The Contribution of Cultural Competence to Evidence-Based Care for Ethnically Diverse Populations

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.

Racial/ethnic disparities in client unilateral termination: The role of therapists’ cultural comfort

“…These findings are consistent with the previous studies examining counselor variability in racial/ethnic disparities (e.g., Hayes et al, 2014;Imel et al, 2011;Owen, Imel, et al, 2011). Although low rates of unilateral termination for all clients would be ideal, it is likely the differential unilateral termination rates within therapists' caseloads reflect aspects of therapists' cultural orientation (Huey, Tilley, Jones, & Smith, 2014;Imel et al, 2011). At the same time, high rates of unilateral termination for both White and REM clients may also reflect therapists' lack of cultural sensitivity.…”

The association between relationship distress and psychopathology is consistent across racial and ethnic groups.

“…Therefore, the consistency of the association across races and ethnicities may inform clinicians wanting to use evidence-based care in a culturally competent practice (for a review of cultural competence in treating mental illness, see Huey, Tilley, Jones, & Smith, 2014). …”

Cultural accommodation of group substance abuse treatment for Latino adolescents: Results of an RCT.

“…However, the majority of treatments cited in these meta-analyses was not ESTs and included a range of non-RCT study designs that generally compare a culturally adapted treatment to a mixture of other treatment conditions (e.g., no-treatment control, treatment-as-usual, a specifically defined treatment) without cultural modifications. Some meta-analytic studies have been focused more squarely on the efficacy of ESTs for ethnic minority adults and children with psychological disorders (see Huey & Polo, 2008; Huey, Tilley, Jones, & Smith, 2014; Miranda et al, 2005) and conclusions regarding the benefit provided by culturally adapted treatments beyond that of their standard version EST counterparts are not conclusive. While there is some support for the efficacy of ESTs in mitigating psychological disorders for Latino adolescents (see Rossello & Bernal, 1999; Szapocznik et al, 2006; Waldron & Turner, 2008) many argue that direct comparison studies (i.e., testing a standard versus culturally accommodated version of an EST) are needed in order to fully understand if and how ethnic minorities benefit from such treatments (Castro, Barrera, & Holleran Steiker, 2010; Huey & Polo, 2008; Huey et al, 2014; Whaley & Davis, 2007).…”