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Martin P, Haroz EE, Lee C, Bolton P, Martin K, Meza R, McCarthy E, Dorsey S. A qualitative study of mental health problems among children living in New Delhi slums. Transcult Psychiatry 2024:13634615231202098. [PMID: 38389504 DOI: 10.1177/13634615231202098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
Children living in urban slums in India are exposed to chronic stressors that increase their risk of developing mental disorders, but they remain a neglected group. Effective mental health interventions are needed; however, it is necessary to understand how mental health symptoms and needs are perceived and prioritized locally to tailor interventions for this population. We used an existing rapid ethnographic assessment approach to identify mental health problems from the perspective of children living in Indian slums, including local descriptions, perceived causes, impact, and coping behavior. Local Hindi-speaking interviewers conducted 77 free-list interviews and 33 key informant interviews with children and adults (N = 107) from two slums in New Delhi. Results identified a range of internalizing and externalizing symptoms consistent with depression, anxiety, and conduct problems in children. Findings included both common cross-cultural experiences and symptoms as well as uniquely described symptoms (e.g., "madness or anger," "pain in the heart and mind") not typically included on western standardized measures of psychopathology. Mental health problems appeared to be highly interconnected, with experiences such as harassment and fighting often described as both causes and impacts of mental health symptoms in children. Community perspectives indicated that even in the face of several unmet basic needs, mental health problems were important to the community and counseling interventions were likely to be acceptable. We discuss implications for adapting mental health interventions and assessing their effectiveness to reduce the burden of mental illness among children living in urban slums in India.
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Affiliation(s)
- Prerna Martin
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
| | - Emily E Haroz
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Catherine Lee
- UNICEF New York Child Protection in Humanitarian Action, New York, NY, USA
| | - Paul Bolton
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- USAID, Washington, DC, USA
| | - Kiran Martin
- Asha Community Health and Development Society, New Delhi, India
| | - Rosemary Meza
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | | | - Shannon Dorsey
- Department of Psychology, University of Washington, Seattle, WA, USA
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Kaiser BN, Kaufman J, Wall JT, Healy EAF, Ayuku D, Aarons GA, Puffer ES. Assessing ad-hoc adaptations' alignment with therapeutic goals: a qualitative study of lay counselor-delivered family therapy in Eldoret, Kenya. Implement Sci Commun 2023; 4:105. [PMID: 37644561 PMCID: PMC10464241 DOI: 10.1186/s43058-023-00477-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 07/26/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND A key question in implementation science is how to balance adaptation and fidelity in translating interventions to new settings. There is growing consensus regarding the importance of planned adaptations to deliver interventions in contextually sensitive ways. However, less research has examined ad-hoc adaptations, or those that occur spontaneously in the course of intervention delivery. A key question is whether ad-hoc adaptations ultimately contribute to or detract from intervention goals. This study aimed to (a) identify ad-hoc adaptations made during delivery of a family therapy intervention and (b) assess whether they promoted or interrupted intervention goals. METHODS Tuko Pamoja (Swahili: "We are Together") is an evidence-informed family therapy intervention aiming to improve family dynamics and mental health in Kenya. Tuko Pamoja employs a task-shifting model, delivered by lay counselors who are afforded a degree of flexibility in presenting content and in practices they use in sessions. We used transcripts of therapy sessions with 14 families to examine ad-hoc adaptations used by counselors. We first identified and characterized ad-hoc adaptations through a team-based code development, coding, and code description process. Then, we evaluated to what extent ad-hoc adaptations promoted the principles and strategies of the intervention ("TP-promoting"), disrupted them ("TP-interrupting"), or neither ("TP-neutral"). To do this, we first established inter-coder agreement on application of these categories with verification by the intervention developer. Then, coders categorized ad-hoc adaptation text segments as TP-promoting, TP-interrupting, or TP-neutral. RESULTS Ad-hoc adaptations were frequent and included (in decreasing order): incorporation of religious content, exemplars/role models, community dynamics and resources, self-disclosure, and metaphors/proverbs. Ad-hoc adaptations were largely TP-promoting (49%) or neutral (39%), but practices were TP-interrupting 12% of the time. TP-interrupting practices most often occurred within religious content and exemplars/role models, which were also the most common practices overall. CONCLUSION Extra attention is needed during planned adaptation, training, and supervision to promote intervention-aligned use of common ad-hoc adaptation practices. Discussing them in trainings can provide guidance for lay providers on how best to incorporate ad-hoc adaptations during delivery. Future research should evaluate whether well-aligned ad-hoc adaptations improve therapeutic outcomes. TRIAL REGISTRATION Pilot trial registered at clinicaltrials.gov (C0058).
