Cultural competence and evidence-based practice in mental health services: A complementary perspective.

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.

Controversies in Knowledge Translation for Community-Based Drug Treatment: The Need to the End Policies of the War on Drugs and Mass Incarceration of Drug Offenders to Achieve Health Equity

“…20 There is movement underway from efficacy studies to effectiveness studies. 21 Still, the vast majority of NIH behavioral grants continue to be awarded for efficacy trials. 22 It is important to question the types of proposals being funded for knowledge development.…”

“…25 There are problems in generalizing findings from efficacy research into real-world settings. 21,25 Optimal processes for disseminating empirically based interventions into real-world clinical settings have yet to be identified. 21,25 Cost and staff training are relevant factors.…”

“…21,25 Optimal processes for disseminating empirically based interventions into real-world clinical settings have yet to be identified. 21,25 Cost and staff training are relevant factors. 24 There is also the perception of a gap between providers' experience in real-world settings and that of researchers, so many of "the treatments that receive research attention are resourceintensive interventions studied under rarefied conditions for fixed periods of time" (p. 39).…”

“…26 Thus, it is appropriate to ask: are these treatments valid for minorities? 21 Numerous sociocultural questions "frame current debate about the role of patient characteristics in EBPP" (p. 278). 23 It is relevant to consider "the extent to which social factors and cultural differences necessitate different forms of treatment or, conversely, the extent to which interventions widely tested in majority populations can be readily adapted for patients with different ethnic or sociocultural backgrounds" (p. 279).…”

“…23 Yet, "advocates of cultural competence and empirically supported treatment agree that treatments that have been shown to work with predominantly European American populations should be tried with ethnic/racial minority individuals;" this follows from ethnic/racial minorities in the United States sharing "some cultural characteristics with the mainstream society" (p. 572). 21 Given some shared characteristics, it is also assumed that "culturally specific interventions developed for ethnic/racial minority groups are effective with other cultural groups, including European Americans" (p. 572). 21 Much needed are more effectiveness studies which address issues of external validity-versus efficacy studies that emphasize internal validity and fail to include adequate representation of ethnic/racial minorities; furthermore, efficacy studies tend to fail to analyze data by ethnicity/race even when a rare sample includes people of color.…”