CULTURAL ADAPTATION MODIFICATIONS Framework

Component

Definition Adaptation Examples

Language Refers to the oral and written communication of

the treatment (Bernal &

Dominguez, 2012)

Many African Americans are suspicious of clinical terms (Ginsberg, & Drake,

2002)

Use of theoretical terms for cognitive distortions may be difficult for children

and adolescents to understand (Joyce-Beaulieu, Sulkowski, 2015).

The group was referred to as a “Stress Reduction group” and clinical terms such as “anxiety” and

“internalizing” were avoided

Some of cognitive errors (“Thinking Traps”) were renamed to provide more concrete and developmentally appropriate terminology which

facilitated comprehension of the material Persons Refers to the

client-therapists dyad and

Ethnic-match leads to lower rates of premature termination (Thompson,

Bazile, & Akbar, 2004)

Interventionists need to be aware of the mental health stigma and mistrust of research that persists within the African

American community

It is important that clients feel understood by the therapists. Therapists should also

make attempts to understand the values and worldview of the client and avoid

engaging in any stereotypes and colorblindness (Thompson et al., 2004).

The intervention was delivered by an African-American female

Prior to the delivery of each lesson, interventionist engaged and examined literature pertaining to cultural characteristics of African Americans and reflected upon how these characteristics influence

intervention components

Interventionist engaged in continuous rapport building with participants to increase relationship

Content Content presented in the intervention should be reflective of the values and

views present in the cultural group (Bernal et

al., 1995)

African American culture is considered to more collectivist than the dominant

culture (Larson et al., 2001).

Included case examples (through vignettes and use of multimedia) that were reflective of the collectivist

(whole group nature) of the ECG

Participants were encouraged to engage in open and honest discussions about their experiences (avoid making assumptions, have participants tell their own

stories)

Examples highlighting how family members and community groups can be assets in the treatment

process was incorporated Metaphors The visual and verbal

forms presented should be aligned with symbols and concepts that are shared by

that culture (Bernal et al., 1995; Bernal, Rodriguez,

2012)

Fostering identification and positive affiliation with one’s racial group is associated with racial pride and identity

(Quintana, 2007), which promote resiliency in African Americans (Neblett,

et al., 2009)

Visuals of African American teenagers were included throughout the curriculum

Goals Goals should be consistent with the values, customs, and traditions of the group

in question (Bernal et al., 1995)

African American community is founded on ideals of empowerment and independence (Schwartz et al., 2009) Ethnic-Racial Socialization is a process

in which information regarding one’s race/ethnicity is transmitted from adults to youth (verbally or nonverbally). Often

it entails African American parents promoting the development of their child’s ethnic-racial identity and preparing them from discrimination.

Examples of famous African American role models and leaders that overcome obstacles (e.g., Malcolm X, Oprah Winfrey, Jennifer Hudson, Frank Ocean,

Jay-z) were integrated into the curriculum Participants were encouraged to identify strengths

and positive affirmations

Discussions included ways in which, as African American youth, they could respectfully and effectively advocate for themselves and establish

Other messages include cultural socialization, promotion of mistrust, and

silence about race (Aldana & Byrd, 2015)

what they need to feel supported across various settings (e.g., home, school)

Methods Refers to the procedures used to achieve treatment goals (Bernal, et al., 1995)

African Americans appreciate a more problem-solving approach in which that therapy provides them with concrete and direct techniques (Thompson et al., 2004)

Peer share is an important component of interventions (Ginsberg, & Drake, 2002,

Gordon-Hollingsworth, et al., 2015;

Kelly, 2006)

African American youth typically have less well-developed coping strategies and

tend to engage in less active coping strategies and more avoidant strategies

(Vaughn, & Roesch, 2003; Gaylord-Harden, Gipson, Mance, & Grant, 2008)

Historically, music associated with African American culture (e.g., Hip Hop)

communicates struggles, accomplishments and feelings of unity which can be very therapeutic to African

American individuals (Cork, 2013)

During lessons, participants were encouraged to reflect upon past/current stressors. Group discussions and activities focused on providing participants with suggestions alternative reactions to

past issues/ ways to manage current stressors Interventionist attempted to normalize mental health

issues and interventions through psychoeducation, having honest conversations about mental health in the African American community, sharing personal experiences, empowering students to take advantage

of mental health resources and supports available (e.g., talking with school counselor) Delivery of intervention occurred in groups Collective reflection and sharing out was a key

component during sessions

Participants were provided with a range of coping strategies that included distractive techniques (e.g.,

reading, watching T.V., listening to music), active techniques, seeking social support, and acceptance.

Other forms of multimedia (e.g., v

All coping mechanisms and strategies discussed were modeled and practiced (positive feedback was

provided by interventionist)

Music, and its use as both an expressive and coping strategy, was discussed. Other forms of multi-media

(i.e. video clips) were also used.

Concepts Refers to the case conceptualization of treatment to ensure that is

aligned in a congruent manner (Bernal et al., 1995; Graham et al., 2014)

Important to connect psychoeducation to individuals’ experiences (Graham et al.,

2014)

Vignettes relevant to the lived experiences of participants were included and participants were

encouraged to provide their own examples that connected to the lesson’s objective

Included discussions of culturally responsive risk and protective factors.

Context African Americans are often exposed to

numerous stressors including those associated with discrimination and

marginalization (Kelly, 2006).

Individuals experiences with discrimination (e.g., microaggressions)

can affect core beliefs (Graham et al., 2014) so it is important that experiences with racism are validated (Kelly, 2006).

Discussions pertaining to cognitive restructuring avoided assuming that all “fears” were irrational

(given individuals’ experiences with micro-aggressions and discrimination). Interventionist made a point to ensure that individuals feelings were

validated and that the “restructuring” focuses more on the individuals own self-concept and negative

feelings about the self

Integrated opportunities for discussions about race and discrimination

APPENDIX K