1	Promises and Challenges of Evidence-Based Practices for Latino Youth and Families Improving Systems of Care for Latino Youth and Families: Effective and Evidence-Based Strategies for Engagement and Treatment July 21-23, 2004 Miami, Florida Mario Hernandez, Ph.D. Louis de la Parte Florida Mental Health Institute
2	Basic Assumption Culture is an important variable in determining how people (consumers, staff & providers) see and interpret (know) the world around them and the basis of how they make decisions.
3	Why is Culture Important? Striking disparities for people of color in mental health services despite having similar community rates of mental disorders. People of color have less access to mental health care than do whites (European American).
4	Why is Culture Important? People of color are less likely to receive needed care and when they receive it, it is more likely to be poor in quality. Culture and social context influence mental health, mental illness, and mental health services in America.
5	Defacto System
6	Evidence-Based Programs and Cultural Competence: What we know and do not know We know more about effective practices and programs than what is reflected through research done using randomized control trials. There are practices and interventions that consumers and practitioners have found to be helpful in addressing their problems and achieving their goals but for which the evidence base has not been fully established.
7	Status of EBTs Little research related to evidence-based programs has been conducted with diverse populations making it difficult to ascertain whether currently identified evidence-based programs are in fact best practices models for specific racial, ethnic, and cultural communities.
8	Status of EBTs Most studies reporting findings for racial and ethnic minorities had small samples and were not randomized controlled trials. The research used to generate professional treatment guidelines for most health and mental health interventions does not include or report large enough samples of racial and ethnic minorities to allow group specific determinations of efficacy.
9	Status of EBTs Currently we do not know whether and what types of adaptations and modifications of an evidence-based program are needed to ensure that its implementation does not create or exacerbate disparities across cultural groups.
10	Status of EBTS Evidence suggests that culturally oriented interventions are more effective than usual care at reducing dropout rates for people of color receiving mental health services. Because stigma and help-seeking behaviors are two culturally determined factors in service use, research is needed on how to change attitudes and improve utilization of mental services.
11	Status of EBTS While it is important to conduct research involving specific racial, ethnic, and cultural communities, their role should not be limited to just being subjects of research. It is imperative that partnerships are developed with specific racial, ethnic, and cultural communities so they can participate fully in the design, implementation, and evaluation of promising and best practices models.
12	"What beliefs underly our science..." What beliefs underly our science base?
13	Terms The efficacy of an intervention is defined as its effect under “ideal conditions”. The effectiveness of an intervention is defined as its effect under “normal conditions” in field settings.
14	Science Assumes… The Case for EBTS and for Their Dissemination and Implementation EBTS provide guidance to better serve our patients or clients. Using the scientific approach to evaluate treatment is the best way to advance our knowledge so that we can provide even better care in the future. We need to use wisely the limited resources for mental health services. We have treatments that work and most practitioners do not use them. Is there a better alternative than to use science to guide practice?
15	Science Assumes… Some of the Resistance to EBT and its Dissemination and Implementation Will the evidence-based treatment approach lead to more misuse by managed care? Are Evidence-Based Relationships (EBRs) more important than EBTs? Do we have enough evidence to begin the dissemination and implementation of EBTs? Will the dissemination and implementation of EBTs require someone to set standards for treatment?
16	Science Assumes… Changes in Clinical Psychology are Needed Conduct and support effectiveness research. Modify and expand the agenda for researchers. Form partnerships with practitioners and applied programs.
17	Science Assumes… Challenge to APA Journals to advance the cause of dissemination and implementation of EBTs. Education. Facilitating partnerships between clinicians and researchers. Influence public policy to enhance effectiveness research.
18	Michael E. Addis - Clark University 2002 American Psychological Association D12 Practical constraints on practitioners’ ability to use research products. Lack of research on process and outcome of both empirically supported treatments and existing services in different practice contexts. Lack of research on acceptability of research of research products to end users including practitioners, clients, and administrators. Lack of research on training in the integration of science and practice at the undergraduate, graduate, and postgraduate levels. Systemic economic contingencies that favor or punish evidence-based decision making. The tendency to construct dissemination as a hierarchical and unidirectional process of transmission from research to clinical practice.
19	Cultural Blindness Culturally-blind agencies are characterized by the belief that helping approaches traditionally used by the dominant culture are universally applicable; if the system worked as it should, all people - - regardless of race or culture - - would be served with equal effectiveness.
20	"What do you believe?" What do you believe? What do the people you serve believe? What does your community of providers within system of care believe?
21	Evidence-Based Treatment Survey CMHA/ORC Macro/USF
22	Evidence-Based Treatment Survey Racial Composition
23	Evidence-Based Treatment Survey Racial Composition
24	Advantages of Using Evidence-Based Treatments
25	Disadvantages of Using Evidence-Based Treatments
26	Racial Composition of Those Indicating Cultural Differences as a Disadvantage for Using Evidence-Based Treatments
27	"Is there a future for..." Is there a future for us in NIMH? What has NIMH funded? What is the future of EBT research for Latinos?
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35	"What Can Systems Of Care..." What Can Systems Of Care Do?
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38	Challenge to our System of Care Transformation Regarding Serving Latinos…Structural Racism “Structural racism” refers to the ways in which History, Institutional policies, Cultural stereotypes and norms, All interact to maintain racial hierarchies, and racial groups that are inequitable.
39	Defacto System
40	Systems of Care Need To… System of Care Reforms need to be aggressively proactive in the sense that they change both themselves and the environments in which they function in a conscious manner so as to make their access mechanisms, and their service arrays utilized by Latino children and their families.
41	Systems of Care Need To… Seek ways to transform the de facto mental health service system into an intentional system that would articulate with other service sectors where these other sectors impinge on the treatment and care of Latino children and their families.
42	Systems of Care Need To… Engage Latino partners Collaborate with Latino partners Plan with local Latino partners Incorporate resulting plans into your local System of Care.
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45	Four Service Models Mainstream agencies providing outreach services to minorities. Mainstream agencies supporting services by minorities within minority communities. Agencies providing bilingual/bicultural services. Minority-owned services providing services to minority people.
46	Recommendations for Action Investigate differences in outcomes, if any, for persons belonging to different racial, ethnic, and cultural groups as well as any modifications or adaptations that may be needed to enhance the effectiveness of specific evidence-based programs within these groups. Investigate factors that contribute to consumer and practitioner access to evidence-based programs and the extent to which these factors differ across racial, ethnic, and cultural groups and design strategies to increase access accordingly.
47	Culture and EBP More research of culturally adapted and culturally specific practices is needed. Application of quality assurance reviews specific to cultural discrepancies.
48	Finding EBPs Office of the Surgeon General http://www.surgeongeneral.gov/sgoffice.htm Strengthening America’s Families http://www.strentheningfamilies.org SAMHSA Model Programs http://www.model programs.samhsa.gov
49	Finding EBPs Promising Practices Network on Children, Families and Communities http://www.promisingpractices.net Evidence-Based Practices in Mental Health Services for Foster Youth-California Institute for Mental Health http://www.cimh.org/downloads/Fostercaremanual.pdf National Implementation Resource Network http://nirn.fmhi.usf.edu
50	Ask Yourself a Question? Do you…view Latinos as “them” or a part of “us” That is… or “outsiders” or “insiders” who are a part of the exciting transformations possible through systems of care?