Evidence-Based Psychosocial Treatments for Ethnic Minority Youth

Abstract

This article reviews research on evidence-based treatments (EBTs) for ethnic minority youth using criteria from Chambless et al. (1998), Chambless et al. (1996), and Chambless and Hollon (1998). Although no well-established treatments were identified, probably efficacious or possibly efficacious treatments were found for ethnic minority youth with anxiety-related problems, attention-deficit/hyperactivity disorder, depression, conduct problems, substance use problems, trauma-related syndromes, and other clinical problems. In addition, all studies met either Nathan and Gorman's (2002) Type 1 or Type 2 methodological criteria. A brief meta-analysis showed overall treatment effects of medium magnitude (d = .44). Effects were larger when EBTs were compared to no treatment (d = .58) or psychological placebos (d = .51) versus treatment as usual (d = .22). Youth ethnicity (African American, Latino, mixed/other minority), problem type, clinical severity, diagnostic status, and culture-responsive treatment status did not moderate treatment outcome. Most studies had low statistical power and poor representation of less acculturated youth. Few tests of cultural adaptation effects have been conducted in the literature and culturally validated outcome measures are mostly lacking. Recommendations for clinical practice and future research directions are provided.

Preparation of this article was supported by AHRQ grant PO1 HS1087 and NIMH grant K08 MH069583. We thank John Weisz for his conceptual and technical assistance with the meta-analysis.

Notes

¹Weisz and colleagues (Weisz, Donenberg, & Han, 1995; Weisz, Huey, & Weersing, 1998) distinguished between “research therapy” as conducted in university-based settings and “clinic therapy” as practiced in community settings. Research therapy is often characterized by (a) inclusion of youth who were recruited for treatment, (b) homogenous samples with one focal problem, (c) therapists with extensive pretherapy training and supervision, and (d) therapy that is highly structured and/or guided by a manual. Youth psychotherapy outcome research is based almost exclusively on research therapy. However, Weisz and colleagues argued that research therapies may have limited generalizability to clinical practice.

Note: Criteria adapted from Division 12 Task Force on Psychological Interventions (Chambless et al., 1998, Chambless et al., 1996) and from Chambless and Hollon (1998).

²In a meta-analysis of psychotherapy outcome studies, Kazdin and Bass (1989) found a median sample size of 12 per condition, with treatment versus no-treatment comparisons yielding large effects (M ES = .85), and treatment versus placebo comparisons yielding small to medium effects (M ES = .38).

