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Developing Culturally Effective Family-Based Research Programs: Implications for Family Therapists

Posted on: Thursday, 22 July 2004, 06:00 CDT

Recently, some family scholars have developed greater sensitivity to the relative neglect of families of color in clinical and empirical research. Consequently, a proliferation of research elucidating many nuances of ethnic families has come to the forefront, containing a wealth of knowledge with useful implications for family therapists and other mental health providers. The findings of these studies hold enormously important implications for how family therapists can better engage and accommodate families of color in therapy. In this article we discuss some of the etiological and methodological issues associated with planning, conducting, and disseminating family-based prevention and intervention research programs with ethnic minority families.

The historical and current landscapes of mental health are fraught with gross disparities with regard to addressing the needs of populations and communities of color. We believe that these disparities are the consequence, at least in part, of the lack of conceptual, theoretical, and methodological frameworks that appropriately position communities of color within a historical, political, and socioeconomic context that can adequately account for the lived experiences of various ethnic minority groups in the United States. This neglect-whether or not overt-has contributed to the perpetuation of misunderstandings, oppressive attitudes, and ultimately, poorly designed programs of intervention and psychotherapy. Most research has failed to explore and/or inform the field of the salient roles of culture and ethnicity, essentially assuming them to be benign or insignificant factors, thus leading to the development of clinical theories and interventions that also neglect, minimize, or completely disregard the significance of culture and ethnicity in the lives of families.

Furthermore, the socially constructed and politically situated concepts of race, culture, and ethnicity have been seriously under- addressed in the clinical and scientific literature (Murry, Smith, & Hill, 2001; Turner, 2001; Turner & Hench, 2003). When these concepts have been used, and when ethnic minorities have been included in research studies, it has often been to further denigrate and negatively portray communities of color in comparative studies of White versus "Other" families that consistently report deficit and poorer outcomes for populations of color. One of our objectives is to underscore the complexities involved in conducting mental health research that demonstrates effectiveness and efficacy for different subgroups in a highly multicultural society. Some of the often debated and controversial topics that will be incorporated into this discussion include: (a) The existence of gross disparities in mental health among different ethnic groups; (b) the necessity of including populations of color in research studies; (c) the frequent findings in research studies indicating that ethnic minority groups do not fare well when compared with White majority groups; (d) the warning to be cautious when comparing ethnic minority groups against each other and White majority groups; (e) the negligence of research efforts addressing the mental health needs of populations of color contributing to inadequate and ineffective clinical treatments for these groups; and (f) the importance of clearly articulating the theoretical significance of culture and ethnicity in each study, and incorporating this framework to inform the entire research process.

Our overall purpose is to address some of the thought processes that we believe are instrumental to conducting ethical and responsible research, particularly when it involves communities of color. A rationale for the importance of developing culturally sensitive research is provided along with specific examples of etiological and methodological issues associated with planning and conducting family-based intervention programs of research within ethnic minority communities. Moreover, we will specifically address how these important findings can affect the delivery of clinical interventions that are culturally appropriate and effective.

A report published by the National Institute of Mental Health (1999) addressing race and ethnicity in a multicultural society identified several factors as primary contributors to current mental health disparities. Among the factors listed were: (a) The dearth of empirically tested preventive interventions and psychotherapy treatments available for use with ethnic minority families and communities; (b) lack of psychotherapy treatment research meeting the basic criteria for demonstrating treatment efficacy for ethnic minority families and communities; and (c) frequent use of inadequate and/or irrelevant research questions with mental health implications for the increasingly diverse demographic changes in the country.

THE COMPLEXITY OF CONDUCTING RESEARCH IN DIVERSE CONTEXTS

Conducting culturally sensitive and responsive research in a multicultural context is a monumental undertaking. The layers of complexity are almost endless as one considers issues related to the intersections of race, culture, ethnicity and economics, as well as the host of potential factors influencing the research process. Historical and political context, sources of funding, institutional affiliation, research bias, individual/community bias, research focus, and specific research methods being employed are only a few of these factors. Decisions throughout the research process, all the way from early decisions such as which research topics and populations merit investigation, to later decisions such as which methods and publication outlets are employed in a study have profound implications on outcome.

