Cultural adaptation and implementation of evidence-based parent-training: A systematic review and critique of guiding evidence

Abstract

With advances in knowledge regarding efficacious evidence-based interventions, there have been significant attempts to culturally adapt, implement, and disseminate parent training interventions broadly, especially across ethnic and cultural groups. We sought to examine the extent to which researchers and developers of evidence-based parent training programs have used cultural adaptation models, tested implementation strategies, and evaluated implementation outcomes when integrating the interventions into routine care by conducting a systematic review of the literature for four evidence-based parent training interventions: Parent-Child Interaction Therapy (PCIT), The Incredible Years (IY), Parent Management Training-Oregon Model (PMTO™), and the Positive Parenting Program (Triple P). A total of 610 articles across the four programs were identified. Of those, only eight documented a rigorous cultural adaptation process, and only two sought to test the effectiveness of implementation strategies by using rigorous research designs. Our findings suggest that there is much work to be done to move parent-training intervention research towards a more rigorous examination of cultural adaptation and implementation practices.

Implementing evidence‐based treatment protocols: Flexibility within fidelity.

“…Although RCTs may be limited by a lack of participant diversity (e.g., race, ethnicity, socioeconomic status), some research has specifically examined the degree to which evidence-based protocols can be adapted for cultural and ethnic minorities. For example, Baumann and colleagues (2015) reviewed the ways in which empirically-supported parent training protocols have undergone cultural adaptation (see also Stirman et al, 2013). As cited by Baumann and colleagues (2015), cultural adaptations involve “the systematic modification of an evidence-based treatment (EBT) to consider language, culture, and context in such a way that is compatible with the client’s cultural patterns, meanings, and values” (Bernal, Bonilla, & Bellido, 1995, p. 362).…”

“…For example, Baumann and colleagues (2015) reviewed the ways in which empirically-supported parent training protocols have undergone cultural adaptation (see also Stirman et al, 2013). As cited by Baumann and colleagues (2015), cultural adaptations involve “the systematic modification of an evidence-based treatment (EBT) to consider language, culture, and context in such a way that is compatible with the client’s cultural patterns, meanings, and values” (Bernal, Bonilla, & Bellido, 1995, p. 362). Although relatively few studies on parenting interventions specifically focused on the effectiveness of cultural adaptations, the current evidence suggests that protocols can be appropriately modified using cultural adaptation frameworks.…”

Transportability of an Evidence-Based Early Childhood Intervention in a Low-Income African Country: Results of a Cluster Randomized Controlled Study

“…Gardner, Montgomery, & Knerr, 2015), most are not available in SSA countries. Several reviews strongly indicate that EBIs can be effective for children from different cultural backgrounds if adapted appropriately (Baumann et al, 2015; F. Gardner et al, 2015).…”

Preliminary Validity of the Eyberg Child Behavior Inventory with Taiwanese Clinic-Referred Children

“…This presents a conundrum, as behavioral parent training (BPT) programs are often cited as the gold standard and best practice for addressing disruptive behaviors in young children because of the robust treatment effects found across a range of ages and externalizing behaviors (e.g., Chambless and Ollendick 2001; Eyberg et al 2008; Forgatch et al 2004; Sanders 2012; Kaminski et al 2008; Webster-Stratton and Reid 2004). Its effectiveness/efficacy with and without cultural adaptation has been demonstrated for children with externalizing behaviors in various cultural groups (e.g., Baumann et al 2015; Homen et al 2015; Leung et al 2017; Matos et al 2009; Sumargi et al 2015), including Taiwanese families (Chen and Fortson 2015; Huang et al 2003). It is difficult, however, to deliver an evidence-based behavioral parent training program without measures that effectively assess for disruptive behavior disorders and/or that can be used in repeated assessments.…”