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This newsletter focuses on racial equity. As you will see in the conclusion, we welcome your input on how Blueprints can strategically advance racial equity to improve the lives of all children, youth, and families. Please email your ideas to us at: blueprints@colorado.edu
Now, taking a step back, we ask:
Why is it important for evidence-based programs (EBPs) to be representative of diverse populations?
Before we discuss some of our own thinking, we thought it would be interesting to pose the question to ChatGPT. Below are its autogenerated responses with some edits for clarity.
- Equity and Fairness: Ensuring that evidence-based programs are applicable to diverse populations promotes equity in access to services and resources. When programs are designed and tested on a narrow, non-representative group, it can perpetuate disparities and exclude marginalized or underrepresented communities from benefiting from those programs.
- Cultural Relevancy: Diverse populations often have unique cultural norms, values, and needs. An evidence-based program that takes these factors into account is more likely to be culturally relevant, which enhances acceptability by reaching and engaging communities and their youth in a manner that is consistent with the cultural context and values of that community.
- Generalizability: The findings and recommendations from evidence-based programs should be applicable to a broader population beyond the initial research group. However, if the program is only tested on a homogenous group, whether it will generalize to other communities is not known until it has been rigorously evaluated.
- Community Engagement and Trust: Engaging diverse populations in program development and evaluation builds trust within communities. When communities see themselves represented in the process, they are more likely to trust the program and be willing to participate, which supports the program’s success.
- Funding Support: Policymakers and funders often prioritize EBPs across diverse populations. Having research that includes a wide range of demographics and contexts can help secure resources for scaling and sustaining EBPs.
While the points raised by our ChatGPT robot friends are supported by the current state of the field, there are additional important considerations – for example, cultural adaptation and the development of and testing of culturally tailored EBPs. Following is a summary of each.
Cultural Adaptation
Cultural adaptation involves changing content and materials of an EBP to align with the cultural preferences and sensitivities of the target group.
In thinking about what kinds of changes are needed as Blueprints certified interventions are implemented among diverse populations, communities are encouraged to
- Check with the intervention developer on this question for the population(s) they are serving
- If changes are deemed necessary, consider the “stoplight” framework profiled in a previous newsletter (click here to read more) and depicted in Figure 1 (below).
Figure 1: Using the “Traffic Light” Analogy to Balance Fidelity and Adaptation
Source: Implementation Science at a Glance (p. 12)
Blueprints programs with “green light” adaptations have a good possibility of working (particularly Model and Model Plus programs). However, the more extensive the changes made, and/or the more divergent the target population is from the population in which the program was tested, the greater the need to evaluate the program to make sure it is still effective.
We discussed these points in our last newsletter (click here to read more).
Culturally Tailored Evidence-Based Programs
This approach to designing and implementing evidence-based programs considers the cultural context, values, beliefs, and needs of the target population. These programs have also been demonstrated through rigorous evaluation to be effective. Culturally tailored EBPs combine the best available evidence with cultural relevance.
Two examples of culturally tailored EBPs are profiled in this month’s e-newsletter (both are rated as Promising). They include:
- Familias Unidas, which is a family-based intervention to empower Latino or Hispanic parents residing in the United States in an emerging immigration context to build a strong parent-support network and help their adolescent children respond effectively to the risks of substance use and unsafe sexual behavior. Influenced by culturally specific models, the program first builds a strong parent-support network and then uses the network to increase knowledge of culturally relevant parenting, strengthen parenting skills, and apply new skills in a series of activities designed to help their adolescent children deal successfully with the challenges of daily life. These activities are led by a Spanish-speaking bicultural facilitator.
- Strong African American Families (SAAF) Program, which is an interactive educational program for African American parents and their early adolescent children living in rural communities. The goal of SAAF is to foster resilience among African American youth and prepare them to avoid the negative consequences associated with poverty, exposure to negative community influences and discrimination. The program promotes positive parent-child relationships; enhanced parenting which includes high levels of monitoring and strong communication; and future orientation, resistance skills and acceptance of parental influence by adolescents. All sessions are led by African American community members trained in the SAAF curriculum.
Next, we detail how Blueprints supports prevention efforts within diverse populations.