The Surgeon General's (U.S. Department of Health and Human Services, 1999) report on mental health states that, to be effective, the diagnosis and treatment of mental illness must be tailored to all characteristics that shape a person's image and identity. In addition, the consequences of not understanding such influences can be profoundly deleterious. However, programmatic strategies have only been recently implemented at institutional research levels to ensure that research is relevant to ethnic minority groups. This relevance refers both to research focus and the diversity of populations included in the investigation. These institutional changes are intended to eventually lead to the development of a body of evidence-based preventive and clinical intervention programs that can better serve the needs of various cultural groups.

Evidence-Based Research Programs

For the sake of clarity, we are defining evidence-based research as meeting the following criteria proposed by Chambless et al. (1996): (a) Pre- and posttreatment status is assessed for clients from one or more ethnic minority group(s); (b) clients are blocked according to their particular ethnic group membership and randomly assigned to different treatments or to treatment and control groups; (c) multiple, culturally cross-validated assessment instruments are employed; and (d) findings are replicated. As late as 1996, in a report documenting updates on empirically validated treatments, Chambless et al. stated that they were aware of no psychotherapy treatment that demonstrated efficacy for ethnic minority populations. Furthermore, most studies they reviewed did not specify the ethnicity of their subjects, or used only White subjects.

Although preventive and clinical research addressing these concerns is currently underway with support from federal agencies as well as private foundations, evidence-based research with ethnic minority populations is clearly in its infancy. Several recommendations were proposed by Chambless et al. (1996) to ameliorate research concerns involving populations of color: (a) Specify ethnic group membership of participants in all studies (this is now required by most funding agencies); (b) give incentives to investigators for studies of ethnicity and treatment; (c) encourage researchers to report effect sizes on major outcome variables by ethnicity; (d) report barriers preventing researchers from conducting research on diverse populations thereby presenting an opportunity to learn from other researchers and populations; and (e) continue to provide services to diverse populations to the best of our ability and knowledge.

The increased risk status of ethnic minority children and their families to poverty and other related risk factors commonly associated with poverty, such as additional stressful life conditions, living in communities with poor social infrastructures, exposure to high crime, language barriers, teenage pregnancy, school dropout, and racial and cultural discrimination, have been well documented. Yet despite the overrepresentation of ethnic minorities living in poverty and engaged in prevention programs developed for high risk groups, serious efforts to examine preventive and clinical intervention issues relevant to the experiences of minority groups have not taken place until recent years (Roosa & Gonzales, 2000).

Researchers are only now beginning to understand the dimensions involved in developing sound methodological approaches t\o investigating the efficacy and effectiveness of mental health and social interventions targeting different cultural groups. Cauce, Coronado, and Watson (1998) proposed two broad models often employed by researchers studying different ethnic minority or cultural groups. The first model is referred to as the cultural equivalence model, which assumes mostly similarities across groups except for differences due to life circumstances. This framework is typically used in studies examining macro-level or "universal" processes across groups, and is reminiscent of an etic (or universalist) perspective. Under this model, the researcher controls for differences in potentially confounding variables, such as socioeconomic status, and differences in attitudes, values, and behaviors are thought to be minimized or to disappear altogether. The second approach, referred to as the cultural variance model, presupposes that the unique struggles of various ethnic and cultural groups lead to variations in culture specific values, beliefs, histories, and life experiences. These studies are typically conducted without a comparison group, as it is believed that because of unique backgrounds, each ethnic group develops fundamentally different adaptation and/or resilience processes. Therefore, the risk and protective factors associated with a particular cultural group are not necessarily shared by other dominant or minority population and therefore cannot be compared (Roosa & Gonzales, 2000). This approach is consistent with emic perspectives. Both approaches have their merits and shortcomings and their usefulness must be understood within the context of the research aim.

