A case for modular design: Implications for implementing evidence-based interventions with culturally diverse youth.

Abstract

Community-based therapists are frequently faced with the complex task of applying existing research knowledge to clients who may differ markedly from those enrolled in controlled outcome studies. The current paper examines the utility of modular psychotherapy design as one method of facilitating the flexible delivery of evidence-based mental health services to ethnically and culturally diverse children and families. Modularity complements existing approaches to the provision of culturally-sensitive, empirically-informed treatment through its ability to balance the prioritization of research evidence and local practitioner cultural knowledge. Specific applications of modular principles to clinical work with diverse youth are highlighted. Special considerations and limitations relevant to modular psychotherapy and the overall mental health services research literature are discussed, as well as the continued importance of individual clinicians’ cultural competence and use of treatment progress monitoring, both of which should be combined with identified treatment modules to support the delivery of high-quality care.

Therapist report of adaptations to delivery of evidence-based practices within a system-driven reform of publicly funded children’s mental health services.

“…Within the implementation framework, Consolidated Framework for Implementation Research (CFIR), these types of adaptations are considered to be part of the “adaptable periphery,” elements or structures that can be adapted to increase the fit of the intervention with an organization or setting without undermining the intervention’s integrity (Damschroder et al, 2009). Furthermore, growing evidence supports community clinicians adapting and matching core components of EBPs to meet the needs of their culturally diverse clients, using models such as the Distillation and Matching Model (Chorpita & Daleiden, 2009; Chorpita et al, 2013; Lyon, Lau, McCauley, Vander Stoep & Chorpita et al, 2014). Minimal research has investigated whether community therapists make recommended or systematic adaptations to EBPs for their ethnic minority clients, and some evidence suggests that therapists might inappropriately omit components that they perceive as culturally unacceptable (Lau, 2012; Morawska et al, 2012).…”

Using Modular Psychotherapy in School Mental Health: Provider Perspectives on Intervention-Setting Fit

“…In the current study, cultural value appropriateness included general comments about service engagement and notions that ethnic minority clients may be less engaged in more traditional psychotherapy services. As a function of its built-in adaptability, a modular approach may be one method through which practitioners working with ethnically and culturally diverse populations can overcome some, but likely not all, of the commonly-cited tension between model fidelity and flexible service delivery (Kendall & Beidas, 2007; Lyon, Lau, McCauley, Vander Stoep, & Chorpita, under review). In light of recent findings that attention to a greater number of components of cultural adaptation (e.g., language, content, goals) is associated with increased intervention effectiveness (Smith, Domech Rodriguez, & Bernal, 2011), future research should study whether clinicians implementing modular psychotherapy in schools are able to address those components.…”

The Consistencies and Vagaries of the Washington State Inventory of Evidence-Based Practice: The Definition of “Evidence-Based” in a Policy Context

“…This follows WSIPP's existing standards for research quality which include the following: (1) Use of a control/comparison group or sophisticated statistical methods (e.g., propensity score matching, regression discontinuity, or instrumental variables); (2) Intent-to-treat methodology, in which results for completers and non completers are (4) well-validated and/or standardized outcome measures. The process of identifying programs includes literature searches by WSIPP as well as an external nomination process managed by EBPI (Lyon et al 2014). WSIPP conducts independent searches of the literature, including contacting the evaluators and developers of programs to find both published and unpublished work that document positive and unfavorable outcomes.…”