Discuss how this would specifically inform one intervention recommendation you would make for social work practice with the homeless.

Research Article

Cultural Adaptation of Interventions in Real Practice Settings

Flavio F. Marsiglia1 and Jamie M. Booth2

Abstract This article provides an overview of some common challenges and opportunities related to cultural adaptation of behavioral interventions. Cultural adaptation is presented as a necessary action to ponder when considering the adoption of an evidence-based intervention with ethnic and other minority groups. It proposes a roadmap to choose existing interventions and a specific approach to evaluate prevention and treatment interventions for cultural relevancy. An approach to conducting cultural adaptations is proposed, followed by an outline of a cultural adaptation protocol. A case study is presented, and lessons learned are shared as well as recommendations for culturally grounded social work practice.

Keywords evidence-based practice, literature

Culture influences the way in which individuals see themselves

and their environment at every level of the ecological system

(Greene & Lee, 2002). Cultural groups are living organisms

with members exhibiting different levels of identification with

their common culture and are impacted by other intersecting

identities. Because culture is fluid and ever changing, the process

of cultural adaptation is complex and dynamic. Social work and

other helping professions have attempted over time to integrate

culture of origin into the interventions applied with ethnic

minorities and other vulnerable communities in the United

States and globally (Sue, Arredondo, & McDavis, 1992). In

an ever-changing cultural landscape, there is a renewed need

to examine social work education and the interventions social

workers implement with cultural diverse communities.

Culturally competent social work practice is well established

in the profession and it is rooted in core social work practice

principles (i.e., client centered and strengths based). It strives

to work within a client’s cultural context to address risks and

protective factors. Cultural competency is a social work ethical

mandate and has the potential for increasing the effectiveness

of interventions by integrating the clients’ unique cultural assets

(Jani, Ortiz, & Aranda, 2008). Culturally competent or culturally

grounded social work incorporates culturally based values,

norms, and diverse ways of knowing (Kumpfer, Alvarado,

Smith, & Bellamy, 2002; Morano & Bravo, 2002).

Despite the awareness about the importance of implementing

culturally competent approaches, practitioners often struggle

with how to integrate the client’s worldview and the application

of evidence-based practices (EBPs). When selecting and

implementing social work interventions, practitioners often

continue to unconsciously place themselves at the center of

the provider–consumer relationship. Being unaware of their

power in the relationship and undervaluing the clients per-

spective in the selection of EBPs tends to result in a type

of social work practice that is culturally incompetent and

nonefficacious (Kirmayer, 2012). This ineffectiveness can

be experienced and interpreted by practitioners in several

ways. In instances when clients do not conform to the content

and format of existing interventions, they are easily labeled as

being resistant to treatment (Lee, 2010). In other cases, when

clients fail to adapt to a given intervention that does not feel

comfortable to them, the relationship is terminated or the

client simply does not return to services. Thus, terms such

as noncompliance and nonadherence may hide deeper issues

related to cultural mismatch or a lack of cultural competency

in the part of the practitioner.

Culturally grounded social work challenges practitioners to

see themselves as the other and to recognize that the responsi-

bility of cultural adaptation resides not solely on the clients but

involves everyone in the relationship (Marsiglia & Kulis,

2009). In order to do this, practitioners need to have access

to interventions or tools that are consistent with the culturally

grounded approach. A culturally grounded approach starts with

assessing the appropriateness of existing evidence-based inter-

ventions and adapting when necessary, so that they are more

1 Southwest Interdisciplinary Research Center (SIRC), School of Social Work,

Arizona State University, Phoenix, AZ, USA 2 School of Social Work, University of Pittsburgh, Pittsburgh, PA, USA

Corresponding Author:

Jamie M. Booth, School of Social Work, University of Pittsburgh, 2117

Cathedral of Learning, 4200 Fifth Avenue, Pittsburgh, PA 15260, USA.

Email: jmbooth2@outlook.com

Research on Social Work Practice 2015, Vol. 25(4) 423-432 ª The Author(s) 2014 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/1049731514535989 rsw.sagepub.com

relevant and engaging to clients from diverse cultural back-

grounds, without compromising their effectiveness. This process

of assessment, refinement, and adaptation of interventions will

lead to a more equitable and productive helping relationship.

The ecological systems approach provides a structure for

understanding the importance of cultural adaptation in social

work practice. Situated on the outer level (macro level) of

the ecological system, culture frames the norms, values, and

behaviors that operate on every other level: individual beliefs

and behaviors (micro level), family customs and communica-

tion patterns (mezzo level), and how that individual perceives

and interacts with the larger structures (exo level), such as

the school system or local law enforcement (Szapocznik &

Coatsworth, 1999). In this approach, the relationships between

individuals, institutions, and the larger cultural context within

the ecological framework are bidirectional, creating a dynamic

and rapidly evolving system (Bronfenbrenner, 1977; Gitterman,

2009). The bidirectional nature of relationships is an important

concept to consider when discussing the cultural adaptation

of social work interventions for two reasons: (1) regardless

of the setting, in social work practice, the clients and the

social workers engage in work partnerships in which both par-

ties must adapt to achieve a point of mutual understanding and

communication and (2) culture is in constant flux, as individ-

uals interact with actors and institutions which either maintain

or shift cultural norms and values over time.

Although culturally tailoring prevention and treatment

approaches to fit every individual may not be feasible, cultu-

rally grounded social work may require the adaptation of

existing interventions when necessary while maintaining the

fidelity or scientific merit of the original evidence-based

intervention (Sanders, 2000). This article discusses the need

for cultural adaptation, presents a model of adaptation from

an ecological perspective, and reviews the adaptations con-

ducted by the Southwest Interdisciplinary Research Center

(SICR) as a case study. The recommendations section con-

nects the premises of this article with the existing literature

on cultural adaptation and identifies some specific unresolved

challenges that need to be addressed in future research.

Empirically Supported Interventions (ESIs) in Social Work Practice

EBP has become the gold standard in social work practice and

involve the ‘‘conscientious’’ and ‘‘judicious’’ application of

the best research available in practice (Sackett, 1997, p. 2).

It is commonly believed that utilizing EBP simply requires the

practitioner to locate interventions that have been rigorously

tested using scientific methods, implement them, and evaluate

their effect; however, EBP acknowledges the role of individ-

uals and relationships in this process. EBP requires the inte-

gration of evidence and scientific methods with practice

wisdom, the worldview of the practitioner, and the client’s

perspectives and values (Howard, McMillen, & Pollio, 2003;

Regehr, Stern, & Shlonsky, 2007). The clinician’s judgment and

the client’s perspective are not only utilized in the selection of

the EBP intervention; they are also influential in how the inter-

vention is applied within the context of the clinical interaction

(Straus & McAlister, 2000). Achieving a balance between both

the client and the practitioner’s perspective in the application of

ESIs is essential for bridging the gap between research and prac-

tice (Howard et al., 2003). However, the inclusion of the clini-

cian’s judgment and the client’s history potentially muddles

the scientific merit of the intervention being implemented. This