Before engaging in a discussion about culturally informed treatment protocols, it is important to delineate a few basic terms. At the core of cultural adaptations lies an understanding of the term “culture.” Typically thought of as a complex and multifaceted construct, the term encompasses a group of people’s shared history, values, norms, goals, and practices that are transmitted from generation to generation through social interactions. Equally important yet often overlooked in our thinking about culture are subcultures. Subcultures are generally smaller, more homogenous groups that make up the larger cultural or ethnic group. Subcultural groups, such as Mexican or Puerto Rican, often have unique cultural experiences that differentiate them from other groups within the same ethnicity. Hispanic/Latino children and families, for instance, vary across subcultures in terms of immigration circumstances (e.g., reasons for migration, generational status) and sociodemographic characteristics (e.g., educational and income levels) (Umana-Taylor, Diversi, & Fine, 2002). Both culture and subculture can be manifested through observable factors, such as patterned behaviors, symbols, and artifacts, and through cognitive components, such as belief systems and schemas, both of which have been considered in designing and delivering treatment protocols to diverse cultural groups (Barrera, Castro, Strycker, & Toobert, 2012).

When it comes to defining parameters related to culturally informed interventions, the terminology becomes more convoluted with different theories using different terms to describe similar types of cultural modifications. Nevertheless, three distinct categories of cultural consideration in treatment modification typically emerge in the literature: cultural attunement, cultural tailoring, and cultural adaptation.

Cultural attunement, also referred to as cultural sensitivity, is the process by which culturally relevant treatment elements are added to a previously existing treatment protocol in order to enhance treatment engagement and retention of a specific ethnic minority group (Falicov, 2009). Using bilingual therapists, integrating cultural idioms into treatment, and addressing culturally specific barriers to participation are all examples of attunement strategies designed to increase the attractiveness and effectiveness of the therapy program for a specific cultural group. It is important to note, however, that the cultural attunement process focuses on adding to the standard treatment protocol without modifying core treatment components.

Cultural tailoring, or a culturally prescriptive approach, utilizes a more individualized method to modify existing treatment protocols. Kreuter and Skinner (2000) suggest that culturally tailored treatment programs incorporate culturally specific information that is intended to meet the needs of a particular client rather than an entire ethnic group. When using a tailoring approach, cultural modifications are determined by collecting information about the client’s personal connection to his/her cultural background as it relates to the targeted therapeutic goal.

Cultural adaptation is a third category of treatment modification. Although this term often is used interchangeably with “cultural attunement” and/or “cultural tailoring,” cultural adaptation has been defined by Bernal and colleagues as “the systematic modification of an [EBT] protocol to consider language, culture, and context in such a way that it is compatible with the client’s cultural patterns, meanings, and values” (Bernal, Jimenez-Chafey, & Domenech Rodriguez, 2009, p. 362). The key feature that differentiates cultural adaptation from attunement or tailoring is the systematic nature of the modification process. As described in more detail later in this chapter, models of cultural adaptation tend to: (1) use a culture-based theoretical foundation to identify components of therapy that may need adapting in order to successfully treat a particular ethnic minority group, and (2) carefully examine the standard treatment using input from minority group members to shape the adaptation.

In our review of the literature, we found a modest body of work focusing on the treatment of mental, emotional, and behavioral problems in ethnic minority youth. In an effort to advance the knowledge base, this chapter synthesizes theory and research by discussing three key questions: Do current EBTs need to be modified for use with ethnic minority youth? What elements of EBTs should be modified for ethnic minority youth? For whom (what subgroups of ethnic minority youth or individuals) should EBTs be modified? Thus, we begin by providing an evaluative summary of the current research that supports the efficacy of standard treatment protocols with ethnic minority youth. Then we discuss theoretical and methodological approaches to developing culturally informed treatments. Challenges and recommendations to advance the treatment of disorders in ethnic minority youth are identified last with a special focus on clinical application today.