The Changing Face of Mental Health Service Delivery

The metaphor of America as a melting pot in which people from distinct cultural, racial, and ethnic groups blend into one composite American culture that reflects the values, norms, and mores of all, is an idea that is familiar, popular, and enduring (Boyd-Franklin, 2000, 2003; Murry et al, 2001 ; Turner & Hench, 2003). This notion that the United States is culturally synergistic is one that has had widespread public influence, from government and politics to entertainment and education, influencing both popular and scientific inquiry. However, to the minds of many, the idea of a melting pot is more myth than reality, as is evidenced by the failed articulation of a widely agreed upon model of ethnic and cultural fusion. Even more salient is the steadfast and resolute adherence of some groups to the value, belief, and behavior systems of their cultures of origin.

The human services fields, including marriage and family therapy (MFT), social work, clinical and counseling psychology, and psychiatry as well as many social science disciplines, including family science, psychology, sociology, and behavioral medicine have been guided by the "melting pot" perspective, which either minimizes or denies the significance of cultural variation in prevention or intervention services (Hines & Boyd-Franklin, 1996; McAdoo, 1997; McGoldrick & Giordano, 1996; Turner, 2001; Turner & Hench, 2003). In the fields of health, mental health, and social services, the identification of needs and methods of treatment and intervention identified as salient and appropriate to middle-class European Americans has been assumed to be the appropriate gauge for understanding and delivering services to everyone (John, Brown, & Primm, 1997; McGoldrick & Giordano, 1996; Miller, 1999). The manner in which problems are defined (i.e., what is pathological and deviant), the theoretical constructs that determine assessment and intervention methods, the prevention and intervention strategies devised, the programming and delivery of services, and even the evaluation of outcomes have been developed primarily in terms of what seems appropriate for the White, American middle class (Corbie- Smith, Thomas, & St. George, 2002; CorbieSmith, Thomas, Williams, & Moody-Ayers, 1999; Miller, 1999; Turner & Wallace, 2003). Inadequate consideration has been paid to the particular-and, perhaps, unique- concerns of the various other groups represented in the melting pot. However, historically, many ethnic groups have tenaciously, albeit implicitly, held to the customs, values, mores, and folkways of their cultures of origin. Moreover, during the late twentieth century, many ethnic groups began to openly embrace, reverence, and explicitly reconnect to their cultures of origin (McGoldrick & Giordano, 1996; Murry et al., 2001). Hence, differences due to culture, ethnicity, and, perhaps, race are being celebrated and often deliberately maintained. Because of the degree to which these differences shape and define one's lived experience in American culture-whether perceived, real or some combination of both-it is imperative that sufficient effort be exerted toward a clarification and an appreciation of the function of race, ethnicity, and culture in problem occurrence, prevention, and treatment. However, this clarification has not proven itself to be an easy task (Beatty, 1994; McGoldrick & Giordano, 1996).

TOWARD DEVELOPING CONCEPTUAL CLARITY OF RACE, CULTURE, AND ETHNICITY

There is a lack of conceptual clarity in the scientific literature with respect to the terms race, culture, and ethnicity (Dilworth-Anderson & Burton, 1996; Martinez, Eddy, & DeGarmo, 2003; Murry, Smith, & Hill, 2001; Turner 2000). These terms are often thought of as synonyms and used interchangeably, although the meanings can vary substantially. Moreover, this can be problematic and confusing in making comparisons between research studies and in determining the most appropriate methodological and analytical approach to take in conducting the research. To demonstrate this point, in the alcohol studies literature, ethnicity is a term used to refer to any of four conditions-race, national heritage, religion, and special populations. Likewise, Cheung (1997) asserts that the concept of ethnicity is often inexact and simplistically defined in drug abuse studies, with the terms race and ethnicity often used interchangeably. Cheung further concludes that, in spite of the vast profusion of research findings pertaining to ethnic and racial variations in drug use, the relationship between ethnicity and drug use has not been thoroughly examined.