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Affiliation(s)
- Bonnie N Kaiser
- Department of Anthropology; Global Health Program, University of California San Diego, La Jolla, CA, USA.
- Duke Global Health Institute, Durham, NC, USA.
| | | | | | - Elsa A Friis Healy
- Duke Global Health Institute, Durham, NC, USA
- Department of Psychology & Neuroscience, Duke University, Durham, NC, USA
| | - David Ayuku
- Department of Behavioral Sciences, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Gregory A Aarons
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- ACTRI Dissemination and Implementation Science Center, University of Cailfornia San Diego, La Jolla, CA, USA
| | - Eve S Puffer
- Duke Global Health Institute, Durham, NC, USA
- Department of Psychology & Neuroscience, Duke University, Durham, NC, USA
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Yahalom J, Hamilton AB. Cultural Pragmatism: In search of alternative thinking about cultural competence in mental health. JOURNAL OF THEORETICAL AND PHILOSOPHICAL PSYCHOLOGY 2023; 2023:10.1037/teo0000230. [PMID: 37901114 PMCID: PMC10601384 DOI: 10.1037/teo0000230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
Researchers have tended to approach cultural competence through two primary models: acquisition of culturally tailored skills and orientation to cultural process. While each model plays an important, complementary role in cultural competence, both can be limited in conceptualizing and responding to cultural understandings of distress. This article draws on research in multicultural psychology, medical anthropology, and pragmatic philosophy, to introduce cultural pragmatism, a novel orientation to cultural competence that reconceptualizes what it means to hold something to be true in the mental health fields. This article first draws on research in multicultural psychology and anthropology to identify an important limitation regarding how truth is understood in contemporary cultural competence models and how this limitation can impact culturally competent care. Following this, the article considers philosophical pragmatism as an alternative, and introduces a model for practicing cultural pragmatism in clinical settings. As a whole, this article makes two interrelated arguments: first, that a better articulated theory of truth is needed to achieve the goals of cultural competence and, second, that cultural pragmatism can help resolve the limitation that cultural competence approaches currently exhibit.
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Affiliation(s)
- Jonathan Yahalom
- US Department of Veterans Affairs, West Los Angeles
- University of California, Los Angeles
| | - Alison B Hamilton
- US Department of Veterans Affairs, West Los Angeles
- University of California, Los Angeles
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Schilling S, Mebane A, Perreira KM. Cultural Adaptation of Group Parenting Programs: Review of the Literature and Recommendations for Best Practices. FAMILY PROCESS 2021; 60:1134-1151. [PMID: 33908027 PMCID: PMC8551301 DOI: 10.1111/famp.12658] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Group parenting programs based on cognitive-behavioral and social learning principles are effective in improving child behavior problems and positive parenting. However, most programs target non-Hispanic, White, English-speaking families and are largely inaccessible to a growing Hispanic and non-White population in the United States. We sought to examine the extent to which researchers have culturally adapted group parenting programs by conducting a systematic review of the literature. We identified 41 articles on 23 distinct culturally adapted programs. Most cultural adaptations focused on language translation and staffing, with less focus on modification of concepts and methods, and on optimizing the fit between the target cultural group and the program goals. Only one of the adapted programs engaged a framework to systematically record and publish the adaptation process. Fewer than half of the culturally adapted programs were rigorously evaluated. Additional investment in cultural adaptation and subsequent evaluation of parenting programs is critical to meet the needs of all US families.
