Crossroads: The Psychology of Immigration in the New Century

criticized for limited generalizability outside the university
clinic settings where they are developed and particularly to
ethnic minority and immigrant populations.
A few studies have examined the effectiveness of evidencebased
practice with immigrant clients in treatment. For
example, Duarté-Veléz, Bernal, and Bonilla (2010) described
a culturally adapted cognitive–behavioral therapy (CBT) for
a Latino adolescent coping with depression. This adaptation
of CBT involved the consideration of specific cultural
values concerning sexual orientation, masculine identity,
spirituality, and family. Two other examples of treatments
that have demonstrated effectiveness with immigrant
populations include the Culturally Informed and Flexible
Family-Based Treatment for Adolescents (Santisteban &
Mena, 2009), which combines family and individual CBT
with educational interventions to treat intrafamily stress and
conflict, and Cuento Therapy
(TEMAS; G. Constantino
et al., 1988), a culturally
sensitive cognitive therapybased
intervention aimed to
reduce anxiety and improve
academic self-esteem and
performance with Latino/a
students.
Despite these studies,
research documenting the
effectiveness of EBTs with
diverse communities is still in
its infancy. In fact, much of
what is known about the use of EBTs with immigrants has
been drawn from research on the impact of evidence-based
mental health treatments on ethnic minorities, particularly
African American and Latino/a American clients. Miranda
et al. (2005) found substantial evidence demonstrating that
evidence-based treatments for depression (e.g., CBT) improve
outcomes for African Americans and Latinos and that these
results are equal to or greater than those for White Americans.
Research on the EBTs with Asian Americans has been very
limited, and the evidence that does exist seems to suggest that
cognitive therapy is effective for the treatment of anxiety and
depression (C. G. Hall & Eap, 2007; Miranda et al., 2005).
C. G. Hall and Eap (2007) cautioned, however, that “this
evidence is based on relatively few patients” (p. 455) and that
these studies have been criticized for their methodology.
Implementation of EBTs in real-world settings, such as
Immigrant Populations in Clinical Contexts
Research on culturally adapted interventions
indicates that interventions in clients’
native languages are more effective than
those conducted in English, culturally
adapted interventions are more effective
than those not targeted to specific cultural
groups, and ethnic matching in the
therapeutic dyad is likely to improve client
retention and therapeutic outcome.
community clinics and schools, involve numerous challenges.
In particular, extensive adaptations to the intervention are
often required, though researchers reporting on intervention
effectiveness rarely report on the various adaptations made
in the implementation process.
In recent years, another approach has been evolving in the
field among those advocating for learning from practicebased
evidence (Birman et al., 2008). While empirically
based researchers generally treat existing community
practices, or “treatment as usual,” as substandard practices,
many clinical programs have developed creative ways
of working with immigrant populations that have not
yet been documented in the literature. For example, the
Latino Mental Health Clinic, the Haitian Mental Health
Clinic, the Portuguese Mental Health Clinic, and the Asian
Mental Health Clinic at the Cambridge Health Alliance are
outpatient clinics staffed by
immigrant and multilingual
mental health practitioners
who have provided direct
clinical services (assessment,
psychotherapy, and
psychopharmacology) to
immigrant communities for
over a decade.
Rural areas also have needs
for these types of services,
though access can be difficult.
In Maine, for example, the
Maine Migrant Health
Program provides integrated primary care from a mobile
van to address this barrier. Although several clinicians have
written about their experiences with clients in these clinics
(Desrosiers & St. Fleurose, 2002; Halperin, 2004; Tummala-
Narra, 2009), a lack of resources for systematic research has
precluded documentation of the lessons learned in clinical
practice with these different immigrant communities.
Nonetheless, it is important to learn from the wisdom of
these clinicians and how they have modified traditional
approaches to treatment in their work with immigrant
clients. Thus, the practice-based evidence approach seeks to
understand “practice as usual” and gather evidence on its
effectiveness (Beehler, Birman, & Campbell, 2011; Birman et
al., 2008).
Research on culturally adapted interventions indicates
that interventions in clients’ native languages are more
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