Although methodological shortcomings, such as selection bias and incomparability of measurement, prevail and account for some of the confusion and imprecision, ultimately the more debilitating problem, Cheung (1997) concludes, is the dearth of conceptual precision of the meaning of ethnicity and, hence, the scarcity of well-developed and tested theories specifying the relationship between ethnicity, race, culture, and behavior. It should be noted that this is not a concern peculiar to drug abuse but is an impediment in other areas of research (Cauce et al., 1998; Dilworth-Anderson, Burton, & Turner, 1993; John et al., 1997; McAdoo, 1997; Miller, 1999). We acknowledge that the definitions we provide below are socially and contextually based and thus are in constant flux.

Definitions

Culture, as a social science construct is multifaceted and convoluted. The domain of social scientists from a multiplicity of specialties, scholars and experts have argued its meaning, its application, and the complexities of the systemic processes that characterize it (McGoldrick & Giordano, 1996). There is conceptual confusion regarding the terms culture, ethnicity, and race-terms that are all too often and erroneously used interchangeably (Berry, 1998; Cauce, Cornado, & Watson, 1998; Logan, 1996; McAdoo, 1997). Although these terms have some common characteristics, the terms all have different, although subtle, meanings.

Culture refers to the sum total of the ways of living built up by a group of human beings and transmitted from one generation to another (Logan, 1996; Murry et al., 2001). It alludes to elements such as values, norms, beliefs, attitudes, folkways, behavior styles, and traditions that are linked together to form an integrated whole that functions to preserve the society (Johnson, 1997; Nobles, 1997; Staples, 1997).

Ethnicity refers to a person's identification with a group of people of the same race or nationality who share a common and distinctive culture (McGoldrick & Giordano, 1996; Smith, 1996). Ethnicity points to connectedness based on commonalities (e.g., religion, nationality, region) whereby distinctive facets of cultural patterns are shared and where transmission over time creates a common history. The term ethnic minority is often used to refer to marginalized cultural groups.

Race, traditionally a biological concept, refers to a group of people related genetically (albeit this inference is highly controversial due to negligible traces of genetic variation among humans and the historically racist use of genetic difference to oppress certain groups) by common descent, blood, and heredity. People of the same race may, or may not, share a common culture (Heiss, 1997; Logan, 1996; McAdoo, 1997; McGoldrick & Giordano, 1996; Pinderhughes, 1989). Although race is most often used in social science research to connote biological information, there is a significant debate about whether race is more a biological or social construction (Bamshed & Olson, 2003; Heiss, 1997; Johnson, 1997; Staples, 1997). Race, although often presented as a biological term, takes on ethnic meaning when and if members of that biological group have evolved specific ways of living. Race takes on a cultural significance as a result of the social processes that sustain majority-minority status (Murry et al., 2001). All too often in social science research, race is used as a simplistic variable connoting mere physical characteristics, but still often interpreted in ways that suggest broader implications. Given the subtle differences in the meanings and the interchangeabilityof the words in both common and scientific usage, it is imperative that investigators clearly define their usage in their investigations.

Problems with the Lack of Conceptual Clarity

It has been noted that severely limited and insufficient research efforts, along with crucial methodological deficiencies, have resulted in the provision of inadequate and ineffective clinical treatment to ethnic groups (Beatty, 1994; Boyd-Franklin, 1990; Jackson, McCullough, & Gurin, 1997; Turner, 1995); however, the lack of construct or conceptual clarity of ethnicity and culture has perhaps had a more deleterious effect (Cauce et al, 1998; Department of Health and Human Services, 2001). The challenges encountered by those who research enculturated ethnic minority groups, such as African Americans, are especially daunting (Gil, Wagner, & Vega, 2000; Ortega, Rosenheck, Alegria, & Desai, 2000). Enculturation is the process by which an individual learns the traditional content of a culture and assimilates its practices and values. At the outset, the clear articulation of a distinct African American culture may be very difficult, especially with regard to theories and etiology pertaining to relational problems and mental health. Moreover, the phenomena of "code switching,""biculturalism," and "multiculturalism" have been observed and often reported in the literature (Beatty, 1994; Harper, 1991; Johnson, 1997; Nobles, 1997). That is to say that many African Americans, as well as other ethnic minorities, are very familiar with the customs and norms of both the White majority and the specific ethnic minority group they most often find themselves in and are often quite capable of functioning at high levels in both White and ethnic minority (e.g., Black, Latino/a, Native, Asian) worlds. However, for researchers, bi- and multiculturalism poses some rather interesting questions and considerations. As a case in point, perhaps the phenomena of code switching (implicitly changing cultural codes to fit the present cultural context) can explain the weakness of the effects of ethnicity in some schoolbased drug abuse prevention studies, which take place in a milieu in which majority (White) norms and language prevail. A number of questions important to the research process are raised by the phenomenon of enculturation (e.g., Which culture is most influential, in which settings, in which behaviors, and at what ages? Do participants respond appropriately to the setting? Is learning maintained, or does it diminish when the setting changes?).