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Affiliation(s)
- Samantha Schilling
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC; USA
| | - Alexander Mebane
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC; USA
| | - Krista M. Perreira
- Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill, NC; USA
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Cycyk LM, De Anda S, Moore H, Huerta L. Cultural and Linguistic Adaptations of Early Language Interventions: Recommendations for Advancing Research and Practice. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:1224-1246. [PMID: 33769864 PMCID: PMC8702869 DOI: 10.1044/2020_ajslp-20-00101] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 09/29/2020] [Accepted: 12/30/2020] [Indexed: 05/28/2023]
Abstract
Purpose Speech-language pathologists are responsible for providing culturally and linguistically responsive early language intervention services for legal, ethical, and economic reasons. Yet, speech-language pathologists face challenges in meeting this directive when children are from racial, ethnic, or linguistic backgrounds that differ from their own. Guidance is needed to support adaptation of evidence-based interventions to account for children's home culture(s) and language(s). This review article (a) describes a systematic review of the adaptation processes applied in early language interventions delivered to culturally and linguistically diverse populations in the current literature and (b) offers a robust example of an adaptation of an early language intervention for families of Spanish-speaking Mexican immigrant origin. Method Thirty-three studies of early language interventions adapted for culturally and linguistically diverse children ages 6 years and younger were reviewed. Codes were applied to describe to what extent studies document the purpose of the adaptation, the adaptation process, the adapted components, and the evaluation of the adapted intervention. Results Most studies specified the purpose of adaptations to the intervention evaluation, content, or delivery, which typically addressed children's language(s) but not culture. Study authors provided limited information about who made the adaptations, how, and when. Few studies detailed translation processes or included pilot testing. Only one used a comprehensive framework to guide adaptation. A case study extensively documents the adaptation process of the Language and Play Every Day en español program. Conclusions Future early language intervention adaptations should focus on both linguistic and cultural factors and include detailed descriptions of intervention development, evaluation, and replication. The case study presented here may serve as an example. Increased access to such information can support research on early language interventions for diverse populations and, ultimately, responsive service provision.
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Miller CJ, Barnett ML, Baumann AA, Gutner CA, Wiltsey-Stirman S. The FRAME-IS: a framework for documenting modifications to implementation strategies in healthcare. Implement Sci 2021; 16:36. [PMID: 33827716 PMCID: PMC8024675 DOI: 10.1186/s13012-021-01105-3] [Citation(s) in RCA: 156] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 03/22/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Implementation strategies are necessary to ensure that evidence-based practices are successfully incorporated into routine clinical practice. Such strategies, however, are frequently modified to fit local populations, settings, and contexts. While such modifications can be crucial to implementation success, the literature on documenting and evaluating them is virtually nonexistent. In this paper, we therefore describe the development of a new framework for documenting modifications to implementation strategies. DISCUSSION We employed a multifaceted approach to developing the Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS), incorporating multiple stakeholder perspectives. Development steps included presentations of initial versions of the FRAME-IS to solicit structured feedback from individual implementation scientists ("think-aloud" exercises) and larger, international groups of researchers. The FRAME-IS includes core and supplementary modules to document modifications to implementation strategies: what is modified, the nature of the modification (including the relationship to core elements or functions), the primary goal and rationale for the modification, timing of the modification, participants in the modification decision-making process, and how widespread the modification is. We provide an example of application of the FRAME-IS to an implementation project and provide guidance on how it may be used in future work. CONCLUSION Increasing attention is being given to modifications to evidence-based practices, but little work has investigated modifications to the implementation strategies used to implement such practices. To fill this gap, the FRAME-IS is meant to be a flexible, practical tool for documenting modifications to implementation strategies. Its use may help illuminate the pivotal processes and mechanisms by which implementation strategies exert their effects.
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Affiliation(s)
- Christopher J Miller
- VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research (CHOIR), Boston, MA, USA.
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - Miya L Barnett
- Department of Counseling, Clinical, & School Psychology, University of California, Santa Barbara, Santa Barbara, CA, USA
| | - Ana A Baumann
- Washington University at St. Louis, St. Louis, MO, USA
| | - Cassidy A Gutner
- ViiV Healthcare, Innovation & Implementation Science, Research Triangle, NC, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Shannon Wiltsey-Stirman
- National Center for PTSD Dissemination and Training Division, Palo Alto, CA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
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Ametaj AA, Smith AM, Valentine SE. A Stakeholder-Engaged Process for Adapting an Evidence-Based Intervention for Posttraumatic Stress Disorder for Peer Delivery. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 48:793-809. [PMID: 33813717 DOI: 10.1007/s10488-021-01129-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE Peer providers represent a growing sector of the U.S. workforce, yet guidance is needed on best practices for adapting behavioral health interventions for peer delivery. METHODS We utilized the Framework for Reporting Adaptations and Modifications to Evidence-based interventions (FRAME; Wiltsey Stirman et al. 2013, 2019) to describe how we systematically adapted Skills Training in Affective and Interpersonal Regulation (STAIR) for posttraumatic stress disorder (PTSD) for peer delivery. Our process was iterative and relied on engagement of multiple stakeholders, including a work group of organizational leaders (N = 5), peer interventionists (N = 4), intervention experts (N = 2), and trial participants (N = 18). The FRAME was used to guide rapid coding across multiple data sources, including researcher field notes, meeting minutes, and intervention manual documents, and content analysis of semi-structured interviews with peer interventionists and trial participants. RESULTS Phase 1 (pre-trial) focused on modifications for fit with the local context and peer model. Key modifications focused on improving intervention design and packaging, removing clinical and stigmatizing language, and addressing peer interventionist training gaps. We used a hybrid approach to delivery, whereby we integrated peer model principles (self-disclosure, mutuality) into a directive approach. Phase 2 (trial) included reactive fidelity-consistent adaptations, such as additional educational resources. Phase 3 (post-trial) focused on adaptations to support roll-out of the intervention at the peer organization (e.g., group format). CONCLUSION Our stakeholder-engaged process may serve as a helpful exemplar to others tailoring interventions for peer delivery. Future research is needed to understand the role of stakeholder engagement and adaptation in implementation success.
