Dr. Stan Huey Delivers Keynote at Connecticut’s 14th Annual EBT Conference (2022)

This year's 14th annual Evidence-Based Practices Conference kicked off with a keynote address from Dr. Stan Huey, Associate Professor of American Studies and Ethnicity at the University of Southern California. Dr. Huey discussed "Cultural Adaptation of Evidence-Based Treatments: What We Know and Why it Matters."

Dr. Huey shared "what we know" from research is that evidence-based treatments can work for all kids across racial and ethnic backgrounds. His research has found that there are dozens of EBTs that demonstrate positive outcomes for children from minority groups. These EBTs work to treat a variety of mental health issues. Dr. Huey is currently conducting a review of the related meta-analyses available to see if the EBTs studied produced different treatment outcomes based on race and ethnicity. There have been 29 different meta-analyses reviewed to date, with a majority finding that treatment outcomes were not impacted by race and ethnicity.

Many EBTs that have been studied and used can be “culturally tailored”, but that research is less clear about the benefits of doing so. Cultural tailoring involves adapting treatment to be more responsive to the lived experiences of people from different ethnic and racial minority groups. Conventional therapies were largely developed for White, Western, English-speaking populations, and are still currently delivered mostly by White clinicians. He commented about how the research is inconclusive about formally “culturally tailoring” treatment in part because many clinicians naturally tailor how they implement EBTs based on the backgrounds and experiences of the clients they serve.

Culturally Responsive Treatment (CRT) is the emerging field of documenting, classifying, and studying the many ways to adapt treatments for specific cultural groups. It is a way to formalize the different modifications and strategies for cultural tailoring. Dr. Huey commented that while there is no clear consensus or empirical evidence base for the cultural tailoring of treatment, it is now the norm. When the culture of the client is not fully considered, miscommunication is more frequent, engagement is poorer, and dropout and failure rates are higher. Addressing system biases and providing culturally competent treatment helps reduce stigma, improve access, and increase completion rates.

His research on culturally tailoring treatment for East and Southeast Asian-American populations found that the more culturally tailored the treatment was, the more impactful it was and more likely it was the client would improve from treatment. In this study, treatment that was culturally tailored to be relevant for the specific subgroup population of a client was found to have the greatest impact, while treatment culturally tailored more broadly for Asian-Americans, in general, was less effective. Treatment delivered that was tailored for an even more general population of American ethnic minorities was found to be the least effective.

He also did find that certain adaptations for CRTs can be detrimental to treatment outcomes, especially if the adaptations take away or distract from the core treatment components. Some studies have shown cultural adaptation helps, and others showed it contributed to less positive outcomes.

Despite the complexity of these findings, there are ways to provide effective and culturally responsive care to produce better outcomes for all children. His recommendations for clinicians and providers include:

• Use CBT and other EBTs as first-line treatments as there is lots of evidence that they work across racial and ethnic demographics.
• Strive to have continuous assessment and feedback as ongoing feedback helps recalibrate treatment expectations and monitor progress.
• Provide expert clinical supervision or consultation.
• Use best practices for engagement and addressing barriers to treatment.
• For cultural tailoring:

• Use EBTs that either already include tailored elements or adopt an existing tailoring model to address cultural factors.
• Minimize interference of “active ingredients” of treatment.
• Approach tailoring as a hypothesis to test, not an assumption that it will improve outcomes. 

If interested in viewing Dr. Huey's session, please contact Christine Hauser at chauser@uchc.edu. Learn more about how evidence-based treatments are improving the quality of care for children in Connecticut.