In every ethnic group there is usually considerable within group variation, reflecting heterogeneity over a variety of biopsychosociocultural indicies, including economic, social, political, cultural, religious, and regional indices (Beauvais & Trimble, 2003; Boyd-Franklin, 2003; Martinez et al., 2003; McGoldrick & Giordano, 1996; Turner & Hench, 2003). To ascertain the effects of culture and ethnicity, whether or not any exist, on behavioral primary prevention requires the resolution of many unanswered questions: Is it necessary to plan specific primary prevention research for groupings with significant differences? Should research in neighborhoods that are heavily Cuban differ from that in neighborhoods that are Mexican American? Are there variables specific to communities in which there are large numbers of interracial families that must be considered? Do income differentials within the same ethnic group matter?Do any intra- ethnic, intra-cultural, or intra-race variables matter? Furthermore, the scientific literature is fraught with controversial assertions that factors related to socioeconomic conditions, rather than race, wield far more influence on the behavior and lifestyles of ethnic minorities (Wilson, 1987,1996). In this case, the fact that one is poor is determinant, causal, and explanatory, rather than the fact that one is of a specific cultural or ethnic group. It should be noted that this point of view is highly contested and unsubstantiated by empirical findings (Billingsley, 1992; Boyd- Franklin, 2003; Heiss, 1997; Hill, 1997; McAdoo, 1997; Nobles, 1997; Rivers & Scanzoni, 1997). Some have argued that scientific support extolling the need for prevention and intervention strategies based on culturally specific or sensitive approaches or for the effectiveness or superiority of such prevention strategies is scant and unconvincing (Jessor & Jessor, 1977; Johnson et al, 1990; Kazdin, 1993). However, given the paucity of such studies, along with the comparative lack of success in involving ethnic minorities in prevention programs along with the documented growing mental health-related prevention and intervention needs in ethnic minority communities suggest that this argument is without merit (Cauce et al., 1998; John et al., 1997; Miller, 1999).

Researchers should be cognizant of the multifaceted problems and challenges related to ethnicity and mental health and should confront these problems directly. All too often, the ethnic variable is given minimal or cursory attention, often only comparing groups using race as a simple categorical variable. Researchers must show some regard for how the ethnic identification variable is used in the research. For example, in etiologic studies of African American drug use and abuse, one has to be concerned about how being an African American is conceptualized. Is it conceptualized as a risk factor associated with vulnerability to drug use, low socioeconomic status, poverty, stress, and availability of drugs in the community? Or is it conceptualized as a protective factor associated with strength, survival, adaptability, resilience, and resistance to drug use? To illustrate, in their evaluation of a comprehensive community- based program, Johnson et al. (1990) discussed ethnicity as a risk factor. In contrast, it could have been viewed as a protective factor, especially given empirical evidence of the moderately high rates of cigarette and alcohol abstainers in certain subgroups of African Americans, and what arguably could be the lower-than- expected use of drugs, considering the high number and pervasiveness of risk factors in African American communities (e.g., urban areas and high poverty). Or is it a mediator or filter that ultimately has no meaning outside of how it processes information or impacts on perceptions and attitudes, resources, and behaviors? Jessor (1998), for example, characterized ethnicity as a distal causal agent; it has no direct effect on outcome but, rather, indirectly may affect other factors more proximal to the behavior observed.