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Affiliation(s)
- Amantia A Ametaj
- Department of Epidemiology, Harvard Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
| | - Ash M Smith
- Department of Psychiatry, Boston Medical Center, 720 Harrison Ave, Suite 1150, Boston, MA, 02118, USA
| | - Sarah E Valentine
- Department of Psychiatry, Boston Medical Center, 720 Harrison Ave, Suite 1150, Boston, MA, 02118, USA. .,Department of Psychiatry, Boston University School of Medicine, 72 E Concord St, Boston, MA, 02118, USA.
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Cluster Randomized Trial of a Multicomponent School-Based Program in Mexico to Prevent Behavioral Problems and Develop Social Skills in Children. CHILD & YOUTH CARE FORUM 2019. [DOI: 10.1007/s10566-019-09535-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Baumann AA, Mejia A, Lachman JM, Parra Cardona JR, López-Zerón G, Amador Buenabad NG, Vargas E, Domenech Rodríguez MM. Parenting Programs for Underserved Populations in Low- and Middle-Income Countries: Issues of Scientific Integrity and Social Justice. GLOBAL SOCIAL WELFARE : RESEARCH, POLICY & PRACTICE 2019; 6:199-207. [PMID: 32095423 PMCID: PMC7036747 DOI: 10.1007/s40609-018-0121-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Research suggests that parenting programs are effective for preventing behavioral and emotional difficulties in children, but a lot more attention needs to be paid to issues of context and culture during the development, testing and implementation of these interventions. The views and needs of underserved and disenfranchised communities in the US and the Global South are often not taken into account for the development and testing of interventions. The successful implementation of evidence-based interventions for vulnerable children and families in underserved and marginalized communities requires careful consideration of how existing paradigms of prevention, evaluation, and implementation science impact issues of social justice and equity. This paper will describe how a team of parenting program researchers has been collaborating with their partners globally in generating local knowledge by balancing the need for rigorous scientific methods with issues of power. Authors from the U.S., Latin America, Africa and Southeast Asia draw on their experiences regarding challenges and successes with issues regarding study design and measurement, the transferability and adaptation of interventions, and the dissemination and implementation of different parenting interventions while placing communities at the center of their efforts through participatory methods. We describe innovative approaches that span the continuum of intervention development, adaptation, optimization, evaluation, implementation, and scale up of different parenting programs for vulnerable children and families across the world. We conclude by offering specific and pragmatic recommendations to increase access of culturally relevant and effective parenting programs in these communities.
