Melanie M. Domenech Rodríguez

Cultural Adaptation of an Evidence Based Intervention: From Theory to Practice in a Latino/a Community Context

The cultural tailoring of interventions to reach underserved groups has moved from descriptive and proscriptive models to their application with existing evidence based treatments. To date few published examples illustrate the process of cultural adaptation. The current paper documents the adaptation of an evidence based parent training intervention, Parent Management Training—Oregon Model (PMTO™), for Spanish-speaking Latino parents using both process (Domenech Rodríguez and Wieling in Voices of color: first-person accounts of ethnic minority therapists, Sage, Thousand Oaks, 2004) and content (Bernal et al. in J Abnorm Child Psychol 23:67–82, 1995) models. The adaptation took place in stages: a pilot study to ensure feasibility, focus groups to establish appropriate format and goals, and a test of the intervention. Throughout the process the treatment manual was treated as a living document. Changes were applied and documented as the team developed improvements for the adaptation. The present discussion details both process adaptations, (e.g., engaging the treatment developer, community leaders, and parents, and decentering the manual), and content adaptations, (e.g., shaping the appropriateness of language, persons, metaphors, concepts, contexts, methods, and goals). The current research provides support for the idea that cultural adaptations can improve service delivery to diverse groups and can be conducted systematically with documentation for replication purposes. Suggestions for improving the empirical measurement and documentation of the adaptation process are included.

True Confessions?: Alumni's Retrospective Reports on Undergraduate Cheating Behaviors

College cheating is prevalent, with rates ranging widely from 9 to 95% (Whitley, 1998). Research has been exclusively conducted with enrolled college students. This study examined the prevalence of cheating in a sample of college alumni, who risk less in disclosing academic dishonesty than current students. A total of 273 alumni reported on their prevalence and perceived severity of 19 cheating behaviors. The vast majority of participants (81.7%) report having engaged in some form of cheating during their undergraduate career. The most common forms of cheating were “copying from another students assignment” and “allowing others to copy from your assignment.” More students reported cheating in classes for their major than other classes. Males and females cheated at the same rates in classes for their major, and males reported higher rates of cheating than females in nonmajor classes. Respondents reported that their top reasons for cheating were “lack of time” and “to help a friend.”

Community-Based Applied Research With Latino Immigrant Families: Informing Practice and Research According to Ethical and Social Justice Principles

This manuscript describes the implementation of two community-based programs of research with Latino immigrant populations exposed to intense contextual challenges. We provide background on our program of research and specific implementation of an evidence-based parenting intervention. We also describe how our research efforts were seriously affected by immigration-related events such as the ICE raids in Utah and a history of discrimination and exclusion affecting Latino immigrants in Michigan. These external political and social challenges have affected the very core principles of our efforts to implement community-based approaches. The current manuscript describes key lessons that we have learned in this process. Finally, reflections for research, practice, and social policy are included.

Examining the Impact of Differential Cultural Adaptation with Latina/o Immigrants Exposed to Adapted Parent Training Interventions

Objective: There is a dearth of empirical studies aimed at examining the impact of differential cultural adaptation of evidence-based clinical and prevention interventions. This prevention study consisted of a randomized controlled trial aimed at comparing the impact of 2 differentially culturally adapted versions of the evidence-based parenting intervention known as Parent Management Training, the Oregon Model (PMTOR). Method: The sample consisted of 103 Latina/o immigrant families (190 individual parents). Each family was allocated to 1 of 3 conditions: (a) a culturally adapted PMTO (CA), (b) culturally adapted and enhanced PMTO (CE), and (c) a wait-list control. Measurements were implemented at baseline (T1), treatment completion (T2) and 6-month follow up (T3). Results: Multilevel growth modeling analyses indicated statistically significant improvements on parenting skills for fathers and mothers (main effect) at 6-month follow-up in both adapted interventions, when compared with the control condition. With regard to parent-reported child behaviors, child internalizing behaviors were significantly lower for both parents in the CE intervention (main effect), compared with control at 6-month follow-up. No main effect was found for child externalizing behaviors. However, a Parent × Condition effect was found indicating a significant reduction of child externalizing behaviors for CE fathers compared with CA and control fathers at posttest and 6-month follow-up. Conclusion: Present findings indicate the value of differential cultural adaptation research designs and the importance of examining effects for both mothers and fathers, particularly when culturally focused and gender variables are considered for intervention design and implementation.

