While evidence-based programs generally lead to improved outcomes, requiring all programs to incorporate only interventions proven effective from an empirical review as a condition for funding may shortchange Hispanics and other communities of color. These communities are frequently under-represented in research studies that seek to find evidence of an intervention’s success. These are some of the highlights of a comprehensive literature review for NAHF conducted by Dr. Luis Torres, Assistant Professor in the University of Houston’s Graduate College of Social Work in Houston, Texas.
Requiring evidence-based interventions is not a complete guarantee that the best programs will always be implemented, Torres says. For example, cultural appropriateness is recognized as being critical in the selection and use of evidence-based programs, but minorities are vastly underrepresented in the very studies researchers use to ensure interventions are useful to all cultural groups.
“Evidenced-based refers to both a process and to canned interventions,” said Torres. “Evidence-Based Interventions are tested through a series of research studies and randomized experiments. So lets say I’m testing an intervention that improves parenting skills. Let’s say I have 100 people I recruit to my study of about the same age and roughly the same education and socio-economic background. I randomly assign 50 individuals to the intervention group and 50 people to a control group. Chances are, I’ll see improvement in both groups, but statistically lets say I find better results among the group that received the intervention. If this process is replicated more than one time with other researcher teams and the results are the same, the intervention is said to have ‘evidence.’
“Now, lets say I take this program, which was largely tested on middle-class, Caucasian individuals with one child per couple, and bring it to an inner-city barrio where parents have multiple children,” Torres continued. “Lets say these families live under the poverty level, and have additional stressors such as low education, language issues, and documentation problems. Chances are, the intervention won’t work the same way, largely because minorities with these same issues weren’t even included in the initial research trial,” Torres said.
Under-representation of minorities in these research trials is an ongoing problem. In an analysis conducted for the Surgeon General’s report Mental Health: Culture, Race and Ethnicity almost a decade ago, of 9,266 participants involved in the efficacy studies that shaped the major evidence-based treatment guidelines for bipolar disorder, schizophrenia, depression, and attention deficit/hyperactivity disorder (ADHD), only 561 (6 percent) were Black, 99 (1percent) were Hispanic, 11 (0.1 percent) were Asian American/Pacific Islanders, and none (0 percent) were American Indians/Alaskan Natives. This under-representation of minorities in RCTs continues, despite a mandate by the National Institutes of Health to include and increase the representation of women and minorities in clinical trials.
“It’s important to increase minority representation at every level of the evidence gathering process, and especially in randomized clinical trials (RCTs),” says Torres. “The seal of approval for evidence-based is the RCT, so we definitely want Hispanic representation when determining if an intervention really works.”
Despite the growing demographic importance of Hispanics, which are the largest and fastest-growing minority in the country, their health, mental health and psychosocial problems continue to be understudied and under-treated. High-prevalence Hispanic health issues include suicide and teenage pregnancies, in addition to domestic violence, alcohol, tobacco and drug use.
Torres and other researchers recommend the adoption of a continuum of evidence, which may include accounts of an intervention’s success from personal experience, word of mouth, and/or the community. Rather than focusing only on the gold standard of randomized clinical trials, Torres says community-defined evidence should be part of the process of determining if a treatment or program is effective.
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