PSYCH 620 Week 5 Culturally Responsive Practice Example

Adapting a Stress Group for Somali Mothers Without Losing What Makes It Work: Cultural Adaptation, Cultural Humility and Evidence

[Student Name]

University of Phoenix

PSYCH/620: Multicultural and Social Issues in Psychology

Week 5 Assignment

[Instructor Name]

[Date]

The agency, the mothers' group and its staff are composites written for a model paper; research findings come from the sources listed.

Culturally responsive practice means changing how services are designed and delivered so they fit the people who use them. It requires more than good intentions. This paper describes how my agency will redesign a group program that failed one community, using research on cultural adaptation and cultural humility.

The Problem

Last spring, our resettlement agency in Phoenix offered a six-session stress-management group for refugee mothers. The curriculum, adapted from a widely used cognitive behavioral program, taught relaxation, identifying stressful thoughts, problem solving and building support. Twelve women attended the first session, including five Somali mothers. By the third session, none of the Somali mothers returned.

When I visited several of them at home, they explained why, politely. The group met Friday afternoons, close to Jumu'ah prayer. The only available Somali interpreter was a man, which made women reluctant to speak about family life. The facilitator asked participants to share their feelings in a circle with women from other countries, which felt exposing. And the examples in the handouts, such as stress from a demanding boss, had little to do with their worries: children's safety at school, relatives in Somalia and the cost of rent.

Cultural Competence and Cultural Humility

Sue et al. (2009) reviewed the case for cultural competency in psychotherapy, describing it at several levels: the provider's awareness, knowledge and skills, the agency's policies and the broader system of care. They noted that while the concept has strong support among practitioners, the research base was still developing, with some evidence that cultural adaptations and ethnic matching can help but many unanswered questions about which elements matter most.

Cultural humility offers a complementary stance. Hook et al. (2013) built a short scale on which clients rate whether their counselor seemed curious, respectful and free of any air of superiority about the client's background. In their samples, the higher a client scored the counselor on that scale, the better the client rated their partnership in therapy and the more progress the client described. Humility of this kind means that a counselor who has read widely still lets each client teach them what that client's culture means to them.

Does Adaptation Help?

Griner and Smith (2006) meta-analyzed 76 studies of culturally adapted mental health interventions and found a moderate overall benefit of adapted interventions. Programs built for one cultural group produced effects roughly four times larger than programs for mixed groups, and sessions held in a client's first language, where that was not English, did about twice as well as sessions in English. These findings directly address our group's design: it served a mixed group and relied on interpretation.

The women did not reject stress management; they rejected a Friday afternoon, a male interpreter and a story about a boss.

A Framework for Adaptation

Bernal et al. (1995) proposed an ecological validity framework for adapting interventions for Hispanic clients that has since been applied widely. It identifies eight dimensions: language, persons (the match between client and therapist), metaphors (symbols and sayings), content (cultural knowledge), concepts (how the problem is framed), goals, methods and context. The framework encourages systematic adaptation rather than piecemeal changes.

The Redesigned Group

Using the framework, and after two planning meetings with six Somali mothers and a Somali community health worker, we redesigned the group as follows.

Language and persons: the group will be held in Somali, co-led by a Somali woman community health worker trained in the curriculum and a female counselor, without interpretation. Only Somali mothers will attend, following the meta-analytic evidence for single-group delivery.

Metaphors and content: sessions will use Somali proverbs about patience and community, and examples will reflect participants' concerns, such as a child being teased at school or a phone call about a sick relative.

Concepts and goals: stress will be framed as the heavy load mothers carry, rather than as a mental health problem, and goals will include family harmony and children's success, which participants named as priorities.

Methods: instead of sharing feelings in a circle, the group will use small-group discussion, storytelling and practicing skills together. Relaxation exercises will include breathing practices participants connected with prayer.

Context: sessions will meet Tuesday mornings after school drop-off at a community center near where most families live, with child care for younger children and tea.

Who Shapes the Adaptation

The planning meetings changed the design in ways staff would not have predicted. The mothers asked that the first session include their own mothers or mothers-in-law if they wished, since decisions about family stress are often made together; we agreed to an optional opening session for extended family. They also asked that the group not be described as being for women who are "stressed," a word that, translated, sounded close to being unwell in the mind. The flyer now invites mothers to "a circle for mothers carrying many responsibilities." These changes came from the community, not from the literature, which is the point of involving community members from the start rather than asking them to review a finished plan.

Keeping the Active Ingredients

Adaptation must not remove what makes the intervention work. The redesigned group keeps the core components of the original: learning a relaxation skill, recognizing thoughts that increase stress, practicing structured problem solving and strengthening support. Each session still includes practice and a small home activity. A curriculum consultant will review the adapted version to confirm that these components remain intact.

Cultural Humility in Practice

The counselor co-leading the group is not Somali. She will meet with the community health worker before each session to discuss the plan and after each session to reflect on what worked. Participants will be invited to suggest changes midway through. This practice reflects the humility Hook and colleagues described: approaching participants as experts on their lives and staying open to correction.

Evaluation

We will measure attendance across sessions, a brief stress measure translated and reviewed by community members at the first and last sessions and participants' own descriptions of changes. Success would mean that most women attend at least four of six sessions, compared with none past the third session last spring. If attendance improves but stress scores do not change, we will review whether the active ingredients were delivered as planned.

Training the Co-Leaders

The community health worker who will co-lead has deep community trust but no formal training in the curriculum. She will complete the program's facilitator training with the counselor, practice each session in a mock group with agency staff and receive weekly supervision. The counselor, in turn, will receive an orientation from the community health worker on Somali family life and on topics that are sensitive to raise in a group, such as marital conflict. Pairing the two roles combines cultural knowledge with clinical skill, and each leader is expected to learn from the other.

Limits

Meta-analytic evidence for adapted interventions comes from varied studies with different definitions of adaptation. Our group will be small, and results will not generalize to other Somali communities without further testing. Somali mothers in Phoenix also differ among themselves by age, education and years in the United States.

Conclusion

The first group failed because its design did not fit the women it aimed to help. Research on adapted interventions and cultural humility points to a redesign led with the community, delivered in Somali by a Somali woman and shaped around participants' priorities, while keeping the components that make stress management effective.

References

Bernal, G., Bonilla, J., & Bellido, C. (1995). Ecological validity and cultural sensitivity for outcome research: Issues for the cultural adaptation and development of psychosocial treatments with Hispanics. Journal of Abnormal Child Psychology, 23(1), 67-82. https://doi.org/10.1007/BF01447045

Griner, D., & Smith, T. B. (2006). Culturally adapted mental health interventions: A meta-analytic review. Psychotherapy: Theory, Research, Practice, Training, 43(4), 531-548. https://doi.org/10.1037/0033-3204.43.4.531

Hook, J. N., Davis, D. E., Owen, J., Worthington, E. L., Jr., & Utsey, S. O. (2013). Cultural humility: Measuring openness to culturally diverse clients. Journal of Counseling Psychology, 60(3), 353-366. https://doi.org/10.1037/a0032595

Sue, S., Zane, N., Nagayama Hall, G. C., & Berger, L. K. (2009). The case for cultural competency in psychotherapeutic interventions. Annual Review of Psychology, 60, 525-548. https://doi.org/10.1146/annurev.psych.60.110707.163651