basis of how they make decisions. Culture and social context influence mental There are practices and interventions that health, mental illness, and mental health consumers and practitioners have found to be services in America. helpful in addressing their problems and achieving their goals but for which the evidence base has not been fully established. Karen A Blasé, Ph.d., Dean L. Fixsen, Ph.d., Co-Directors, National Implementation Research Network, Mental Health: A Report of the Surgeon General (U.S. Department of Louis de la Parte Florida Mental Health Institute, Health and Human Services [DHHS], 1999) Consensus Statement on Evidence-Based Programs and Cultural Competence. 1
Status of EBTs Status of EBTs Status of EBTS Little research related to evidence-based Currently we do not know whether and what While it is important to conduct research programs has been conducted with diverse types of adaptations and modifications of an involving specific racial, ethnic, and cultural populations making it difficult to ascertain evidence-based program are needed to communities, their role should not be limited whether currently identified evidence-based ensure that its implementation does not to just being subjects of research. It is programs are in fact best practices models create or exacerbate disparities across imperative that partnerships are developed for specific racial, ethnic, and cultural cultural groups. with specific racial, ethnic, and cultural communities. communities so they can participate fully in the design, implementation, and evaluation of promising and best practices models. Karen A Blasé, Ph.d., Dean L. Fixsen, Ph.d., Co-Directors, National Implementation Research Network, Karen A Blasé, Ph.d., Dean L. Fixsen, Ph.d., Co-Directors, National Implementation Research Network, Karen A Blasé, Ph.d., Dean L. Fixsen, Ph.d., Co-Directors, National Implementation Research Network, Louis de la Parte Florida Mental Health Institute, Louis de la Parte Florida Mental Health Institute, Louis de la Parte Florida Mental Health Institute, Consensus Statement on Evidence-Based Programs and Cultural Competence. Consensus Statement on Evidence-Based Programs and Cultural Competence. Consensus Statement on Evidence-Based Programs and Cultural Competence. Status of EBTs Status of EBTS Most studies reporting findings for racial and Evidence suggests that culturally oriented What beliefs underly our science base? ethnic minorities had small samples and interventions are more effective than usual were not randomized controlled trials. care at reducing dropout rates for people of color receiving mental health services. The research used to generate professional treatment guidelines for most health and Because stigma and help-seeking behaviors mental health interventions does not include are two culturally determined factors in or report large enough samples of racial and service use, research is needed on how to ethnic minorities to allow group specific change attitudes and improve utilization of determinations of efficacy. mental services. 2
Science Assumes… Science Assumes… Terms Some of the Resistance to EBT and Challenge to APA its Dissemination and Implementation The efficacy of an intervention is defined as Journals to advance the cause of dissemination its effect under “ideal conditions”. Will the evidence-based treatment approach lead to and implementation of EBTs. more misuse by managed care? Education. Are Evidence-Based Relationships (EBRs) more The effectiveness of an intervention is Facilitating partnerships between clinicians and important than EBTs? defined as its effect under “normal conditions” researchers. Do we have enough evidence to begin the in field settings. dissemination and implementation of EBTs? Influence public policy to enhance effectiveness Will the dissemination and implementation of EBTs research. require someone to set standards for treatment? Clinical Psychology: Science and Practice, V11 N2 Clinical Psychology: Science and Practice, V11 N2 Last, JM. Ed, A dictionary of Epidemiology. 3 rd ed. American Psychological Association D12 2004 American Psychological Association D12 2004 New York, NY. Oxford University Press, 1995.) Paul W. Kettlewell Geisinger Medical Center Paul W. Kettlewell Geisinger Medical Center Science Assumes… Science Assumes… Science Assumes… The Case for EBTS and for Their Different Rationales for Psychotherapy Changes in Clinical Psychology are Dissemination and Implementation Dissemination Research Needed EBTS provide guidance to better serve our patients Practical constraints on practitioners’ ability to use research products. or clients. Lack of research on process and outcome of both empirically Conduct and support effectiveness research. supported treatments and existing services in different practice Using the scientific approach to evaluate treatment is Modify and expand the agenda for contexts. the best way to advance our knowledge so that we Lack of research on acceptability of research of research products to researchers. can provide even better care in the future. end users including practitioners, clients, and administrators. We need to use wisely the limited resources for Form partnerships with practitioners and Lack of research on training in the integration of science and practice mental health services. at the undergraduate, graduate, and postgraduate levels. applied programs. Systemic economic contingencies that favor or punish evidence-based We have treatments that work and most practitioners decision making. do not use them. The tendency to construct dissemination as a hierarchical and Is there a better alternative than to use science to unidirectional process of transmission from research to clinical guide practice? practice. Clinical Psychology: Science and Practice, V11 N2 Clinical Psychology: Science and Practice, V11 N2 American Psychological Association D12 2004 American Psychological Association D12 2004 Michael E. Addis - Clark University Paul W. Kettlewell Geisinger Medical Center Paul W. Kettlewell Geisinger Medical Center 2002 American Psychological Association D12 3
Evidence-Based Treatment Survey Cultural Blindness Racial Composition Culturally-blind agencies are characterized by Evidence-Based Treatment White the belief that helping approaches traditionally Black or African American Survey used by the dominant culture are universally Other Ethnic Background applicable; if the system worked as it should, all American Indian or Alaskan Native people - - regardless of race or culture - - would Multicultural White and Asian Asian be served with equal effectiveness. Native hawaiian or other Pacific CMHA/ORC Macro/USF Islander Multicultural White and Black or African Descent Multicultural White and Hispanic Descent American N=615 Towards A Culturally Competent System of Care Volume 1 CMHS/ORC Macro/FMHI/USF A Monograph on Effective Services for Minority Children Who Are Severely Emotionally Disturbed Evidence-Based Treatment Survey Advantages of Using Evidence-Based Treatments Racial Composition What do you believe? 350 315296 500 450 300 450 250 400 What do the people you serve believe? 196 200 350 142 300 150 100 250 100 78 53 35 34 31 15 14 13 11 200 30 50 What does your community of 150 8 6 5 0 100 27 14 7 providers within system of care 19 4 2 Protocols/Guidelines Client Satisfaction Validity Removes Subjectivity Collaboration Accountability Innovative Unclassified 50 2 2 Researched Outcomes Effective Consistency Good Social Marketing Insurance company Accepts Treatment/Care plans Decrease Adverse Effects Use of Models 1 Easy to use with Little or .. 0 White American Other Ethnic Background American Asian American believe? Black or Indian or Multicultural hawaiian or other Pacific Multicultural Multicultural African Alaskan White and White and White and Black or Hispanic Native Asian # of Responses N=615 N=615 CMHS/ORC Macro/FMHI/USF CMHS/ORC Macro/FMHI/USF 4
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