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Affiliation(s)
| | - Anilena Mejia
- Instituto de Investigaciones Científicas y Servicios de Alta
Tecnología (INDICASAT)
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Baumann AA, Domenech Rodríguez MM, Wieling E, Parra-Cardona JR, Rains LA, Forgatch MS. Teaching GenerationPMTO, an evidence-based parent intervention, in a university setting using a blended learning strategy. Pilot Feasibility Stud 2019; 5:91. [PMID: 31338206 PMCID: PMC6626357 DOI: 10.1186/s40814-019-0476-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Accepted: 07/05/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Despite the large number of evidence-based practices (EBPs) ready for implementation, they are the exception in usual care, especially for ethnic minority patients, who may not have access to trained health professionals. Providing EBP training as part of a graduate curriculum could help build the pipeline of professionals to provide quality care. METHODS We conducted a before-after study to determine whether we could implement a blended learning strategy (BL; i.e., in vivo and online training) to teach an EBP in university settings. Feasibility in this pilot was operationalized as knowledge acquisition, satisfaction, fidelity, acceptability, and usability. Using GenerationPMTO as the EBP, our aim was to train graduate students enrolled in Psychology, Social Work, and Family Therapy programs in the EBP in one academic year. Two therapists from a community agency were also students in this pilot. A total of 13 students from five universities were trained in the intervention. Adaptations were made to the intervention and training strategy to optimize training fidelity. Focus groups were conducted with the students to capture their perspective about the training. RESULTS Students demonstrated significant knowledge acquisition from baseline (Mean = 61.79, SD = 11.18) to training completion (Mean = 85.27, SD = 5.08, mean difference = - 23.48, 95% CI = - 29.62, - 17.34). They also reported satisfaction with the BL format, as measured by teaching evaluations at the end of the course. Instructors received acceptable fidelity scores (range of 7-9 in a 9-point scale). Qualitative findings from focus groups showed support for acceptability and usability of BL training. CONCLUSIONS BL training in university settings can be conducted with fidelity when provided by appropriately trained instructors. BL that integrates EBP and adaptations may be uniquely applicable for training providers in low-resource and ethnically diverse settings. The BL enhanced knowledge of GenerationPMTO was acceptable and usable to students, and was delivered with high instructor fidelity to the training model.
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Affiliation(s)
- Ana A. Baumann
- George Warren Brown School of Social Work, Washington University, St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO 63130 USA
| | | | - Elizabeth Wieling
- Family Social Science, University of Minnesota, 290 McNeal Hall, 1985 Buford Circle, St. Paul, MN 55108 USA
| | - J. Rubén Parra-Cardona
- Steve Hicks School of Social Work, University of Texas at Austin, 1925 San Jacinto Blvd 3.130F. STOP D3500, Austin, TX 78712-0358 USA
| | - Laura A. Rains
- Implementation Sciences International, Inc., 10 Shelton-McMurphey Boulevard, Eugene, OR 97401 USA
| | - Marion S. Forgatch
- Implementation Sciences International, Inc., 10 Shelton-McMurphey Boulevard, Eugene, OR 97401 USA
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Wiltsey Stirman S, Baumann AA, Miller CJ. The FRAME: an expanded framework for reporting adaptations and modifications to evidence-based interventions. Implement Sci 2019; 14:58. [PMID: 31171014 PMCID: PMC6554895 DOI: 10.1186/s13012-019-0898-y] [Citation(s) in RCA: 540] [Impact Index Per Article: 108.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 04/22/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND This paper describes the process and results of a refinement of a framework to characterize modifications to interventions. The original version did not fully capture several aspects of modification and adaptation that may be important to document and report. Additionally, the earlier framework did not include a way to differentiate cultural adaptation from adaptations made for other reasons. Reporting additional elements will allow for a more precise understanding of modifications, the process of modifying or adapting, and the relationship between different forms of modification and subsequent health and implementation outcomes. DISCUSSION We employed a multifaceted approach to develop the updated FRAME involving coding documents identified through a literature review, rapid coding of qualitative interviews, and a refinement process informed by multiple stakeholders. The updated FRAME expands upon Stirman et al.'s original framework by adding components of modification to report: (1) when and how in the implementation process the modification was made, (2) whether the modification was planned/proactive (i.e., an adaptation) or unplanned/reactive, (3) who determined that the modification should be made, (4) what is modified, (5) at what level of delivery the modification is made, (6) type or nature of context or content-level modifications, (7) the extent to which the modification is fidelity-consistent, and (8) the reasons for the modification, including (a) the intent or goal of the modification (e.g., to reduce costs) and (b) contextual factors that influenced the decision. Methods of using the framework to assess modifications are outlined, along with their strengths and weaknesses, and considerations for research to validate these measurement strategies. CONCLUSION The updated FRAME includes consideration of when and how modifications occurred, whether it was planned or unplanned, relationship to fidelity, and reasons and goals for modification. This tool that can be used to support research on the timing, nature, goals and reasons for, and impact of modifications to evidence-based interventions.