Problems with Etiology, Theory, and Methods

Very few well-established empirical research and theoretical models seriously consider the effects of culture and ethnicity (Dilworth-Anderson et al., 1993; Murry et al., 2001; Turner 2000; Turner & Alston, 1995; Turner & Hench, 2003). This inadequacy has slowed progress in the planning and development of treatment and prevention programs for minority communities. Fortunately, stimulated by an increased awareness of the saliency of culture and recognition of the disparities in health and mental health delivery and practice, studies of the etiology of mental health problems and treatment among minority groups are rare, but they are on the rise (Cauce et al., 1998; Murry et al., 2001). Unfortunately, many, if not most, of those currently available are methodologically limited, thus seriously impeding their utility toward furthering our understanding of the determinants of health and mental health- related problems among ethnic and minority populations. Whereas studies should incoiporate strong designs (such as prospective longitudinal designs) and be theoretically driven, most of the etiologic studies of ethnic and minority populations are lacking in scientific rigor (Cauce et al., 1998). Moreover, many studies fail to concentrate on or even consider larger systemic issues, such as racism and discrimination that greatly affect ethnic groups (Logan, 1996; Martinez et al., 2003; McAdoo, 1997; McGoldrick & Giordano, 1996, Turner, 2001).

Historically, ethnic, racial, or minority status has been limited to descriptive use. However, the treatment of ethnic and minority status as explanatory variables rather than as merely descriptive ones is imperative (Beatty, 1994; Castro, Harmon, Coe, & Tafoya- Barraza, 1994; Collins, 1995; Kuramoto, 1994; Martinez et al., 2003; Sage, 1994). That is to say, ethnic and/or minority status should be an integral part of the conceptualization of the research and not merely a device to tease out meaningless categories or make unsubstantiated and uncorroborated comparisons. If at all possible, there should be a clear and significant conceptual rationale that provides direction to the design and implementation of the prevention intervention and the ability to address the results of the intervention in a manner that contributes to greater understanding of that group (Beatty, 1994; Turner 2001; Turner & Hench, 2003). Arguments in favor of the development of theories that address the health and mental health needs of specific ethnic and cultural groups abound. These arguments, supporting the need for the development of theory that synthesizes what is known about mental health service and prevention with what is known about the culture of a particular ethnic group and their experiences, are quite compelling (Beatty, 1994; Beauvais & Trimble, 2003; Cauce et al., 1998; Martinez et al., 2003). Furthermore, it has been proposed that these theories have a high degree of cultural specificity. For example, in discussions of HIV/AIDS prevention in African American communities, Randolph and Banks (1993) argue that Afrocentric theoretical perspectives (which are well developed) need to be incorporated into prevention practice and research.

For many ethnic minority populations, evidence suggests that less emphasis should be pl\aced on individual risk or personality factors, in favor of a greater focus on factors related to family, community, and the environment. At the very least, the research base ought to consist of more studies that are theoretically guided by these factors.

Promising findings have resulted from a relatively new and growing body of research on protective factors as related to primary prevention with ethnic minorities. According to Hawkins, Catalane, Kosterman, Abbott, and Hill (1999), protective factors mediate or moderate the effects of exposure to risk, and as such, the results of research on protective factors are important to prevention policy. Protective factors are likely to differ across cultural groups, although some similarities may exist. Case in point, Brook (1993) discovered that protective factors in Puerto Rican and African American youth differ. For both groups, the effects of certain risk factors, such as peer and drug context were ameliorated by family protective factors. However, the specific family dimensions differed between the two groups. For example, among African American families, models of low drug use in the family were found to be more important as a protector for the drug context domain than family attachment and control. In Puerto Rican families, the opposite was found. It has been postulated that religiosity and racial consciousness significantly contribute to protecting African Americans from engaging in detrimental behaviors (Wallace, Brown, Bachman, & LaVeist, 2003; Wallace, Forman, Caldwell, & Willis, 2003). Although some progress has been made, it is clear that more etiologic work is needed to identify the specific factors important in various ethnic individuals, families and communities and to determine how they can be incorporated into prevention intervention efforts.

