Hispanic individuals are underrepresented in clinical and research populations and are often excluded from clinical trials in the United States. Hence, there are few data on the effectiveness of most empirically validated therapies for Hispanic substance users. The authors conducted a multisite randomized trial comparing the effectiveness of 3 individual sessions of motivational enhancement therapy with that of 3 individual sessions of counseling as usual on treatment retention and frequency of substance use; all assessment and treatment sessions were conducted in Spanish among 405 individuals seeking treatment for any type of current substance use. Treatment exposure was good, with 66% of participants completing all 3 protocol sessions. Although both interventions resulted in reductions in substance use during the 4-week therapy phase, there were no significant Treatment Condition ϫ Time interactions nor Site ϫ Treatment Condition interactions. Results suggest that the individual treatments delivered in Spanish were both attractive to and effective with this heterogeneous group of Hispanic adults, but the differential effectiveness of motivational enhancement therapy may be limited to those whose primary substance use problem is alcohol and may be fairly modest in magnitude.

As the Latino population in the United States grows, it is imperative to attend to the appropriateness of the mental health care that is being provided to its members. Latinos experience many of the same behavioral health disorders as other ethnic and cultural groups in the United States, but underutilize services relative to many other groups. Such underutilization may be related to issues such as stigma, language, and acculturation level, all of which often create barriers to treatment. First generation Latinos (i.e., individuals born outside the United States) are especially vulnerable to adverse experiences when seeking and receiving treatment. This may be due in part to acculturation and language issues which may further contribute to future underutilization of services. A well established therapeutic alliance developed through the appropriate use of cultural constructs may help mitigate some of the barriers faced by some Latino groups, especially those who are first generation. This paper reviews several cultural constructs that have been highlighted in the Hispanic behavioral health literature and discusses their potential implications for clinical care. This paper offers a number of practical clinical guidelines for mental health professionals who work with Latino groups. These clinical recommendations are based on a synthesis of selected cultural constructs and the clinical experiences of the authors' work in a large community-based Hispanic mental health clinic.

Much has been written concerning ethno-cultural constructs and their application to the behavioral health treatment of Latinas(os). Perhaps because of the inherent complexity of attempting to describe ethno-cultural beliefs and treatment implications while avoiding stereotyping and overgeneralizing, writings in this area often begin with brief descriptions of select cultural values. Often what follow are treatment implications and recommendations, embedded in a broader theoretical discussion. This article builds upon this work by placing cultural concepts in ecological perspective and offering practice recommendations that follow from specific cultural beliefs. Although not exhaustive, these recommendations are intended to offer concrete approaches to care that are consistent with a contextual understanding of individuals of Hispanic heritage, particularly of individuals of Puerto Rican ethnicity living in an urban setting.

The effectiveness of a competency-based supervision approach called Motivational Interviewing Assessment: Supervisory Tools for Enhancing Proficiency (MIA: STEP) was compared to Supervision-As-Usual (SAU) for increasing clinicians’ motivational interviewing (MI) adherence and competence and client retention and primary substance abstinence in a multisite Hybrid Type 2 effectiveness-implementation randomized controlled trial. Participants were 66 clinicians and 450 clients within one of eleven outpatient substance abuse programs. An independent evaluation of audio recorded supervision sessions indicated that MIA: STEP and SAU were highly and comparably discriminable across sites. While clinicians in both supervision conditions improved their MI performance, clinician supervised with MIA: STEP, compared to those in SAU, showed significantly greater increases in the competency in which they used fundamental and advanced MI strategies when using MI across seven intakes through a 16-week follow-up. There were no retention or substance use differences among the clients seen by clinicians in MIA: STEP or SAU. MIA: STEP was substantially more expensive to deliver than SAU. Innovative alternatives to resource-intensive competency-based supervision approaches such as MIA: STEP are needed to promote the implementation of evidence-based practices.

A rapidly growing Latino population challenges the U.S. mental health system. Despite a high service need, significant disparities in access to care have resulted in patterns of low utilization and frequent dropout. Furthermore, natural ambivalence as individuals access a traditionally underutilized source of support may further compromise the effective therapeutic engagement of Latinos. Thus, practitioners and researchers seek to identify means by which to enhance service delivery for this historically underserved population. Following the demonstrated efficacy of motivational interviewing with highly ambivalent client populations and drawing on the authors' clinical experiences with monolingual Spanish-speaking Latinos in a community mental health setting, this article describes the application of motivational interviewing principles to 3 Latino cultural values and offers clinical practice recommendations to help create a client-centered and culturally congruent therapeutic milieu.