Introduction to the special section on multicultural and community psychology: clinical psychology in context

African American adolescent suicidal ideation and behavior: The role of racism and prevention

Suicide is one of the most devastating, yet preventable, health disparities for African American adolescents. African American adolescent suicidal ideation and behavior may have different manifestations and risk factors relative to those of adolescents from other ethnic backgrounds that impact prevention efforts. For example, in addition to more common manifestations of suicidal ideation and behavior, African American youth may engage in violent or high-risk behaviors, use more lethal means, or report ideation at lower depression levels. The Adapted-Coping with Stress Course (A-CWS), an adaptation of Gregory Clarke and colleagues' Coping with Stress Course, was developed to address the cultural nuances of African American adolescents. The A-CWS is a 15-session cognitive-behavioral, group-based preventive intervention that aims to enhance adaptive coping skills and reduce suicidal ideation, by incorporating strategies that counter stressors associated with systemic racism that burden African American adolescents. This study evaluated the feasibility and acceptability of the A-CWS intervention, using a sample of predominantly African American ninth-grade students. Results indicated that the adolescents were very favorable and receptive to the A-CWS intervention and that the intervention could be conducted feasibly. The A-CWS intervention serves as a model to advance culturally-grounded, evidence-based preventive intervention, for an underserved sector of adolescents.

Using Mindfulness- and Acceptance-Based Treatments With Clients From Nondominant Cultural and/or Marginalized Backgrounds: Clinical Considerations, Meta-Analysis Findings, and Introduction to the Special Series

A growing body of research suggests that mindfulness- and acceptance-based principles can increase efforts aimed at reducing human suffering and increasing quality of life. A critical step in the development and evaluation of these new approaches to treatment is to determine the acceptability and efficacy of these treatments for clients from nondominant cultural and/or marginalized backgrounds. This special series brings together the wisdom of clinicians and researchers who are currently engaged in clinical practice and treatment research with populations who are historically underrepresented in the treatment literature. As an introduction to the series, this paper presents a theoretical background and research context for the papers in the series, highlights the elements of mindfulness- and acceptance-based treatments that may be congruent with culturally responsive treatment, and briefly outlines the general principles of cultural competence and responsive treatment. Additionally, the results of a meta-analysis of mindfulness- and acceptance-based treatments with clients from nondominant cultural and/or marginalized backgrounds are presented. Our search yielded 32 studies totaling 2,198 clients. Results suggest small (Hedges' g=.38, 95% CI=.11 - .64) to large (Hedges' g=1.32, 95% CI=.61 - 2.02) effect sizes for mindfulness- and acceptance-based treatments, which varied by study design.

Lost in translation: an interpretative phenomenological analysis of mental health professionals' experiences of empathy in clinical work with an interpreter

OBJECTIVES

Although empathy is considered by many to be fundamental to psychotherapeutic practice, little is known about how working with an interpreter may affect empathy in clinical work. Accordingly, the present study aims to provide an exploration of mental health professionals' experiences of empathy in clinical work with an interpreter.

DESIGN

A qualitative methodology was utilized in order to provide a rich understanding of participants' shared experiences of empathy in work with an interpreter. Data were gathered using a semi-structured interviewing approach. Interpretative phenomenological analysis (IPA) was chosen as the method of analysis as this would provide a highly descriptive and in-depth account of participants' experiences.

METHOD

Interviews were conducted with 10 mental health professionals regularly working with linguistic interpreters. Interviews were transcribed and analysed using IPA.

RESULTS

The analysis yielded four major themes which described the effects of translation upon empathic dialogues with service-users; changes in the quality of empathic communication with service-users; the effects of cultural similarities and dissimilarities upon empathy within client-interpreter and client-professional dyads; and opportunities for the interpreter to enrich participants' understanding of service-users' perspectives.

CONCLUSIONS

The difficulties participants encountered in work with an interpreter highlight a need for training in cross-language empathy for interpreters and mental health professionals, and encourage the use of transcultural models of psychotherapy in work with non-English speaking service-users. Some of the difficulties associated with adopting traditional humanistic models of empathy, which tend to centralize the therapist within empathic processes, when working with interpreters are also discussed.

Cultural factors and family-based HIV prevention intervention for Latino youth

Latino youth are the fastest growing ethnic group in the United States and are at considerable risk for HIV and other sexually transmitted infections (STIs), given that they have an earlier onset of sexual activity and use condoms less consistently than European American adolescents. Theorists and scholars have emphasized the importance of taking culture into account in sexuality interventions with Latino adolescents, yet few culturally tailored interventions have been developed for this population. Given the emphasis on familismo and collectivism among Latinos, family-based programs are likely to be well received and could contribute to long-term maintenance of adolescent safety. In this synthesis of the relevant literature, cultural factors that have been identified as relevant to Latino sexuality are reviewed and implications for family-based intervention with Latinos are addressed.

A randomized controlled trial of a parent-centered intervention in preventing substance use and HIV risk behaviors in Hispanic adolescents

The present study evaluated the efficacy of Familias Unidas + Parent-Preadolescent Training for HIV Prevention (PATH), a Hispanic-specific, parent-centered intervention, in preventing adolescent substance use and unsafe sexual behavior. Two hundred sixty-six 8th-grade Hispanic adolescents and their primary caregivers were randomly assigned to 1 of 3 conditions: Familias Unidas + PATH, English for Speakers of Other Languages (ESOL) + PATH, and ESOL + HeartPower! for Hispanics (HEART). Participants were assessed at baseline and at 6, 12, 24, and 36 months postbaseline. Results showed that (a) Familias Unidas + PATH was efficacious in preventing and reducing cigarette use relative to both control conditions; (b) Familias Unidas + PATH was efficacious, relative to ESOL + HEART, in reducing illicit drug use; and (c) Familias Unidas + PATH was efficacious, relative to ESOL + PATH, in reducing unsafe sexual behavior. The effects of Familias Unidas + PATH on these distal outcomes were partially mediated by improvements in family functioning. These findings suggest that strengthening the family system, rather than targeting specific health behaviors, may be most efficacious in preventing and/or reducing cigarette smoking, illicit drug use, and unsafe sex in Hispanic adolescents.

A re-examination of cultural factors that mitigate risk and promote resilience in relation to African American suicide: a review of the literature and recommendations for future research

Suicide among African Americans has been acknowledged by the U.S. Surgeon General as a growing crisis. However, suicide remains understudied in this population. In this article, the authors examine the literature related to cultural protective factors that buffer African Americans from suicide risk. They present an overview of suicide among African Americans, review the culture and world-view of African Americans, and examine the degree to which these cultural variables protect against suicide risk. Finally, they discuss the limitations of the extant research on African American suicide, set an agenda for future research, and discuss its implications for clinical practice and public policy.