Methodological Issues

There are several methodological issues concerning mental health research in ethnic communities that should be addressed, in particular three research design issues that are particularly relevant to prevention and intervention research that should be accentuated because of their potentially detrimental impact on research implementation, analysis, and interpretation in regard to ethnic minorities.

Problems with research access and high rates of attrition. The first issue is the problem of achieving access to ethnic minority communities. For example, investigators who research African Americans have been confronted with a number of serious methodological problems, including low rates of response, high rates of attrition, and refusal to participate; trepidations about the validity and accuracy of data provided; and in some cases, a deliberate protest of the research effort by community groups (Corbie-Smith et al., 1999, 2002; Gross, Julion, & Fogg, 2001). These problems occur for a variety of reasons, but are often attributed to the historical mistreatment of African Americans in research investigations and the consequential mistrust it has engendered in the community. One of the most infamous occurrences of this maltreatment is the Tuskegee syphilis study of African American males in which treatment, once it became available, was denied to the participants to maintain fidelity to the initial research design and questions (Beatty, 1994). The legacy of the Tuskegee study is portentous and consequential to investigators now working with African American communities, particularly in HIV/AIDS research and prevention (Corbie-Smith et al., 2002). There are other factors that affect access to ethnic minority populations including the high rates of mobility of urban, lower-class persons; and the challenges of locating certain groups, such as young adult men who are not "official" members of households. There has been some headway made in acquiring the accessibility to and cooperation of ethnic minority communities, with the most effective approaches underscoring the importance of ardent community participation and commitment from the outset of the planning process (Murry & Brody, this issue). These concerns are likely to be even more essential in primary prevention research, because it requires the collaboration of the participants over a period of time and, in most cases, the nonoccurrence of a problem. Groups suspicious of mainstream systems often avoid using them until crises occur.

The problems of comparative design. The second methodological problem is the inappropriate employment of the comparative design, especially the tendency to either overuse or misuse it, or to use it exclusively when other approaches may be more appropriate. This methodology entails a comparison of common dependent measures of two or more groups that differ on a variable (e.g., race/ethnicity or sex). Unfortunately, reliance on this design has often resulted in the adoption of a deficit approach to the study of ethnic minority families (Cheng-Gorman & Baiter, 1997; Dilworth-Anderson & Burton, 1996; Murry et al., 2001 ; Turner, 2001 ; Turner & Hench, 2003). This result stems largely from the reality that the conceptual or theoretical foundations of the research, including the theory driving the questions asked, the definitions of the concepts studied, and the measures used, are almost without exception based on White normative samples. The result, whether intended or not, is to elevate the White population to the archetypical position, or standard against which all others are measured (John et al., 1997; Mines & Boyd-Franklin, 1996; Johnson, 1997). Moreover, this further illuminates the importance of clearly articulating the theoretical significance of race and ethnicity and of structuring research questions that aim toward the development and advancement of knowledge about the dynamics and needs of a group rather than the fit of one group to the norms of another.

Comparably, many researchers (McGoldrick & Giordano, 1996; Miller, 1999) have observed that investigations that compare males and females should define gender as a broad matrix of biological, psychological, and social factors, rather than merely basing it on on sex as physiologically and anatomically defined. When an investigator selects a comparative design, the emphasis is, more often than not, focused on the differences between groups rather on the dynamics of the groups being compared. The comparative design is often desirable to researchers in that the differences between groups often appear to be statistically significant, even if they are not necessarily informative. Comparative designs are also relatively easy to write about and publish. Furthermore, such designs may not require the close examination and interpretation of within-group variations or commonalities, which are often quite intriguing.

Among the other limitations often associated with the comparative design are (a) meager sample sizes of the subgroups, which can minimize the significance of intragroup examinations, and (b) the use of either inadequate or inappropriate plans of analysis. A good illustration of this problem involves the well-known "doll preference" studies that purported to demonstrate White preference among African American children. However, Banks (1976) was able to demonstrate that the basis for the statistical analysis was faulty, leading to a misinterpretation of the African American children's choices and responses, thus rendering the finding of White preference erroneous.