A Balancing Act: Integrating Evidence‐Based Knowledge and Cultural Relevance in a Program of Prevention Parenting Research with Latino/a Immigrants

Family therapists have a unique opportunity to contribute toward the reduction of widespread mental health disparities impacting diverse populations by developing applied lines of research focused on cultural adaptation. For example, although evidence-based prevention parent training (PT) interventions have been found to be efficacious with various Euro-American populations, there is a pressing need to understand which specific components of PT interventions are perceived by ethnic minority parents as having the highest impact on their parenting practices. Equally important is to examine the perceived cultural relevance of adapted PT interventions. This qualitative investigation had the primary objective of comparing and contrasting the perceived relevance of two culturally adapted versions of the efficacious parenting intervention known as Parent Management Training, the Oregon Model (PMTO). According to feasibility indicators provided by 112 Latino/a immigrant parents, as well as findings from a qualitative thematic analysis, the core parenting components across both adapted interventions were identified by the majority of research participants as relevant to their parenting practices. Participants exposed to the culturally enhanced intervention, which included culture-specific sessions, also reported high satisfaction with components exclusively focused on cultural issues that directly impact their parenting practices (e.g., immigration challenges, biculturalism). This investigation illustrates the relevant contributions that family therapy scholars can offer toward addressing mental health disparities, particularly as it refers to developing community-based prevention interventions that achieve a balance between evidence-based knowledge and cultural relevance.

Medical professionalism: an experimental look at physicians’ Facebook profiles

Background Use of social networking services (SNS) is on the rise. While many users sign in for personal purposes, it is not uncommon for professionals to connect over SNSs with clients, students, and patients. Methods The present study used an experimental approach to examine how medical doctors’ SNS profiles impacted potential patients’ impressions of professionalism. Participants (N=250 students) were randomly assigned to view one of six Facebook profiles. Profiles were populated with 1) solely professional material, 2) personal material that was strictly healthy, or 3) personal material that included unhealthy behavior. Profiles portrayed a male or female physician resulting in a total of six experimental conditions. Medical professionalism was measured with the First Impressions of Medical Professionalism (FIMP) scale, specifically developed for this study. Results There was a large and statistically significant main effect for profile type, F(2, 250)=54.77, p<0.001, ηp 2=0.31. Post hoc tests indicated that personal profiles that contained healthy behavior were rated as most professional followed by profiles with strictly professional content. Personal unhealthy profiles were rated as least professional. Additionally, female profiles consistently received higher professionalism ratings across all three profile types [F(1, 250)=5.04, p=0.026, ηp 2=0.02]. Conclusion Our results suggest that a physicians SNS profile affects a patients perception of that physicians medical professionalism. A personal, healthy profile may augment a patients perception of that physicians character virtues if the profile content upholds the decorum of the medical field.

Liderazgo: Culturally Grounded Leadership and the National Latina/o Psychological Association:

This article, collaboratively written by the presidents of the National Latina/o Psychological Association (NLPA), presents leadership as conceptualized and practiced in NLPA. We first identify key leadership constructs in the available literature as well as relevant cultural values, describe liderazgo (leadership) through cultural lenses, and articulate the connections to counseling psychology and the social justice underpinnings that have guided NLPA’s formation and development. We then present a number of events and decisions to illustrate how we have operationalized these organizing principles in both the daily management and long-term goals of NLPA. We conclude with a discussion of the future paths and possible directions in the next decade for the organization.