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Affiliation(s)
- Shannon Wiltsey Stirman
- National Center for PTSD and Stanford University, 795 Willow Road NC-PTSD, Menlo Park, CA 94025 USA
| | - Ana A. Baumann
- Washington University in St. Louis, One Brookings Drive, St. Louis, MO 63130 USA
| | - Christopher J. Miller
- Center for Healthcare Organization and Implementation Research (CHOIR),VA Boston Healthcare System, Boston, MA 02130 USA
- Harvard Medical School Department of Psychiatry, Boston, MA 02115 USA
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Evaluation of Family Skills Training Programs to Prevent Alcohol and Drug Use: A Critical Review of the Field in Latin America. Int J Ment Health Addict 2019. [DOI: 10.1007/s11469-019-00060-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
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Haack LM, Araujo EJ. The Collaborative Life Skills Program in Spanish (CLS-S): Pilot Investigation of Intervention Process, Outcomes, and Qualitative Feedback. EVIDENCE-BASED PRACTICE IN CHILD AND ADOLESCENT MENTAL HEALTH 2019; 4:18-41. [PMID: 31938725 PMCID: PMC6959204 DOI: 10.1080/23794925.2018.1560236] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Lauren M. Haack
- University of California, San Francisco (UCSF), 401 Parnassus
Avenue 855, San Francisco, CA 94143, Fax: 415-476-7170,
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Parra-Cardona R, Leijten P, Lachman JM, Mejía A, Baumann AA, Amador Buenabad NG, Cluver L, Doubt J, Gardner F, Hutchings J, Ward CL, Wessels IM, Calam R, Chavira V, Domenech Rodríguez MM. Strengthening a Culture of Prevention in Low- and Middle-Income Countries: Balancing Scientific Expectations and Contextual Realities. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2018; 22:7-17. [PMID: 30058025 DOI: 10.1007/s11121-018-0935-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Relevant initiatives are being implemented in low- and middle-income countries (LMICs) aimed at strengthening a culture of prevention. However, cumulative contextual factors constitute significant barriers for implementing rigorous prevention science in these contexts, as defined by guidelines from high-income countries (HICs). Specifically, disseminating a culture of prevention in LMICs can be impacted by political instability, limited health coverage, insecurity, limited rule of law, and scarcity of specialized professionals. This manuscript offers a contribution focused on strengthening a culture of prevention in LMICs. Specifically, four case studies are presented illustrating the gradual development of contrasting prevention initiatives in northern and central Mexico, Panamá, and Sub-Saharan Africa. The initiatives share the common goal of strengthening a culture of prevention in LMICs through the dissemination of efficacious parenting programs, aimed at reducing child maltreatment and improving parental and child mental health. Together, these initiatives illustrate the following: (a) the relevance of adopting a definition of culture of prevention characterized by national commitments with expected shared contributions by governments and civil society, (b) the need to carefully consider the impact of context when promoting prevention initiatives in LMICs, (c) the iterative, non-linear, and multi-faceted nature of promoting a culture of prevention in LMICs, and (d) the importance of committing to cultural competence and shared leadership with local communities for the advancement of prevention science in LMICs. Implications for expanding a culture of prevention in LMICs are discussed.
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Affiliation(s)
- Rubén Parra-Cardona
- Steve Hicks School of Social Work, The University of Texas at Austin, 1925 San Jacinto Blvd., Stop, D3500, Austin, TX, 78712, USA.
| | - Patty Leijten
- Research Institute of Child Development and Education & Research Priority Area YIELD, University of Amsterdam, Amsterdam, Netherlands
| | - Jamie M Lachman
- Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, UK
- Complexity in Health Improvement, MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Anilena Mejía
- Instituto de Investigaciones Científicas y Servicios de Alta Tecnología, Panama City, Panama
| | - Ana A Baumann
- George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis, USA
| | | | - Lucie Cluver
- Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, UK
- Department of Psychiatry, University of Cape Town, Cape Town, South Africa
| | - Jenny Doubt
- Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Frances Gardner
- Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Judy Hutchings
