Two approaches to tailoring treatment for cultural minority adolescents

Abstract

At this time, compared with mainstream (Caucasian) youth, cultural minority adolescents experience more severe substance-related consequences and are less likely to receive treatment. While several empirically supported interventions (ESIs), such as motivational interviewing (MI), have been evaluated with mainstream adolescents, fewer published studies have investigated the fit and efficacy of these interventions with cultural minority adolescents. Additionally, many empirical evaluations of ESIs have not explicitly attended to issues of culture, race, and socioeconomic background in their analyses. As a result, there is some question about the external validity of ESIs, particularly in disadvantaged cultural minority populations. This review seeks to take a step towards filling this gap, by addressing how to improve the fit and efficacy of ESIs like MI with cultural minority youth. Specifically, this review presents the existing literature on MI with cultural minority groups (adult and adolescent), proposes two approaches for evaluating and adapting this (or other) behavioral interventions, and elucidates the rationale, strengths, and potential liabilities of each tailoring approach.

Do therapist behaviors differ with Hispanic youth? A brief look at within-session therapist behaviors and youth treatment response.

“…Second, following the literature, which shows that MI consistent therapist skills are positively related to treatment outcomes for adolescents through adults (e.g., Barnett, Moyers, et al, 2014; Gaume, Magill, et al, 2014; Moyers, Martin, Houck, Christopher, & Tonigan, 2009), we predicted that therapists’ greater use of MI skills would relate to better treatment response (less substance use frequency and related problems) for both Hispanic and non-Hispanic youth at the three-month follow-up. Third, consistent with prior theoretical work, which suggests that different factors may be salient to Hispanic youth’s treatment response, thus necessitating examination of therapeutic processes and outcomes for Hispanic youth (Feldstein Ewing et al, 2012; Salvador, DeVargas, & Feldstein Ewing, in press), we hypothesized that therapists would show greater MI skills with non-Hispanic versus Hispanic youth.…”

Explaining Racial/Ethnic Differences in Adolescent Substance Abuse Treatment Completion in the United States: A Decomposition Analysis

“…Moreover, little is known about whether minority youth fare better in certain settings or programs. [12] Studies with small, selective samples, suggests minority youth have lower retention and are less likely to complete treatment overall. [13,14]…”

Structure of Problem Recognition Questionnaire with Hispanic/Latino Adolescents

“…These individuals may benefit from more directive or change-focused strategies. Using the PRQ in this way may improve delivery of MI to Hispanic/Latino individuals by showing when clients would benefit from client-centered strategies versus from prescriptive strategies, which may improve the consistency between the intervention and clients’ needs (Feldstein Ewing et al, 2012). Seemingly contradictory responses on the PRQ could also inform the clinical approach with adolescents, such as adolescents with high levels of both Readiness and Treatment Resistance .…”

“…Also, Motivational Enhancement Therapy matched or outperformed other active treatments for Hispanic/Latino individuals (Carroll et al, 2009). It is argued that MI is fitting for Hispanic/Latino individuals (and other racial/ethnic minorities) due to client-centered elements that facilitate the ability for therapists to understand diverse worldviews (Feldstein Ewing, Wray, Mead, & Adams, 2012; Miller et al, 2007). However, it was found that therapists deliver MI less competently with Hispanic/Latino adolescents than with non-Hispanic/Latino adolescents and that the poorer delivery was associated with less responsiveness to treatment (Feldstein Ewing, Gaume, Ernst, Rivera, & Houck, 2015).…”