Enhancing Parenting Practices with Latino/a Immigrants: Integrating Evidence-Based Knowledge and Culture According to the Voices of Latino/a Parents

Effective and emotionally nurturing parenting practices constitute salient protective factors in the lives of children and youth. Although social workers have influenced in important ways the scholarship associated with the development and dissemination of culturally relevant evidence-based parenting interventions for underserved populations, low-income ethnic minorities continue to lack access to culturally relevant and efficacious parenting interventions in the United States due to widespread mental health disparities. Addressing this gap in service delivery is necessary, particularly because populations exposed to historical oppression and intense contextual adversity are at an increased risk for engaging in harsh parenting practices. The purpose of this paper is to reflect on the process of change that we have documented as a group of 130 underserved Latino/a immigrant parents were exposed to a culturally adapted evidence-based parenting intervention. An emphasis on describing the process of change leading to improved outcomes is relevant for clinical social workers engaged in the direct delivery of preventative or clinical parenting interventions. Thus, this manuscript will focus on issues of engagement and retention of parents, with important consideration to the importance of integrating evidence-based knowledge, cultural relevance, and key principles of social work practice.

Cultural Adaptations to Psychotherapy: Real-World Applications

This special issue was born of a series of challenges. As a scholar in the field of cultural adaptations, Domenech Rodríguez had presented and published numerous works, which were met with particular excitement from practitioners hoping to gain insights into how to translate research findings into their diverse clinical practices. When asked “how can I make these cultural adaptations with my clients?” her honest answer was, “I am not sure.” The question posed a wonderful challenge to make research relevant in the real world. How could we take the lessons learned from cultural adaptations conducted as part of grant-funded work that was carried out within research teams and with much mentorship and support from colleagues and transport them to clinicians’ private practices? Meanwhile, Koslofsky was training doctoral students in clinical skills and challenged by her students to bring her course materials on cultural adaptations alive in supervision and clinical practice. She engaged this task with vigor and her efforts led to a panel at the biennial conference of the Society for the Psychological Study of Culture, Ethnicity, and Race where both guest editors met in person and issued the final challenge to each other: Can we find other psychotherapists who are doing the same work? And can we find a home to share this great work with other clinicians? Clinical Case Studies was the perfect home, and we are both thrilled to be able to advance our social justice goals to reduce health disparities in mental health by sharing excellent examples for how to culturally adapt psychotherapy to improve fit, relevance, and outcomes for ethnically and culturally diverse clients. There is an abundance of literature to support the increased effectiveness of culturally adapted evidence-based interventions (Barrerra, Castro, Strycker, & Toobert, 2013; Benish, Quintana, & Wampold, 2011; Chavez-Korell et al., 2012; Chowdhary et al., 2014; Griner & Smith, 2006; Smith, Domenech Rodríguez, & Bernal, 2011). This literature is primarily built on interventions occurring in the context of research trials. There is little, if any, information about how to make these proposed cultural adaptations in real-world settings. In this special issue of Clinical Case Studies, we highlight the important work, the “how to,” that psychotherapists are doing to integrate cultural adaptations into their evidence-based practices. These are by no means an exhaustive or comprehensive list, but rather provide a sampling from which to begin to form ideas about systematic approaches that clinicians could develop over time, much in the same manner that

Strengthening a Culture of Prevention in Low- and Middle-Income Countries: Balancing Scientific Expectations and Contextual Realities

Relevant initiatives are being implemented in low- and middle-income countries (LMICs) aimed at strengthening a culture of prevention. However, cumulative contextual factors constitute significant barriers for implementing rigorous prevention science in these contexts, as defined by guidelines from high-income countries (HICs). Specifically, disseminating a culture of prevention in LMICs can be impacted by political instability, limited health coverage, insecurity, limited rule of law, and scarcity of specialized professionals. This manuscript offers a contribution focused on strengthening a culture of prevention in LMICs. Specifically, four case studies are presented illustrating the gradual development of contrasting prevention initiatives in northern and central Mexico, Panamá, and Sub-Saharan Africa. The initiatives share the common goal of strengthening a culture of prevention in LMICs through the dissemination of efficacious parenting programs, aimed at reducing child maltreatment and improving parental and child mental health. Together, these initiatives illustrate the following: (a) the relevance of adopting a definition of culture of prevention characterized by national commitments with expected shared contributions by governments and civil society, (b) the need to carefully consider the impact of context when promoting prevention initiatives in LMICs, (c) the iterative, non-linear, and multi-faceted nature of promoting a culture of prevention in LMICs, and (d) the importance of committing to cultural competence and shared leadership with local communities for the advancement of prevention science in LMICs. Implications for expanding a culture of prevention in LMICs are discussed.