Providing Evidence-Based Practice to Ethnically Diverse Youths: Examples From the Cognitive Behavioral Intervention for Trauma in Schools (CBITS) Program

• DOI: 10.1097/chi.0b013e3181799f19
• Publication Date: 2009-03-05T20:44:06Z
• Authors: Victoria Ngo; Audra Langley; Sheryl H. Kataoka; Erum Nadeem; Pia Escudero; Bradley D. Stein
• Keywords: Male; Evidence-Based Medicine; Adolescent; Cognitive Behavioral Therapy; 4. Education; Cultural Diversity; 3. Good health; Stress Disorders, Post-Traumatic; 03 medical and health sciences; 0302 clinical medicine; Ethnicity; Indians, North American; Humans; Child; 10. No inequality; School Health Services

At first glance, implementing evidence-based treatments for ethnically diverse youth may appear to raise some concerns. Do manualized treatments work for the diverse youth we see in our communities? Should clinicians only use culturally-specific treatments? Unfortunately, the literature is not definitive. Several studies have found that tailoring interventions for specific populations can increase their effectiveness1–5 while others have found that cultural adaptations of an intervention may actually dilute the effectiveness of the original treatment even though retention is improved.6 What appears to be important is to strike a balance between fidelity to evidence-based treatment and culturally-informed care. This paper provides illustrations from a school-community-academic partnership’s dissemination of the Cognitive-Behavioral Intervention for Trauma in Schools7 program to ethnically diverse communities nationwide. CBITS is an evidence-based intervention program initially developed for ethnic minority and immigrant youth exposed to trauma. CBITS was created to decrease the negative effects of trauma exposure in an ethnically and linguistically diverse group of primarily low-income children while being delivered in the real-world setting of schools. 8, 9 In a randomized controlled study, Mexican and Central American youth showed significant reduction in post-traumatic stress and depressive symptoms.10, 11 Similar positive effects have been found in dissemination evaluations of CBITS in other communities12, including urban African American13, Native American14, and rural communities.15 Although our CBITS partnership recommends program evaluations, we recognize that it is not always feasible for each community to do systematic evaluation for each adaptation or modification of CBITS. In delivering CBITS, we have confronted common issues that arise when trying to deliver an evidence-based intervention to youth from a broad range of ethnic and socioeconomic backgrounds. We present several examples of how we use community partnerships throughout all phases of dissemination, from program development, pre-implementation planning, to delivery of CBITS groups (see Figure 1). Community partnerships refer to collaboration between key stakeholders from the local school and its surrounding community including school personnel, parents, community organizations, faith-based groups, clinicians and researchers. This approach addresses contextual and cultural issues at every stage so that CBITS is tailored for each unique community. We have found this to be a promising model for reaching diverse and underserved populations and increasing community engagement.8, 16 Figure 1 Model for Using Community Partnerships to Provide Culturally-Sensitive Evidence-Based Treatment