Partnering to Adapt Evidence-Based Intervention for Delivery with Ethnic Minority Families

Background:  Although difficulties implementing evidence-based practices (EBPs) exist across cultural environments, disadvantaged groups experience particularly limited access to EBPs in their communities. For individuals who access care, research suggests that ethnic minority families are likely to receive lower quality care than ethnic majority families across multiple quality indicators (Magaña et al., 2013; Magaña, Parish, Rose, Timberlake, & Swaine, 2012). Parents of Hispanic children, for example, reported that providers were not sensitive to family values and were more likely to report that providers did not offer enough information or create an environment that promoted partnership with parents. This research speaks to the need to specifically improve the dissemination of culturally sensitive interventions to improve early intervention for underserved, minority populations. The BRIDGE Collaborative is an academic-community partnership that has adapted a parent-mediated naturalistic developmental behavioral intervention with specific focus on cultural appropriateness for Spanish-speaking families. A community trial of the adapted intervention is currently underway.

Objectives: The objective of this presentation is to share the process of adaptation and implementation of a naturalistic developmental behavioral intervention that was designed for maximum community fit and cultural sensitivity. Additionally, fidelity of implementation of the intervention when delivered in English versus Spanish is examined.

Methods: The BRIDGE Collaborative is an academic-community partnership with the goal of improving access to care for young children with risk for ASD. This group identified an EBP that met stakeholder needs based on input from community sources at multiple levels, including Spanish-speaking providers and families. A systematic, iterative process of adaptation was conducted in collaboration with community stakeholders. The adapted intervention is now being tested in a large urban county, including delivery in English and Spanish. Fifteen agencies participated in a train-the-trainer model of intervention training; agency leaders received training from researchers and returned to their agencies to provide training to therapists. Five of the participating agencies have bilingual leaders and/or therapists who deliver the intervention in both English and Spanish. Video observations of participants were collected both before and after training, and were coded for fidelity of implementation. Additional measures (e.g., satisfaction with services, implementation surveys) were collected from interventionists, as well as families who received intervention.

Results: Feedback from Latino/a providers and parents resulted in the reduction of text in the parent manual, the development of culturally appropriate examples, the creation of summary handouts for intervention strategies and translation of materials into Spanish. Fidelity data from bilingual interventionists indicates substantial differences in strategy use depending on language of delivery (English or Spanish), including decreased prompting of specific skills and less modeling of communication and play when delivered in Spanish.

Conclusions: Differences in how intervention is delivered to English versus Spanish speaking families can inform efforts to improve the quality and fit of treatment for underserved populations. These data support the need for attention to the cultural appropriateness of individual strategies within an intervention. Further, it suggests the need to adapt intervention materials to meet the specific cultural and communication needs of multiple ethnic minority populations.