Advances in Latino Family Research: Cultural Adaptations of Evidence-Based Interventions

The stark contrast between frequent calls for research and practice that are applicable across a broad spectrum of cultural and ethnically diverse groups and the dearth of empirical knowledge about Latino families provided the impetus for this special issue on advances in Latino family research. A focus on empirically based practice frames the issue, focusing specifically on how concepts (expressed emotion, parenting style) can be used within interventions, how Latino parents perceive efforts to deliver evidence-based interventions, and how pilot projects that delivered culturally adapted interventions in three separate cities impacted family functioning. In all, the introduction highlights the complexities for researchers in meeting the needs of the field to ensure that effective interventions are applicable across cultural groups. Meeting the challenges is important to address the need of the growing Latino population. Advances in intervention research with ethnic minorities also stand to contribute to the advancement of intervention research broadly. This special issue provides examples of efforts that are underway to better understand what treatments work for Latino families, provided by whom, for what specific problems, and in which specific circumstances, paving the way to begin attempting to answer a challenge posed more than 40 years ago by Gordon Paul.     

Breathing life into family processes: introduction to the special issue on families and asthma

This introduction to the special issue dedicated to families and asthma proposes that the study of asthma highlights general systems topics such as integration of individual needs into the group, developmental trajectories of risk and resilience, supportive and destructive patterns of interaction, and the cultural adaptation of family therapy. It briefly introduces papers in the special issue and concludes that asthma can serve as an exemplar in the study of family health due to its comorbidity with mental health problems, potential to affect multiple members of the family, disproportionate influence on low-income and minority families, and multiple avenues for intervention.     

The Cultural Adaptation of a Transition Program for Latino Families of Youth with Autism Spectrum Disorder

During the transition to adulthood, effective and culturally relevant supports are critical for families of youth with autism spectrum disorder (ASD). There is a dearth of documented program development and research on supports for Spanish-speaking Latino families during this life stage. The present work describes the cultural adaptation process of an evidence-based transition program for Latino families of youth with ASD. A model of the actions necessary to meaningfully conduct a cultural adaptation in this context is described. After implementing the culturally adapted program titled Juntos en la Transición with five Spanish-speaking families, parents reported high social validity of the program through surveys and interviews. The cultural adaptation process followed in this work is important for the further development of programs that address the transition needs of Latino youth with ASD and their families. Our impressions may also be useful to those who aim to develop culturally sensitive and ecologically valid multifamily group intervention programs for families from cultural and linguistic minority groups.     

Commentary: On the Wisdom and Challenges of Culturally Attuned Treatments for Latinos

In this commentary, I outline the common and distinctive components in the cultural adaptation studies in this special issue and compare cultural adaptations with universalistic and culture-specific perspectives. The term cultural attunement may be more reflective than cultural adaptation insofar as the cultural additions in these studies make the treatments more accessible by adding language translation, cultural values, and contextual stressors. These additions most likely enhance the level of engagement and retention in therapy for Latino families. The work ahead requires a deeper examination of the cultural theories of psychological distress and the cultural theories of change in therapy. A final proposal is made in this commentary for considering the bicultural aspects of the cultural adaptation or attunement enterprise, insofar as the clinical research encounters with immigrants are bicultural encounters. These encounters can reach beyond the notion of cultural "adaptation" of mainstream evidence-based treatments to ethnic minorities and present a unique opportunity for mutually enriching bicultural integration of theory, research, and practice.     

Gender Roles in Immigrant Families: Parenting Views, Practices, and Child Development

Ecological and acculturation frameworks are especially central to understanding the experiences of immigrant populations and to date, current research has yielded new conceptual and methodological tools for documenting the cultural and developmental processes of children and their families. This special issue of 12 articles focuses on immigrant families and the importance of gender along various dimensions: parental roles, parent–child relationships, child outcomes. The collection of articles also represents various innovative methodologies used, including quantitative and qualitative approaches.     

Introduction to the Special Issue: Toward Diversity and Cultural Competence in Genetic Counseling

This introduction provides an overview of the professional issues and original research papers in this special issue. The articles address workforce challenges and/or cross-cultural education and communication with culturally and religiously diverse clients. Additional suggestions are made for moving the profession of genetic counseling toward diversity and cultural competence.     

Exploratory Evaluation and Initial Adaptation of a Parent Training Program for Hispanic Families of Children with Autism

The present paper takes a translational approach in applying the themes of the current special section to prevention and intervention science in Latino families. The paper reviews the current literature on cultural processes in prevention and intervention research with Latino families. Overall, many prevention and intervention programs have either been developed specifically for Latino families or have been modified for Latino families with great attention paid to the socio‐cultural needs of these families. Nevertheless, few studies have tested the role of cultural values or acculturation processes on outcomes. We make recommendations based on findings within basic science and in particular this special section on the incorporation of these values and processes into prevention and intervention science with Latino families.     

