May 2023: Exploring Cultural Adaptation of Evidence-Based Treatment in Clinical Supervision
This month we explore the topic of Cultural and Identity Adaptations of Evidence-Based Treatment. Historically, social workers have been at the forefront of serving individuals and families impacted by adversity and inequalities. However, low-income ethnic minority populations in the United States continue to experience widespread mental health disparities. A fundamental approach to addressing these disparities is culturally adapting efficacious interventions that have been shown to work but need cultural refinement.
Essentially, cultural adaptation refers “to the systematic modification of an evidence-based treatment (EBT) or intervention protocol to consider language, culture, and context in a way that is compatible with the clients’ cultural patterns, meaning, and values.” Culturally adapting an evidence-based intervention maintains the essential components while amending or including cultural references to increase relevance and engagement for a particular population being served. Researchers have evaluated the overall success of cultural adaptations by studying the impact of several culturally adapted interventions in studies, a line of scientific inquiry known as meta-analysis. As a result, these studies have provided conclusive empirical evidence indicating that culturally adapted interventions can effectively reduce risk factors among vulnerable populations and strengthen protective factors.
Culture and identity are essential aspects of a person's life, and they influence how individuals experience and respond to mental health treatment. Therefore, evidence-based treatments must be culturally and identity sensitive to ensure their effectiveness and accessibility to diverse populations. Here are some cultural and identity adaptations that can be made to evidence-based treatments:
Language Adaptations: Providing mental health treatment in a person's native language ensures that individuals fully understand the treatment and communicate their needs effectively.
Cultural Adaptations: Incorporating cultural beliefs, values, and practices into the treatment make it more relevant and acceptable to the individual.
Community Engagement: Engaging with the community can help create trust and rapport with individuals seeking treatment. This can include working with community leaders or partnering with community organizations to provide mental health services.
Family Involvement: In some cultures, family plays a significant role in mental health treatment. Therefore, involving family members in treatment benefits individuals seeking treatment.
Identity Adaptations: Considering the intersection of an individual's identities, such as race, ethnicity, sexual orientation, or gender identity, helps tailor treatment to meet their needs. For example, understanding how experiences of discrimination or oppression can impact mental health can be essential in providing effective treatment.
Flexibility and Responsiveness: Being flexible and responsive to an individual's unique needs and preferences can help make treatment more accessible and effective. This may include adapting treatment goals or techniques to better suit the individual's needs.
We can create more inclusive and equitable mental health services by acknowledging culture and identity's role in mental health.
In January 2023, the American Academy of Pediatrics (AAP) released recommendations for evaluating and treating childhood and adolescent obesity. These recommendations are the most extreme and restrictive to date. This has resulted in outrage from several communities, including Eating Disorder Specialists (CEDS), about the negative impacts of early rigorous diet restriction, promoting bariatric surgeries for young people, and hyper-fixating on weight starting at the young age of 2 years old.
The Health at Every Size (HAES) movement is a weight-neutral approach to health and wellness that promotes health and well-being rather than weight loss. The movement aims to challenge the traditional focus on weight loss and thinness as the only health indicators and promote body positivity and acceptance for people of all sizes.
The HAES movement is based on the belief that health is a complex issue influenced by many factors, including genetics, environment, and socioeconomic status. That weight is not necessarily a reliable indicator of health. Instead, the movement encourages individuals to adopt healthy behaviors, such as eating a balanced diet, engaging in physical activity, and getting adequate sleep, regardless of weight or body size.
The HAES movement also aims to challenge weight-based discrimination and stigma, which can significantly impact the mental and physical health of individuals living with obesity. By promoting body positivity and acceptance, the movement seeks to create a more inclusive and equitable society that values and respects people of all sizes.
Some of the principles of the HAES movement include the following:
Weight inclusivity: The movement promotes the idea that health and well-being are possible at every size and that individuals of all sizes can adopt healthy behaviors.
Health enhancement: The focus is on promoting health and well-being rather than weight loss. This involves adopting healthy behaviors that support physical, emotional, and mental health.
Respectful care: The movement seeks to challenge weight-based discrimination and stigma and to promote respectful, inclusive, and non-judgmental care for individuals of all sizes.
Eating for well-being: The focus is on eating a balanced, nourishing diet that supports health and well-being rather than dieting or restricting food.
Life-enhancing movement: The movement promotes physical activity that is enjoyable, sustainable, and enhances overall well-being rather than exercise that is focused solely on weight loss.
Overall, the Health at Every Size movement aims to promote a more inclusive and equitable approach to health and wellness that values and respects individuals of all sizes.
In preparation for our conversation this month, we would like you to operate from the orientation that the size of our bodies is an identity worthy of adaptation. We offer the following materials for review:
We also ask that you come prepared to discuss one or two ways to explore body identity with your clients in clinical work.
Optional: This American Life: Tell Me I'm Fat
Clinical supervision is an investment in your career and mental health and an opportunity to network with other clinicians. Supervision protects clients, supports practitioners, and ensures that competent social workers and counselors deliver quality services and adhere to professional standards.
