Building cultural competence: A systematic evaluation of the effectiveness of culturally sensitive interventions with ethnic minority youth

Abstract

Growing diversity within the US population accentuates the need for the development and implementation of culturally competent services in the field of child welfare. Despite this, few studies exist that examine the effectiveness of culturally sensitive interventions (CSIs) with ethnic minority populations, who are considerably more at risk of developing psychosocial problems including substance and alcohol abuse, delinquency, low academic achievement, and poor self-esteem. With the demand for evidence-based practice it is imperative that we examine the effectiveness of CSIs designed to prevent and treat youth problems. The main goal of this review was to systematically analyze the methodology of recent CSI research with populations of ethnic minority youth in order to evaluate each intervention's ability to adhere to existing standards of evidence-based practice. The fifteen CSI studies examined in this review illustrate progress in their attempt to adhere to the methodological rigor required of evidence-based practice. This review encourages the field of child welfare to position itself analogously with and embrace the movement toward building cultural competence by further investigating the effectiveness of culturally-sensitive interventions with ethnic minority youth.

Introduction

Reviews that have attempted to focus on ethnic minority research have discovered, in general, a disproportionate lag in psychosocial research with minority participants. Specifically, Ponterotto (1988) uncovered evidence of a phenomenological gap when investigating the state of racial and ethnic minority research by examining studies published in the Journal of Counseling Psychology. In his review, he found that only 53 out of a pool of 934 articles published between 1976 and 1986 (5.7%) were ethnic minority-focused research studies.

In addition reviewers identify several methodological issues present in existing ethnic minority research (Hall, 2001, Phinney, 1990, Ponterotto, 1988). These concerns are mainly related to the internal validity of measurement instruments and the generalizability of study samples. For example, Ponterotto (1988) identified an over-reliance of research on small student (college or university) samples, which typically do not generalize to larger minority populations. In addition, both Hall, 2001, Phinney, 1990 discussed the absence of solid theoretical constructs and culturally sensitive reliable measurement instruments.

Even fewer studies examine the impact CSIs have on ethnic minority youth, who are considerably more at risk of developing psychosocial problems (Gibbs & Haung, 1998). This deficit may be accentuated by the complexities of recruiting minority youth because they may be considerably more vulnerable to multiple discriminations such as poverty, inequality, and racial discrimination (Kazdin, 2003, Kazdin and Weisz, 1998). This unfortunate reality limits researchers' ability to contact, recruit and retain minority youth participants in research studies. Additional factors, which may indirectly steer researchers away from exploring intervention research with minority youth, include difficulties operationalizing various cultural concepts and theories, and locating accurate standardized measures proven to be reliable with diverse youth populations. This, and the general lack of interest by mainstream researchers, has contributed to the absence of intervention research with minority youth (Sue, 2003).

More recently CSIs have gained wider acceptance in the scientific community for their capacity to guide and enhance established evidence-based treatments (Hall, 2001). A recent review by Huey Jr. and Polo (2008) of evidence-based psychosocial treatments for ethnic minority youth did identify progress in the rise and development of culturally sensitive interventions.

Culturally sensitive interventions (CSIs) are defined by Resnicow, Soler, Braithwaite, Ahluwalia, and Butler (2000) as

“the extent to which ethnic/cultural characteristics, experiences, norms, values, behavioral patterns, and beliefs of a target population as well as relevant historical, environmental, and social forces are incorporated in the design, delivery, and evaluation of targeted health promotion materials and programs” (p. 272).

Despite complications in the ability to define and develop curricula that is both culturally specific and appropriate, there is growing evidence that CSIs are more effective than traditional “mainstream” evidence-based interventions. For example, there is evidence that incorporating culturally sensitive and relevant content in therapy can improve client engagement, thereby enhancing the client/clinician relationship (Jackson-Gilfort, Liddle, Tejeda & Dakof, 2001). In addition a recent review by Jani, Ortiz and Aranda (2009) of 23 Latino outcome studies published between 1999 and 2005 uncovered that the majority of culturally tailored studies reported positive outcomes associated with measures of health, substance abuse and mental health. Other reviews have posited that CSIs can improve engagement and retention of ethnic minority youth and their families (see Kumpfer, Alvarado, Smith, & Bellamy, 2002). Competing evidence also exists downplaying the effectiveness cultural tailoring has on an ethnic minority population. For instance, a meta-analysis of mainstream juvenile delinquency programs (n = 305) by Wilson, Lipsey and Soydan (2003) found no significant difference between the effects mainstream, non-culturally tailored, interventions had on ethnic minority participants versus their White peers¹. This evidence sparks a controversial debate as to whether or not CSIs are even needed at all.