In recent years, youth across America have been experiencing an increasing mental health crisis. Many attribute the rise in mental health challenges to the pandemic, and the resulting life changes that youth experienced socially and academically. While there is more widespread recognition about the need to support youth mental health and access barriers in the field, it is also important to acknowledge the disparities in access and quality of care across cultures, races, and ethnicities. It is true that all children and families struggle to access mental health care and these access barriers are greater for youth from marginalized backgrounds. Youth and families from marginalized backgrounds have even more hurdles to tackle, such as racism, stigma associated with seeking care, insurance and transportation challenges, and understandable mistrust in a system that wasn’t built for or by them.
Evidence-based treatments are interventions proven to be effective by researchers through clinical trials. Historically, a lot of the research done to develop these treatments has been facilitated by universities and were run with smaller populations that often were not representative of the diversity in race and ethnicity that we have in America. Therefore, a lot of the evidence-based treatments that we have today were created with research based on a primarily white economically advantaged population. Clinical research conducted with participants from ethnic and racial minority identities lags behind the current research base. Even though the vast majority of participants in these initial studies are not made up of a diverse population, there is a strong belief and some preliminary clinical data that evidence-based approaches can be effective for children and families across all racial and ethnic identities.
When discussing research-based approaches for mental health treatments, it is important to define the distinction between “evidence-based treatments” and “evidence-based practices.” Evidence-based treatments are the interventions proven to be effective through research and clinical trials. Evidence-based practice is the approach where a clinician considers the knowledge that we have from research in combination with their own clinical expertise regarding the client’s individual characteristics, culture, racial and ethnic identities, and preferences. The evidence-based practice approach allows clinicians to think about identities that the client may hold, and the impact that they might have on their mental health or the effectiveness of the proven treatments.
In this approach, a clinician will be intentional about incorporating culturally relevant components to the care plan but will also maintain fidelity to the evidence-based treatment. Keeping the core components of the evidence-based treatment ensures that clinicians are providing the strategies that are proven to work, but the incorporation of cultural components aims to individualize the care plan to address specific identity related concerns. Some of these cultural components that clinicians might ask about and consider in the treatment plan might include typical expressions of distress, help-seeking experiences and preferences, family values and whether they align with treatment goals, migration experiences, experiences of racism or marginalization that may impact mental health, and sociopolitical history. Asking about these concepts and experiences will help the clinician to understand communication styles, the ways that the client may engage with or express their mental health, and experiences that impact them in connection to vital parts of their identity.
There is research being produced on the efficacy of full cultural adaptations for mental health treatments. Cultural adaptations take an evidence-based treatment and adapt its components for a specific population. Some of these adaptations for specific populations have been found to be effective, and others have been found to be equally effective, or even less effective, than the original treatments that are provided with a culturally informed care approach. As the research continues to develop, the recommended approach is to integrate cultural considerations with existing evidence-based treatments to individualize treatment for people of all identities. It is imperative to continue to provide evidence-based treatments and practices, especially to ethnic and racial minority youth, as they need proven strategies and approaches that adequately address their mental health challenges.
When you are meeting with your clinician and beginning to formulate a treatment plan for your family and your child, having a conversation about the identities you and your child hold that may have an impact on their experiences, mental health, or approach to therapy will be helpful in making sure that your clinician is keeping the appropriate cultural considerations in mind. Good practice in culturally informed care might include your clinician asking you and your child directly about your experiences with your culture and identity that have impacted your experiences. Knowing about these factors during assessment can be useful for the clinician in their attempt to accurately diagnose and determine an effective treatment plan. For example, if a child shares that they have experienced being bullied due to their skin color at school, and one of their main challenges is social anxiety and a specific worry about their appearance, knowing that they have experienced racism will be impactful in determining how to address these worries. For a child like this, their worries about their appearance and being bullied are founded in lived experience and should be treated differently than worries that are less likely to occur.
Providing evidence-based practices that incorporate culturally informed care is a good way to ensure that children and families are receiving services that are proven to work, but also have the flexibility to address concerns of race, ethnicity, and other identities that have an impact on mental health. Stay tuned for an example of an evidence-based intervention that addresses the experience of racial trauma in treatment for adolescents.
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