EBP Exchange - UMB School of Social Work

There is certainly reason for concern that evidence supported interventions (ESIs) may not be effective across culttural or race/ethnic groups, given the history of developing these interventions on fairly narrow populations, sometimes in the far reaches of the country and away from more diverse major metropolitan areas.  Many of those concerns were expressed at a conference held last summer at the University of Minnesota in 2007 (see, ttp://ssw.cehd.umn.edu/img/assets/27477/SummaryOfProceedings.pdf).

A recent meta-analysis that has come (Huey and Polo, 200 helps to clarify the robust nature of mental health interventions for youth and to show that there seems to be little difference in benefit received for Caucasian and minority youth. Basically, youth ethnicity (African American, Latino, mixed=other minority), problem type, clinical severity, diagnostic status, and culture-responsive treatment status did not moderate treatment outcome. Most studies had low statisticalpower and poor representation of less acculturated youth. The authors note that these findings are not definitive becasue relatively few studies have been done in this area and validated outcome measures are mostly lacking. Although this does not mean that we should be satisifed with what we have developed or with what we know, it does indicate that there is no particular evidence that the avialable “well-established treatments” (including CBT, MST, Brief Strategic Family Therapy (BSFT) and TF-CBT) will not be effective with minority youth. There is also no overall evidence from the meta-analysis that cultural adaptations have succeeded in boosting the effectiveness of standard interventions.

Another reasonably recent paper indicates that CBT and medications are effective with minority low-income adult women (Miranda, et al., 2006).  This does not, again, mean that we should be satisifed as Wells et al. (2007)  show that relatively simple quality improvements to standard treatments can be very cost effective, across the board. The interventions are described in the paper which indicates that they are also posted at www.rand..  So, there is certainly much to be done to develop a mental health care system that is effective for minority populations–and there is certainly evidence that the funding for mental health care is not sufficient to reduce mental health care disparities (Cook, McGuire, & Miranda, 2007), but there are some promising findings to work from.org/health/projects/pic/order.htmlCook, B. L., McGuire, T., & Miranda, J. (2007). Measuring trends in mental health care disparities, 2000-2004. Psychiatric Services, 58(12), 1533-1540.

Huey, S. J., & Polo, A. J. (2008). Evidence-based psychosocial treatments for ethnic minority youth. Journal of Clinical Child and Adolescent Psychology, 37(1), 262-301.

Miranda, J., Green, B. L., Krupnick, J. L., Chung, J., Siddique, J., Belin, T., et al. (2006). One-year outcomes of a randomized clinical trial treating depression in low-income minority women. Journal of Consulting and Clinical Psychology, 74(1), 99-111.

Wells, K. B., Schoenbaum, M., Duan, N., Miranda, J., Tang, L. Q., & Sherbourne, C. (2007). Cost-effectiveness of quality improvement programs for patients with subthreshold depression or depressive disorder. Psychiatric Services, 58(10), 1269-1278