Adapting evidence-based practices for Asian American and Asian immigrant communities: insights from community-based...

The mental health needs of Asian American and Asian Immigrant (AAAI) communities are largely unaddressed due to limited access to culturally responsive care. Evidence-based practices (EBPs) often fail to meet the cultural needs of AAAI people. While many AAAI-serving therapists and staff at community-based organizations (CBOs) help bridge these gaps to improve care for this population, efforts to document modifications have been scarce. The main objective of this study is to identify types of EBPs used with this population and explore culturally responsive adaptations of EBPs to enhance the effectiveness of mental health services for AAAI clients. Thirty-nine semi-structured qualitative interviews were conducted with CBO executives (n = 15), CBO staff (n = 15), and individual therapists (n = 9) across California. All but one interviewee identified as Asian. Interviews explored the types of EBPs used, strategies for cultural adaptation, and implementation of EBPs. Thematic analysis was used to code interview transcripts to identify EBPs used, cultural adaptations, and the implementation process. Findings indicated that CBOs and therapists have frequently employed EBPs, such as cognitive behavioral therapy (CBT), to provide trauma-informed care to AAAI clients. Almost all interviewees mentioned adopting culturally responsive modifications at the individual level for their clients, including integrating cultural values and addressing cultural stigma. Therapists also emphasized the importance of relationship building to increase trust and safety for trauma-impacted clients, as well as individualizing treatment to meet clients' needs. On the organizational and community levels, implementation factors affect the scope and scale of culturally responsive mental health care and services. Major challenges in serving AAAI communities included a lack of culturally responsive training for therapists and limited accessibility to culturally specific mental health resources. Our findings underscore the importance of culturally adapting EBPs to improve behavioral and mental health outcomes for AAAI communities. They can be used to guide therapist decision-making on the individual level and provide key factors to focus on for the successful implementation of EBPs at the organizational and community levels. Insights from therapists and CBO staff are valuable for identifying promising strategies to improve engagement and enhance the effectiveness of EBPs in serving this population. The study also highlights the need for continued efforts in developing, implementing, and evaluating culturally adapted EBPs for AAAI populations.