Cultural Adaptation in Mental Health Programming: Are We Doing Enough to Promote Change?

INTRODUCTION: While ethnic minorities report lower levels of mental health disorders than Whites, disparities in mental health care lead to worse outcomes for ethnic minority group members who experience mental health problems. Cultural adaptation is a method used to modify evidence-based interventions to address the unique needs of ethnic minorities. This method has been shown to produce favorable outcomes for ethnic minority group members. While treatment at all ages is important, effective early childhood prevention and intervention programs can prevent less favorable outcomes and reduce societal costs later in life. Thus, cultural adaptation of early childhood programs is the focus of this research. The first aim of this study is to develop a tool which will provide a standardized method for researchers to rate the level of cultural adaptation in evidence-based programs used with ethnic minority populations. The second aim is to reveal the extent to which cultural adaptation is being implemented within early prevention and intervention programming, including relationships between cultural adaptation, treatment fidelity, and intervention outcomes. 

METHOD: Study aims will be evaluated in the context of a larger systematic literature review and meta-analysis focused on early childhood prevention and intervention programming. For the present study, the primary variables of interest are racial/ethnic composition of the study sample, level of cultural adaptation, treatment fidelity, and effect size.

RESULTS:  Aim 1 included the development of a cultural adaptation rating scale. An extensive review of the cultural adaptation literature informed the development of the scale, which includes three subscales: surface level adaptation, structural adaptation, and deep structure adaptation. Aim 2 focused on the application of the scale to the studies in the review. First, we hypothesized that cultural adaptation will rarely be discussed in the early childhood prevention and intervention literature. Our hypothesis was supported in that only 6% of the studies included discussed the use of cultural adaptation. Our second hypothesis, that the majority of early childhood behavioral interventions have not been adapted, was also supported in that 70% of the studies included, utilized few or no features of adaptation. Of those programs that did use cultural adaptation, 34% percent of the adaptations were surface level, 39% were structural, and 27% were deep structure. Relationships between cultural adaptation, treatment integrity, and outcome are currently being analyzed.

CONCLUSION: Despite the potential benefits of improving mental health outcomes for ethnic minority children, the development and application of the cultural adaptation rating scale reveals that cultural adaptation is seldom used in early childhood prevention and intervention programming. Furthermore, findings suggest that deep structure adaptations, which require a deep understanding of values, beliefs, and needs of the target population, are less likely to occur than other forms of adaptation. Implications of these findings, limitations of the current study, and future research directions will be discussed.