- Centre for Evidence Based Early Intervention, Department of Psychology, Bangor University, Bangor, UK
| | - Catherine L Ward
- Department of Psychology, University of Cape Town, Cape Town, South Africa
| | - Inge M Wessels
- Department of Psychology, University of Cape Town, Cape Town, South Africa
| | - Rachel Calam
- Division of Psychology and Mental Health, The University of Manchester, Manchester, UK
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Ramos G, Blizzard AM, Barroso NE, Bagner DM. Parent Training and Skill Acquisition and Utilization Among Spanish- and English-Speaking Latino Families. JOURNAL OF CHILD AND FAMILY STUDIES 2018; 27:268-279. [PMID: 29456439 PMCID: PMC5813840 DOI: 10.1007/s10826-017-0881-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
In the U.S., there is a growing Latino population, in which parents primarily speak Spanish to their children. Despite the evidence that language preference is associated with level of acculturation and influences parenting practices in these families, no study has compared how Spanish-and English-speaking Latino families acquire and utilize the skills taught during parent-training programs such as Parent-Child Interaction Therapy (PCIT). Twenty-seven mother-infant Latino dyads received a home-based adaptation of the Child-Directed Interaction (CDI) phase of PCIT as part of a larger randomized control trial. Most infants were male (63%), and their average age was 13.7 months (SD = 1.43). Most families (52%) lived below the poverty line. The Dyadic Parent-Child Interaction Coding System-Third Edition (DPICS-III) was employed to evaluate PCIT skills at baseline and post-treatment, as well as at 3- and 6-month follow-up, assessments. We conducted multiple linear regression analyses among Spanish-speaking (55%) and English-speaking (45%) families to examine differences in acquisition and utilization of do and don't skills at each assessment while controlling for mother's education. Results yielded no group differences in the acquisition rate of do or don't skills at any time point. However, Spanish-speaking mothers used significantly more don't skills than English-speaking mothers at each assessment. Specifically, Spanish-speaking families used significantly more commands at baseline, post-treatment, and the 6-month followup assessments, as well as more questions at post-treatment and at the 6-month follow-up assessments. These findings highlight the importance of addressing cultural values such as respeto to ensure culturally robust parent-training programs for Latino families.
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Affiliation(s)
- Giovanni Ramos
- Department of Psychology, Florida International University, 11200 SW 8th Street, Miami, FL 33199, USA
| | - Angela M Blizzard
- Department of Psychology, Florida International University, 11200 SW 8th Street, Miami, FL 33199, USA
| | - Nicole E Barroso
- Department of Psychology, Florida International University, 11200 SW 8th Street, Miami, FL 33199, USA
| | - Daniel M Bagner
- Department of Psychology, Florida International University, 11200 SW 8th Street, Miami, FL 33199, USA
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16
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Ramaiya MK, Fiorillo D, Regmi U, Robins CJ, Kohrt BA. A Cultural Adaptation of Dialectical Behavior Therapy in Nepal. COGNITIVE AND BEHAVIORAL PRACTICE 2017; 24:428-444. [PMID: 29056846 PMCID: PMC5645023 DOI: 10.1016/j.cbpra.2016.12.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Growing evidence exists on the potential for adapting evidence-based interventions for low- and-middle-income countries (LMIC). One opportunity that has received limited attention is the adaptation of psychotherapies developed in high-income countries (HIC) based on principles from LMIC cultural groups. Dialectical behavior therapy (DBT) is one such treatment with significant potential for acceptability in South Asian settings with high suicide rates. We describe a tri-phasic approach to adapt DBT in Nepal that consists of qualitative interviews with major Nepali mental health stakeholders (Study 1), an adaptation workshop with 15 Nepali counselors (Study 2), and a small-scale treatment pilot with eligible clients in one rural district (Study 3). Due to low literacy levels, distinct conceptualizations of mind and body, and program adherence barriers, numerous adaptations were required. DBT concepts attributable to Asian belief systems were least comprehensible to clients. However, the 82% program completion rate suggests utility of a structured, skills-based treatment. This adaptation process informs future research regarding the effectiveness of culturally adapted DBT in South Asia.
