Community providers’ experiences with evidence-based practices: The role of therapist race/ethnicity.

Abstract

Objectives: Examining therapists' experiences implementing evidence-based practices (EBPs) is fundamental to understanding how these interventions are perceived, adapted, and delivered in community settings. However, little is known about racial/ethnic variation in the experiences of therapists serving racial/ethnic minority youth and their families. Through an innovative QUAN ¡ qual ¡ QUAN mixed-methods approach, we examined differences in therapists' perceptions, adaptations performed, and client-engagement challenges in the largest county-operated department of mental health in the United States. Method: Surveys were completed by 743 therapists (Latinx [44%], White [34%], other ethnic minority [22%]), most of whom were female (88%), master's level (85%), and unlicensed (58%). A subset of therapists (n ϭ 60) completed semistructured interviews. Results: Latinx therapists reported more positive experiences implementing EBPs, making more adaptations to EBPs, and encountering fewer client-engagement challenges than therapists from other racial/ethnic groups. Qualitative analyses expanded on these results, revealing that Latinx therapists commonly described adapting EBPs in terms of language and culture to improve fit and promote client engagement. Informed by these qualitative themes, a refined statistical model revealed that the ability to deliver EBPs in languages other than English might have accounted for differences in therapist-reported EBP adaptations and clientengagement challenges. Conclusions: The findings suggest that racial/ethnic minority therapists have positive experiences in implementing EBPs in community settings. In the case of Latinx therapists, bilingual/bicultural competence may facilitate adapting EBPs in ways that reduce perceptions of engagement challenges with racially/ethnically diverse clients. Public Significance StatementConsidering concerns in the field regarding provider-client cultural mismatch and potential lack of data supporting the efficacy of evidence-based practices (EBPs) for racial/ethnic minority groups, investigators have increasingly called for attention to diversifying the mental health workforce. This study shows that racial/ethnic minority therapists, especially Latinx therapists, capitalize on their language and cultural competencies to serve hard-to-reach racial/ethnic minority youth and their families.

Therapist adaptations to evidence-based practices and associations with implementation outcomes in child therapy sessions.

“…Qualitative analyses of Modifying Presentation descriptions revealed therapists tailoring active teaching techniques in creative ways; modifying language for developmental and cultural needs; and personalizing EBP content to clients’ lived experiences. Such adaptations are consistent with therapists using their local knowledge and multicultural competence to tailor EBP presentation for their clients (Ramos et al, 2020).…”

Scaling-up Child and Youth Mental Health Services: Assessing Coverage of a County-Wide Prevention and Early Intervention Initiative During One Fiscal Year

“…Agencies involved in the PEI initiative shared that having bilingual therapists was one of their engagement strategies (Regan et al, 2017 ). Researchers have found that Latino/a therapists involved in PEI made more culturally congruent adaptations to EBPs than White therapists (Ramos et al, 2020 ). Latino/a therapists frequently made language-based adaptations to the interventions to improve fit with clients.…”

Skill change among Latinx families in a behavioral parenting intervention: The interactive effect of caregiver language preference and acculturation.

“…This strategy is also aligned with recent guidelines for the provision of culturally robust PCIT for marginalized groups (McCabe et al, 2020). Importantly, these types of data-driven adaptations have been shown to lead to fewer client engagement issues among Latinx families receiving care in community settings (Ramos et al, 2021).…”