Prevention and Intervention Research With Latino Families: A Translational Approach

The present paper takes a translational approach in applying the themes of the current special section to prevention and intervention science in Latino families. The paper reviews the current literature on cultural processes in prevention and intervention research with Latino families. Overall, many prevention and intervention programs have either been developed specifically for Latino families or have been modified for Latino families with great attention paid to the socio‐cultural needs of these families. Nevertheless, few studies have tested the role of cultural values or acculturation processes on outcomes. We make recommendations based on findings within basic science and in particular this special section on the incorporation of these values and processes into prevention and intervention science with Latino families.     

Treatment Interventions for Perfectionism—A Cognitive Perspective: Introduction to the Special Issue

The current article provides an overview of the papers included in this special issue and includes a discussion of key issues pertaining to psychological treatments for perfectionism. We describe and review two new treatment intervention studies in this special issue that focus on perfectionism in university students as well as other contemporary research on the use of cognitive-behavioral therapy to treat perfectionists. While the significant reductions in levels of perfectionism as a result of treatment are noteworthy, we caution that perfectionism is a relatively enduring trait; thus, some perfectionists will remain treatment resistant and overall levels of perfectionism may remain relatively high even when significant improvements are realized. Moreover, we discuss the established tendency for perfectionism to be associated with residual symptoms of distress following treatment. As part of our discussion of the other articles in this special issue, we highlight cognitive factors of likely significance in the treatment of perfectionism, including the ruminative response style, the tendency to experience perfectionistic automatic thoughts, and the role of core irrational beliefs in the development of perfectionism. These articles underscore the need to consider key cognitive factors that are central to dysfunctional forms of perfectionism. This special issue on perfectionism is the third special issue on this topic to appear in the Journal of Rational-Emotive and Cognitive-Behavior Therapy under the editorialship of Windy Dryden. We are very grateful for the continuing opportunity in this journal to explore issues related to the cognitive and treatment aspects of perfectionism.     

A Community‐Responsive Adaptation to Reach and Engage Latino Families Affected by Maternal Depression

As family researchers and practitioners seek to improve the quality and accessibility of mental health services for immigrant families, they have turned to culturally adapted interventions. Although many advancements have been made in adapting interventions for such families, we have yet to understand how the adaptation can ensure that the intervention is reaching families identified to be in greatest need within a local system of care and community. We argue that reaching, engaging, and understanding the needs of families entails a collaborative approach with multiple community partners to ensure that adaptations to intervention content and delivery are responsive to the sociocultural trajectory of families within a community. We describe a cultural adaptation framework that is responsive to the unique opportunities and challenges of identifying and recruiting vulnerable families through community partnerships, and of addressing the needs of families by incorporating multiple community perspectives. Specifically, we apply these principles to the cultural adaptation of an intervention originally developed for low‐income African American and White families facing maternal depression. The new intervention, Fortalezas Familiares (Family Strengths), was targeted to Latino immigrant families whose mothers were in treatment for depression in mental health and primary care clinics. We conclude with key recommendations and directions for how family researchers and practitioners can design the cultural adaptation of interventions to be responsive to the practices, preferences, and needs of underserved communities, including families and service providers.     

Adaptation of the Preventive Intervention Program for Depression for Use with Predominantly Low-Income Latino Families

This paper describes the process for and safety/feasibility of adapting the Beardslee Preventive Intervention Program for Depression for use with predominantly low income, Latino families. Utilizing a Stage I model for protocol development, the adaptation involved literature review, focus groups, pilot testing of the adapted manual, and open trial of the adapted intervention with 9 families experiencing maternal depression. Adaptations included conducting the intervention in either Spanish or English, expanding the intervention to include the contextual experience of Latino families in the United States with special attention to cultural metaphors, and using a strength-based, family-centered approach. The families completed preintervention measures for maternal depression, child behavioral difficulties, global functioning, life stresses, and an interview that included questions about acculturative stressors, resiliency, and family awareness of parental depression. The postintervention interview focused on satisfaction, distress, benefits of the adapted intervention, and therapeutic alliance. The results revealed that the adaptation was nonstressful, perceived as helpful by family members, had effects that seem to be similar to the original intervention, and the preventionists could maintain fidelity to the revised manual. The therapeutic alliance with the preventionists was experienced as quite positive by the mothers. A case example illustrates how the intervention was adapted.     