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Affiliation(s)
- Megan K. Ramaiya
- Duke Global Health Institute, 310 Trent Drive, Durham, NC
- Department of Psychology, University of Washington, Box 351525, Seattle, WA
| | - Devika Fiorillo
- Department of Psychiatry and Behavioral Sciences, Emory University, 12 Executive Park Dr. NE, Atlanta, GA
| | - Upasana Regmi
- Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Kathmandu, Nepal
| | - Clive J. Robins
- Department of Psychology & Neuroscience, Duke University, Box 90086, 417 Chapel Drive, Durham, NC
- Department of Psychiatry and Behavioral Sciences, Duke University, Box 90519 Durham, NC
| | - Brandon A. Kohrt
- Duke Global Health Institute, 310 Trent Drive, Durham, NC
- Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Kathmandu, Nepal
- Department of Psychiatry and Behavioral Sciences, Duke University, Box 90519 Durham, NC
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17
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Parra-Cardona JR, Bybee D, Sullivan CM, Rodríguez MMD, Dates B, Tams L, Bernal G. Examining the impact of differential cultural adaptation with Latina/o immigrants exposed to adapted parent training interventions. J Consult Clin Psychol 2017; 85:58-71. [PMID: 28045288 DOI: 10.1037/ccp0000160] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE There is a dearth of empirical studies aimed at examining the impact of differential cultural adaptation of evidence-based clinical and prevention interventions. This prevention study consisted of a randomized controlled trial aimed at comparing the impact of 2 differentially culturally adapted versions of the evidence-based parenting intervention known as Parent Management Training, the Oregon Model (PMTOR). METHOD The sample consisted of 103 Latina/o immigrant families (190 individual parents). Each family was allocated to 1 of 3 conditions: (a) a culturally adapted PMTO (CA), (b) culturally adapted and enhanced PMTO (CE), and (c) a wait-list control. Measurements were implemented at baseline (T1), treatment completion (T2) and 6-month follow up (T3). RESULTS Multilevel growth modeling analyses indicated statistically significant improvements on parenting skills for fathers and mothers (main effect) at 6-month follow-up in both adapted interventions, when compared with the control condition. With regard to parent-reported child behaviors, child internalizing behaviors were significantly lower for both parents in the CE intervention (main effect), compared with control at 6-month follow-up. No main effect was found for child externalizing behaviors. However, a Parent × Condition effect was found indicating a significant reduction of child externalizing behaviors for CE fathers compared with CA and control fathers at posttest and 6-month follow-up. CONCLUSION Present findings indicate the value of differential cultural adaptation research designs and the importance of examining effects for both mothers and fathers, particularly when culturally focused and gender variables are considered for intervention design and implementation. (PsycINFO Database Record
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Wieling E, Mehus C, Yumbul C, Möllerherm J, Ertl V, Laura A, Forgatch M, Neuner F, Catani C. Preparing the Field for Feasibility Testing of a Parenting Intervention for War-Affected Mothers in Northern Uganda. FAMILY PROCESS 2017; 56:376-392. [PMID: 26503176 DOI: 10.1111/famp.12189] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
In this article, we discuss the successful implementation of an adapted evidence-based parenting intervention for families affected by two decades of war in Northern Uganda. The adaptation and adoption of such interventions to support mental health and family functioning is widely endorsed by prevention scientists and considered a priority in global mental health. The preparation and early adoption phases of engaging with a highly vulnerable community affected by war trauma are documented in this paper along with a discussion of the steps taken to adapt a parenting intervention for cultural and contextual fit. This study is a component of an overall program of research aimed at reducing the long-term negative effects of war on parenting practices and childhood outcomes, which have considerable implications for preventing mental, neurological, and substance-use disorders. The processes described here cover a 4-year period culminating in the implementation of the nine-session Enhancing Family Connection intervention piloted with a group of 14 mothers. The lessons in cultural adaptation have been valuable and the feasibility results promising for further testing the intervention.
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Affiliation(s)
- Elizabeth Wieling
- Family Social Science, University of Minnesota, St. Paul, MN
- Victims Voice International (vivo.org), Gulu, Uganda
| | | | - Cigdem Yumbul
- Family Social Science, University of Minnesota, St. Paul, MN
| | - Julia Möllerherm
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Verena Ertl
- Victims Voice International (vivo.org), Gulu, Uganda
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Achan Laura
- Victims Voice International (vivo.org), Gulu, Uganda
| | - Marion Forgatch
- Oregon Social Learning Center, Implementation Sciences International Incorporated, Eugene, OR
| | - Frank Neuner
- Victims Voice International (vivo.org), Gulu, Uganda
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Claudia Catani
- Victims Voice International (vivo.org), Gulu, Uganda
- Department of Psychology, Bielefeld University, Bielefeld, Germany
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Parra-Cardona JR, Zerón GL, Villa M, Zamudio E, Escobar-Chew AR, Rodríguez MMD. Enhancing Parenting Practices with Latino/a Immigrants: Integrating Evidence-based Knowledge and Culture According to the Voices of Latino/a Parents. CLINICAL SOCIAL WORK JOURNAL 2017; 45:88-98. [PMID: 28337047 PMCID: PMC5358511 DOI: 10.1007/s10615-016-0589-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Affiliation(s)
| | - Gabriela López Zerón
- Department of Human Development and Family Studies, Michigan State University (MSU)
| | - Monica Villa
- Holy Redeemer Church (Address: 1721 Junction St., Detroit, Michigan, 48209)
| | - Efraín Zamudio
- Holy Redeemer Church (Address: 1721 Junction St., Detroit, Michigan, 48209)
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