Cultural Competence in Juvenile-Justice Evidence-Based Practice

Sarah Cusworth Walker, Ph.D, Eric Trupin, Ph.D.University of Washington

•The MacArthur Foundation Models for Change Initiative grants began in 1990 to support “rational, fair, effective and developmentally appropriate” policies and procedures in juvenile justice.

•Washington State selected as the most recent Models for Change state.

•The aim of our grant proposal was to “promote adoption of evidence-based practices for culturally diverse youth (esp. Latino youth) involved or at risk of becoming involved with the juvenile justice system.”

•We sought to do this by engaging in a community-involved approach to assess the needs in the community and suggest appropriate EBP’s based on cultural fit.

•We also are also speaking with community providers and examining the literature related to cultural competence to recommend to the community and to the MacArthur Foundation how cultural competence and EBPs can be effectively and practically realized in applied settings.

BACKGROUND

ISSUES/LITERATURE

PRELIMINARY RESULTS

• We have completed approximately 80 surveys in our first two months of data collection. These have not yet been coded, but are distributed about equally between Latino and non-Latino community members (primarily White-NH).

• An interview with a community mental health director and a focus group with White-nonLatino parents who have had children in the juvenile justice system revealed the following insights:

• Participants: Community wide survey targeting youth 13 and older and all adults. Minimum target sample of 200 with demographic distribution representative of the community.

•Procedure: Convenience and judgment sampling. Convenience sampling through attending large community events to complete interviews and sign people up to do interviews later over the phone.

E.g, Cinco De Mayo festival

Richland Community Swim Sign-Up Day

counseling center Parents’ Night

town hall meetings

Judgment sampling: Approaching families waiting for court at the Juvenile Justice Court to complete surveys or sign up for an interview over the phone. Targeting neighborhoods with at-risk demographics (low income, high crime) for Latino and nonLatino families. Neighborhood canvassing to complete surveys.

•Survey development: The survey was developed with input from local and national experts to cover three broad areas: 1. What are the general needs of youth in the community. 2. How well is the juvenile justice system currently working to provide effective services. 3. Is the current system fair and culturally competent.

•The survey is 55 questions long, and has substantial skip patterns for those who have not had juvenile justice experience. There is an adult and youth version and both version have been translated into Spanish.

Survey

Focus GroupsParticipants: One focus group of English-speaking, nonLatino parents. One focus group of Latino parents, English or Spanish speaking. One focus group of youth (both nonLatino and Latino) and one focus group of caseworkers/therapists or probation officers.

Procedure: Focus groups will be 8-10 people and moderated by a psychologist with clinical training in group process and discussion. Focus groups will last approximately 2 hours. For any groups with both English and Spanish speakers, a translator will be present to facilitate the discussion.

Key Informant InterviewsParticipants: To provide a broad perspective on needs in the community, we will identify and interview “experts” on community services in general and evidence-based practices with Latino youth and families in particular: This may include community mental health directors, probation officers, judges, counselors working with Latino clients, the director of United Way, and faith-based groups.

Procedure: Interviews are conducted in person and last approximately one hour.

Instruments: The format is a semi-structured interview using questions to encourage the direction of the conversation.

E.g., Are their unique mental health needs in the local Latino community?

What are the barriers to getting Latino youth with mental health needs into treatment?

If you could choose between an EBP that was developed for a Latino sample across the country, or a more general EBP that came with a cultural competence module – what would you prefer?

The push towards EBP training will help in general because staff gets better

training ...but even with EBPs, staff need to know how to conceptualize cases well to

be effective.

Most therapists don’t think cultural competence training is important . . .They don’t buy into it. You have to already have a commitment to this population [to be a

culturally competent therapist].

Broad characterizations of Latinos in “typical” trainings, like “machismo” or

“family-focused” are not helpful. You have to get to know and respect the client

individually.

The juvenile justice system not only does not support us [the parents] but

undermines the values we’re trying to teach our children about accountability.

Parents: By far the greatest time of risk is the transition to middle school and the

biggest entry into “antisocial” behavior is drug use.

IMPLICATIONS

• The results of the needs assessment will inform the specific issues the local Juvenile Justice Court deals with regarding policy and procedure, but will also inform the topic at large in regards to cultural competence and justice systems in general.

• Preliminary results reflect issues being debated currently around EBPs and cultural adaptations. We summarize here, briefly, our thinking regarding this complex issue.

• Question: Should existing EBPs be adapted to better reflect/serve different cultures?

1. Better define adaptations. Adaptations that do not affect program components are easily justified. Program component adaptation is likely to need a case by case consultation with EBP developer.

• Translating the manuals/materials

• Introducing pre-therapy components (workshop on what “therapy” is for parents prior to starting treatment).

• Actual alterations to the program components (number of sessions)

2. Impractical to create manualized adaptations for every type of cultural unit (e.g., wide variation in cultural amongst ethnic groups).

3. Use a community-process to decide on what EBPs best fit local needs that includes needs and resource assessments.

3. Cultural competence should be viewed as an ETHICAL issue rather than an EMPIRICAL issue. Adaptation should be part of routine ethical practice in which therapists make accommodations for individual clients that fit within the parameters of the EBP model.

4. Educational institutions and local mental health agencies should be responsible for implementing ongoing cultural competence training for therapists. Cultural competence training should emphasize both process (self-awareness) and knowledge components.

5. EBP developers and researchers should make good faith efforts to include representative samples of ethnic, gender and SES clients (and any other demographic that is hypothesized to affect outcomes) in their efficacy and effectiveness trials and develop translated materials.

6. Databases on available EBPs (OJJDP,. SAHMSA, Blueprints) would facilitate decision processes by also rating the representativeness of the sample and making this information explicit in their reviews of various programs.

•Race is a social concept; some of the categories for race we still use today were developed in the 17th century. People are taught to think about personal identity in terms of race (Smedley, 2006).

•People, in fact, have multiple group memberships (e.g., Hays, 2001) that shape identity: age, race, SES, religion, gender, sexual orientation, etc.

•Definitions of culture vary, but most indicate some intergenerational transmission of beliefs and traditions (e.g., Whaley & Davis, 2007).

•Cultural competence also has multiple definitions, but generally tends to focus on either process or knowledge areas or both. E.g., “Multicultural counseling competence is achieved by the counselor’s acquisition of awareness, knowledge and skills.” (Sue & Tornio, 2005).

•QUESTION: How should existing EBPs be adapted to better reflect/serve different cultures?