Understanding for Whom and in What Settings EBPs “Work”
Blueprints’ “Intervention Specificity” standard focuses on the theoretical basis and logic model for the program (you can read more here). To meet this standard, programs must describe:
- The intended participants to receive the intervention.
- The relevant sociodemographic characteristics (age, gender/gender identity, racial and ethnic group, socio‐economic status, urban/suburban/rural residence) of those targeted by the intervention.
- Screening criteria and the screening process if the intended participants are those who have been screened based upon some characteristic(s) (e.g., a risk condition, protective factor status, a minimum level of the study outcome, or some personal or family attribute).
- All inclusion or exclusion criteria for program participation.
Often, we are posed with the question of whether a given Blueprints-certified program will work in certain communities, since preventive interventions serve diverse populations in terms of race, ethnicity, culture, and other sociodemographic factors. For this reason, we include the following information in the “Evaluation Abstract” of all 111 Promising and Model/Model Plus programs currently listed on the Blueprints registry (as of September 2023):
- The target population served by the program in terms of:
- age;
- race/ethnicity;
- gender/gender identity; and
- prevention category, including
- Universal strategies that address the entire population;
- Selective strategies that target subgroups deemed at-risk; or
- Indicated strategies that target youth showing early signs of problem behaviors.
- Sample demographics of studies that meet Blueprints evaluation quality standards to provide information on the program’s generalizability.
- A description of whether the program is implemented at the individual, family, or community level.
- A summary of findings overall (i.e., for the entire sample) and across subgroups to help users understand groups that benefit from interventions, and differential effects that can lead to reducing disparities between subgroups.
Racial and Ethnic Representation in Preventive Intervention Research
The historic momentum concerning acknowledgement of social ills resulting from challenges made worse by the COVID-19 pandemic, however, led Blueprints to question the extent to which preventive interventions collectively (i.e., as a field) are designed to adequately address issues of inequity.
For this reason, we conducted a study among 885 programs with evaluations published from 2010-2021 and recorded in the Blueprints for Healthy Youth Development registry (Buckley et al., 2023). The sample therefore included both certified programs (listed here) and non-certified programs (listed here).
The study emphasized race because COVID-19 brought racial and ethnic inequities to the forefront of public health, exacerbating existing discrepancies for individuals who belong to underserved communities that have been denied equitable opportunities for creating the safety and stability needed to avoid adverse experiences in the first place. Although race is a social construct, it is one of the most powerful and persistent group boundaries in American life today (Okamoto, 2021).
In coding studies, we selected enrollment data for five racial categories to align with U.S. Census coding operations (Asian; Black; Native American; Native Hawaiian or Pacific Islander; and White) and treated ethnicity (coded as Hispanic or Latino) as separate from race (Humes et al., 2011). We found that:
- Two percent of programs were developed for Black or African American youth and four percent targeted Hispanic or Latino populations.
- In the 77% of studies that reported race, 35% of enrollees were White, 28% were Black or African American, and 31% combined different racial groups into one category (e.g., “other”) and/or categorized race (e.g., African American) with ethnicity (e.g., Hispanic).
- In the 64% of studies that reported ethnicity, 32% of enrollees were Hispanic or Latino.
- American Indian or Alaskan Native, Asian American, and Native Hawaiian or Pacific Islander populations were largely missing from the samples or combined in a residual “other” category.
These results led us to conclude that research gaps on racial ethnic groups call for clearer reporting and better representation to understand for whom and in what settings preventive interventions work. The full study can be accessed here and here.
Conclusion
At the forefront of evidence-based programming since the 1990s, the Blueprints registry has come to define excellence in its standards for recommending evidence-based programs.
While Blueprints has done much over the decades to identify and disseminate information on programs shown to benefit racial and ethnic minoritized groups, we recognize the need to do more.
We envision improving the lives of all youth by advancing equitable opportunities for safety and stability. In doing so, we seek to meaningfully engage with thought partners who share our commitment to the values of diversity, equity, inclusion and social justice. We therefore welcome your input on how Blueprints can strategically advance racial equity to improve the lives of all children, youth, and families. Please email your ideas to us at: blueprints@colorado.edu.
And as always, thank you for your continued interest in and support of Blueprints.
Sincerely,
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