Cultural Competence and Evidence-Based Practices

Cultural and linguistic competence is a critical factor in the successful implementation of evidence-based practices. As Davis (1997) defines cultural competence, it is “the integration and transformation of knowledge, information, and data about individuals and groups of people into specific clinical standards, skills, service approaches, techniques, and marketing programs that match the individual’s culture and increase the quality and appropriateness of mental health care and outcomes.”

This definition indicates that evidence-based practices must be congruent with the cultures, values, and help-seeking behaviors of those that would be recipients of such practices – and, in many instances, that would include large numbers of children and families of color. Therefore, cultural competence is about adapting mental health practices and interventions to meet the needs of children, youth and families from many diverse cultures. Cultural competence must be incorporated into the expansion of evidence-based practices.

Currently, many recognized evidence-based practices have not included large numbers of children and families of color in their research studies. Although these practices have proven to be effective in clinical trials and control groups, many do not have evidence that they are effective with different cultural groups or groups with differing cultural values and worldviews. Therefore, it is imperative to address “cultural fit” when identifying evidence-based practices for families and children of color.

It is important to assess whether these interventions include adequate samples of diverse cultural groups or account for differing ways that these groups view and utilize mental health services. Research suggests that some evidence-based practices can be effective for diverse populations when the provider adapts the delivery of services to reflect the child and family’s culture.

Isaacs, Huang, Hernandez & Echo-Hawk (2005) suggest two approaches for ensuring culturally competent evidence-based practices for children and families of color

  • Cultural adaptations of existing evidence-based practices
  • Utilization of culturally-specific interventions, i.e., practice-based evidence models

Cultural adaptations of evidence-based practices involve changes in the approach to service delivery, the nature of the therapeutic relationship, or the components of the intervention itself to accommodate the cultural beliefs, attitudes, and behaviors of the population of interest (Whaley, 2006). Currently, it is unclear how much cultural adaptation can be accommodated by evidence-based practices before the fidelity of the model is compromised. Cultural adaptations of existing evidence-based practices require further study.

On the other hand, there are many practices and interventions in communities of color that are well-developed and well-utilized and respected by diverse populations. However, inequities in access to funding and differing views about what constitutes “evidence” has led to a lack of recognition of many of these practices or their acceptance as evidence-based practices.

Thus, “practice-based evidence” models should be more widely studied and included in practices that might be culturally appropriate for a population group. Isaacs, Huang, Hernandez & Echo-Hawk (2005) define practice-based evidence models as “treatment approaches and supports that are derived from, the positive cultural attributes of the local society and traditions. Practice-based evidence services are accepted as effective by the local community, through community consensus, and address the therapeutic and healing needs of individuals and families from a culturally-specific framework” (p.16).

At the core of evidence-based practices is the need to improve the quality of care and to provide greater accountability for services that are delivered. These two outcomes are also important to children and families of color, as data suggests that they are far more likely to encounter problems in access to mental health services and to receive lower quality services when they do receive care. Thus, quality services that are culturally appropriate must be a key ingredient in evidence-based practices.

References

Davis, King. (1997). Race, health status and managed care. In Epstein, Len and Brisbane, Francis, eds. Cultural competence series. Rockville, MD: Center for Substance Abuse Prevention.

Isaacs, M.R., Huang, L.N., Hernandez, M., and Echo-Hawk, H. (2005). The road to evidence: The intersection of evidence-based practices and cultural competence in children’s mental health. Washington, DC: The National Alliance of Multi-Ethnic Behavioral Health Associations.

U.S. Department of Health and Human Services. (2001). Mental health: Culture, race and ethnicity. A supplement to mental health: A report of the Surgeon General. Rockville, MD: DHHS, U.S. Public Health Services, Office of the Surgeon General.

Whaley, A. (2006). Request for proposals on cultural adaptation: Providing evidence-
based mental health treatment for populations of color initiative. Austin, TX: Hogg Foundation for Mental Health.