The fusion of culture and science: Challenges and controversies of cultural competency and evidence-based practice with an African American family advocacy network
Introduction
There is widespread consensus that evidence-supported interventions (ESIs) or “efficacious mental health treatments for children” (Glisson, 2002, p. 233) have not been diffused, adopted, or implemented in community service delivery systems serving African American child welfare populations (Burns et al., 1999, Hoagwood et al., 2001). Due to the rapid growth in health, social, and economic disparities among African Americans in the United States (Anderson, Scrimshaw, Fullilove, Fielding, & Normand, 2003) and increased attention to issues of race and culture in child welfare service systems, there is a growing need for new ways to deliver effective and culturally-appropriate services among researchers and service providers.
In particular, the current focus on evidence-supported interventions may de-emphasize the use of culture as an organizing practice principle for service provision to African Americans. In this paper, empirically supported interventions are single methods with a strong research and data analysis foundations and evidence-based practice is a 5-step process involving the use of electronic databases, and other knowledge bases such as client, cultural, professional, and implementation knowledge as a basis for decision making and problem solving (it will be explained formally and with greater detail shortly below). For example, the National Association of Public Child Welfare Administrators' Guide for Child Welfare Administrators on Evidence-Based Practice (Wilson & Alexandra, 2005) does not include, refer directly to, or mention the word “culture” in relationship to evidence-based practice (EBP).
The dearth of attention to culture in child welfare systems seeking to implement EBP is the result of a number of key factors. First, service providers may not understand the differences between the ESI approach, which pertains to a single intervention with strong research foundations, and EBP, which involves a five-step process that will be discussed in the next section of this paper. Second, families and professionals may not understand that many ESIs do not specifically incorporate cultural considerations. Third, little research has examined whether ESIs are as efficacious with non-majority groups as they are for Caucasian children and families (Sue & Zane, 2006). Fourth, enculturation, ethnic minority socialization, and acculturation-related issues confound the problems of mental illness and service-related experiences of African American children and families in care (Cauce, 2002). Fifth, little research has identified the factors needed to implement and adapt evidence-supported interventions in actual practice for ethnically-diverse families (Blasé and Fixsen, 2003, Briggs et al., 2007, Isaacs et al., 2005). Sixth, the experiences and views of consumers and families regarding evidence-based practice are underreported (Scheyett, McCarthy, & Rauch, 2006). Finally, little research has examined the utility of socio-cultural coping strategies used by African Americans such as activism, family advocacy and empowerment groups as radical structuralist strategies for promoting access to effective mental health services through the fusion of evidence-based practice, cultural sensitivity, and culturally-competent training with ethnically-diverse parent advocacy groups (Briggs et al., 2006, Snowden, 2001). These racially-diverse family advocacy groups may be instrumental in transforming traditionally-managed behavioral health systems into racially-sensitive and family-driven service delivery systems (Briggs, Briggs, & Leary, 2005).
This paper begins with a brief and concise description of EBP. It highlights cultural competency practice principles for selecting and delivering ESIs while emphasizing client preferences and cultural values with African Americans with mental health needs in child welfare systems. A case study is presented of a pilot project that links cultural competence, radical structuralist-based family advocacy and system change strategies, and evidence-based practice with African American youth and families. This paper develops a training model, principles, and strategies for integrating evidence-based interventions with culturally competent and empowerment-based service delivery approaches with ethnically-diverse parent/family advocates.
Section snippets
Definition of evidence-based practice
EBP aligns closely with the model developed for evidence-based medicine (Gambrill, 2004, Guyatt and Rennie, 2002, Sackett et al., 2000). This original approach to EBP involves the integration of the best available evidence with other factors such as clinical judgments and client preferences in the process of diffusing, adopting, planning, and implementing clinical care.
Principles for developing culturally competent evidence-based services
Afro-centric values are generally not included in mental health prevention and treatment programs because most programs are based upon Eurocentric norms and customs (Corneille, Ashcraft, & Belgrave, 2005). While individual and sub-group norms and values may vary, generally it has been found that values and customs that are central to African American culture include a connection with religion, relationships, community, talk story and oral traditions, rhythm, and styles of expressive
Culturally-appropriate, evidence-based service provision to African American children and families: a case study
The African American Evidence-based Practice Project (AAEBPP) was formed in 2005 as a participatory action research collaborative driven by the interests and needs of families of youth involved in the child welfare and child mental health systems in St. Louis, Missouri. Its intent was to assist in changing culturally insensitive and restrictive care policies and practices in child and family service systems by developing a family advocacy organization with a radical structuralist agenda. The
Discussion
African American parents of youth with serious emotional disorders are particularly disadvantaged in the child welfare system because they receive stigma and blame for their children's emotional and behavioral issues and related circumstances, and because some mental health services may not be appropriate for use with African American families. Given the difficulty that current practice models have in addressing issues of culture, African American families with children with mental health
Challenges for social workers seeking to adopt these roles to train parents in EBP
In order to teach parent advocates to implement the EBP approach appropriately, key resources, personnel, and expertise are needed, including: access to regularly-updated databases and electronic search engines; staff who are able to use the EBP approach (and who are not required to comply with other practice frameworks); staff who have sufficient research training to locate, comprehend, synthesize, and summarize large amounts of research on clinical practice; and organizational processes that
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