Brief Experimental Analysis: A Decision Tool for Bridging the Gap Between Research and Practice

This special issue illustrates how brief experimental analysis (BEA) is gaining recognition as a valuable tool for making treatment decisions about children who are unresponsive to regular classroom instruction. This commentary article provides evidence for why BEA has grown in popularity, briefly summarizes each of the studies included in the series, and discusses issues that are critical to conducting and interpreting data from a BEA. The articles in the issue exemplify how BEA is flexible enough to evaluate diverse intervention options, is time and cost efficient, and is uniquely suited for use in a problem-solving approach to school-based service delivery.     

The Chinese Life-Steps Program: A Cultural Adaptation of a Cognitive-Behavioral Intervention to Enhance HIV Medication Adherence

China is considered to be the new frontier of the global AIDS pandemic. Although effective treatment for HIV is becoming widely available in China, adherence to treatment remains a challenge. This study aimed to adapt an intervention promoting HIV-medication adherence—favorably evaluated in the West—for Chinese HIV-positive patients. The adaptation process was theory-driven and covered several key issues of cultural adaptation. We considered the importance of interpersonal relationships and family in China and cultural notions of health. Using an evidence-based treatment protocol originally designed for Western HIV-positive patients, we developed an 11-step Chinese Life-Steps program with an additional culture-specific intervention option. We describe in detail how the cultural elements were incorporated into the intervention and put into practice at each stage. Clinical considerations are also outlined and followed by two case examples that are provided to illustrate our application of the intervention. Finally, we discuss practical and research issues and limitations emerging from our field experiments in a HIV clinic in Beijing. The intervention was tailored to address both universal and culturally specific barriers to adherence and is readily applicable to generalized clinical settings. This evidence-based intervention provides a case example of the process of adapting behavioral interventions to culturally diverse communities with limited resources.     

Translating Research for Professional Development and Effective Clinical Practice With Older Adults

This paper offers a commentary on the articles in the special series on cognitive behavior therapy with older adults (Carmin, 2012-this issue), noting the commonalities found across discussions of diagnostic interviewing and cognitive-behavioral assessment and treatment for late-life insomnia, depression and suicide risk, PTSD, and OCD. These case studies demonstrate best practices in the application of cognitive-behavioral strategies for assessment and intervention with a diverse range of older adults. Clinicians can improve the effectiveness of their work with aging clients by expanding their skills in assessment and managing interprofessional relationships in integrated health-care settings. Reflected by the papers in this series, ongoing professional development and research attention are both essential as clinicians from the mental health disciplines increase provision of CBT with older adults. Treatments for specific disorders and problems will also benefit from the growing literature on successful aging, and the application of positive psychology in our future collaborations with older adults and their care partners.     

How Does Migration Affect Mothers’ and Fathers’ Roles Within their Families? Reflections on some Recent Research

Collectively, the articles in this special issue reveal that immigration has diverse effects on individual family members that vary depending on their gender and age. Such findings underscore the need for intensive analysis and comparison on a number of levels—fathers versus mothers, sons versus daughters, parents versus children. This commentary highlights some of the findings that emphasise the centrality of gender in colouring the experience of immigration for different family members. Limitations of the findings are noted and suggestions are made for future research examining the effects of migration on families and family members.     

People Awakening: Collaborative Research to Develop Cultural Strategies for Prevention in Community Intervention

The consequences of alcohol use disorder (AUD) and suicide create immense health disparities among Alaska Native people. The People Awakening project is a long-term collaboration between Alaska Native (AN) communities and university researchers seeking to foster health equity through development of positive solutions to these disparities. These efforts initiated a research relationship that identified individual, family, and community protective factors from AUD and suicide. AN co-researchers next expressed interest in translating these findings into intervention. This led to development of a strengths-based community intervention that is the focus of the special issue. The intervention builds these protective factors to prevent AUD and suicide risk within AN youth, and their families and communities. This review provides a critical examination of existing literature and a brief history of work leading to the intervention research. These work efforts portray a shared commitment of university researchers and community members to function as co-researchers, and to conduct research in accord with local Yup’ik cultural values. This imperative allowed the team to navigate several tensions we locate in a convergence of historical and contemporary ecological contextual factors inherent in AN tribal communities with countervailing constraints imposed by Western science.     

Culturally competent outcome evaluation in systems of care for children's mental health

Conclusions The area of culturally competent outcome evaluation and cross-cultural mental health research in general needs to be greatly developed given the culturally diverse nation we live in and the different needs of culturally diverse children and their families. Such evaluation is crucial in supporting the need for and effectiveness of culturally competent programs and special programs with a focus on particular cultural populations. The imperatives for cost effectiveness and clinical effectiveness which have been promoted by the transition to managed systems of care may actually promote the development of higher levels of cultural competence in community-based systems of care. Culturally competent care may well be the most cost-effective and clinically effective care.