Note: AC = Attention Control; ADHD = Attention-Deficit Hyperactivity Disorder; ADIS = Anxiety Disorders Interview Schedule for DSM-IV; ADIS ASI = Addiction Severity Index; AI = attributional intervention; AMGT = anger management group training; AMT = anxiety management training; AP = attention-placebo; ARC = aggressive-rejected control; ARI = aggressive-rejected intervention; ASC = Attention-Support Control; AT = Attention Training; BASC = Behavior Assessment System for Children; BC = behavioral contracting; Beh = multicomponent behavioral treatment; BPC = Behavior Problem Checklist; BSFT = Brief Strategic Family Therapy; CAT = counselor-led assertive training; CBCL = Child Behavior Checklist; CBITS = cognitive-behavioral intervention for trauma in schools; CBT = Cognitive Behavioral Therapy; CBT-G = CBT-Group; CBT-I = CBT-Individual; CC = community comparison; CCPT = Child-Centered Play Therapy; CCT = Child-Centered Therapy; CDG = counselor-led discussion group; CDI = Children's Depression Inventory; CI = Coping Power with child only; CIR = Clinician's Impairment Rating Scale; CL = universal classroom only; C = no-treatment control; Comb = combined medication and behavioral treatment; CPCL = Coping Power + universal classroom treatment; CP = Coping Power only; CPI = Coping Power with child + parent; CPSS = Child PTSD Symptom Scale; CR = cognitive restructuring; CSP = Clinically-Significant Problem; DESBRS = Devereaux Elementary School Behavior Rating Scale; DSM = Diagnostic and Statistical Manual of Mental Disorders (4th ed. American Psychiatric Association, 1994); EH = Emergency Psychiatric Hospitalization; ES = Effect Size; FET = Family Effectiveness Therapy; FIAP = Fostering Individualized Assistance Program; FSSC-R = Fear Survey Schedule for Children, Revised; GAD = Generalized Anxiety Disorders; GBCT = Group Cognitive-Behavioral Treatment; GC = group treatment control; HCSBS = Home and Community Social Behavior Scales; HRT = human relations training; IPPOCS = Interactive Peer Play Observational Coding System; IPT-G = IPT-Group; IPT-I = IPT-Individual; IPT = Interpersonal Psychotherapy; IT = individual therapy; K-SADS = Schedule for Affective Disorders and Schizophrenia for School-Age Children; M-AMT = modified anxiety management training; MCC = minimum contact control; MDFT = multidimensional family therapy; MM = medication management; MST = multisystemic therapy; NCC = no-contact control; NPS = nonstructured problem-solving; NYS = National Youth Survey; OD = Overanxious Disorder; ODD = Oppositional Defiant Disorder; PAT = peer-led assertive training; PC = placebo control; PDG = peer-led discussion group; PEI = Personal Experiences Inventory; PGT = peer group therapy; PIPPS = Penn Interactive Peer Play Scale; PMIEB = Peer-Report Measure of Internalizing and Externalizing Behavior; PTSD = Post-Traumatic Stress Syndrome; PV = psychoeducational videotape condition; RBPC = Revised Behavior Problem Checklist; RCMAS = Revised Children's Manifest Anxiety Scale; RC = rejected-only control; RC = response cost; REE = rational-emotive education; RI = rejected-only intervention; RPT = Resilient Peer Treatment; SAS-A = Social Anxiety Scale for Adolescents; SCAN = Schedule for Classroom Activity Norms; SCARED = Screen for Child Anxiety Related Emotional Disorders; SGC = small-group counseling; SNAP-IV = Swanson, Nolan, and Pelham Questionnaire; SPS = structured problem-solving; SP = standard practice foster care; SRDS = Self-Report Delinquency Scale; SSBS = School Social Behavior Scales; SSRS = Social Skills Rating System; SST = study skills training; STAXI = Stait-Trait Anger Expression Inventory; TASC = Test Anxiety Scale; TBC = Teacher Behavior Checklist; TF-CBT = Trauma-Focused Cognitive-Behavioral Therapy; TLFB = Timeline Follow-Back Method; TOCA-R = Teacher Observation of Classroom Adaptation–Revised; TRF = Teacher's Report Form; UCS = Usual Community Services; US = usual services; WLC = Waitlist Control; WPBIC = Walker Problem Behavior Identification Checklist; YAS = Young Adult Self-Report; YRBS = Youth Risk Behavior Survey.

^a Clinically Significant Problem.

³However, results from the MTA study (Arnold et al., 2003), Brown and Sexson (1988), and Bukstein and Kolko (1998) do suggest that methylphenidate alone is a well-established treatment for African American youth with ADHD.

Note: DSM = Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994).

^a Substance use and other problems were excluded from this analysis because few studies included these as primary referral problems. Studies were excluded if outcomes focused on both externalizing and internalizing problems.

^b Studies with more than one comparison group were excluded from this analysis.

^c All treatment as usual comparisons were also evaluations of Multisystemic Therapy.

Note: AMT = Anxiety Management Training; CBT = Cognitive Behavioral Therapy; MST = Multisystemic Therapy; RECAP = Reaching Educators, Children, and Parents.

Notes: CBT = Cognitive Behavioral Therapy.

^a N = 5.

^b N = 8.

Note: CBT = Cognitive Behavioral Therapy; FET = Family Effectiveness Therapy; FIAP = Fostering Individualized Assistance Program; IPT = Interpersonal Psychotherapy; MST = Multisystemic Therapy; PTSD = Posttraumatic Stress Disorder.