The problem of clustering groups. The third methodological problem is that of clustering groups together in a single category of "other." Often, this category is labeled as "non-White." This is a particularly inappropriate and meaningless strategy in as much as there is often no relevant reason to group unrelated groups into a single category, not to mention the offensiveness of labeling groups of persons as "not something." Given what we know about the epidemiologic and etiologic disparities manifested in mental health and health practice and treatment among racial/ethnic groups, extraordinary thought and care should be given to the appropriateness of clumping groups together and proceeding from a common theoretical base without contending with group-by-group differences that may arise in the analysis and interpretation of findings from the research (Beauvais & Trimble, 2003; Corbie-Smith et al., 2002; Martinez et al., 2003; Turner, 2001; Turner & Hench, 2003). In an effort to better understand how problems are manifested in specific racial and ethnic groups, governmental funding agencies require that all studies exhibit adequate representation of women and minorities unless there is a good reason for not doing so. Although the intention behind this policy appears to safeguard the adequate inclusion of women and ethnic minorities, unfortunately, all too often, the interpretation of adequate representation is seen as equivalent to proportionate statistical representation, often resulting in ethnic subgroup samples that are too small for meaningful analysis.

Finally, more research is needed on all major American ethnic minority groups, with specific emphasis on family, young adults, males, and persons in milieus that are more difficult to approach than the easy-toaccess captive populations, such as prisons and hospitals. Breadth and diversity of ethnic minority populations in primary prevention and intervention research are woefully limited.

ESTABLISHING CULTURALLY BASED RESEARCH PRIORITIES FOR THE FIELD OF MARRIAGE AND FAMILY THERAPY

Much of the future of MFT research specifically related to populations of color is predicated on a host of factors both external and internal to the discipline. As previously discussed, historical and contextual factors, dominant and marginalized discourses, paradigmatic and methodological controversies, as well as the profile of the researchers asking the research questions, are all critical elements in setting this research agenda. \This agenda often involves an iterative cascade of complex and interlocking levels (see Table 1). The field of MFT propelled the legitimization of a systemic paradigm to inform alternative clinical approaches to mental health. As a discipline, we have made impressive strides in developing systemically based theoretical and clinical interventions. However, we are only beginning to understand questions related to the applicability and utility of our interventions across cultural and ethnic groups. We face many challenges as we forge ahead to establish ourselves as competitive players in the sponsored research arena.

We believe two major factors influence the direction of mental health research and MFT research in particular. The first is related to external forces, such as research priorities established by major funding agencies, mandates from state and federal governments, and directives from professional organizations. These entities currently require-almost without exception-emphasis on addressing the needs of populations of color. Federal agencies have established a set of research priorities that are frequently updated and that they believe to be essential for the reduction of mental health disparities. Projects are funded in large degree based on the extent to which grant applicants address these imperatives (see National Institute on Mental Health website http://www.nimh.nih.gov for specific recommendations).

The second factor is related to internal forces. Chief among them would be our value and commitment to explicate the mental health needs of all people, with particular attention to populations that have been underserved and underrepresented. Furthermore, we believe the ideological underpinnings of our discipline, which emphasizes a systemic approach to working with families across mental health and social issues, are significant in guiding future MFT research. We are not suggesting the existence of a homogenous systemic vision within MFT but rather noting that our diverse perspectives and research priorities have the potential to contribute something unique to families and communities. Thus, we must ensure that our research priorities, research questions, populations of interest, methodological advances, and clinical interventions are properly funded and translated into public policy as well as into the priority lists of national funding agencies.

We do not believe it is within our purview to propose specific directions for the future of MFT research. Such a list would likely be simplistic and not account for the diversity of relevant interests represented within the field. However, we are asserting that, regardless of the specific area of research, it is critical that MFTs strive to obtain a thorough understanding of the relative level of impact, meaning, efficacy, and effectiveness of our clinical interventions across cultural and ethnic groups. In fact, we believe the long-term survival of any specific theoretical/ clinical modality in mental health is dependent upon researchers' ability to appropriately adapt and test their interventions cross- culturally. Likewise, it is important for MFT researchers to look beyond our paradigmatic lenses to incorporate knowledge stemming from a variety of disciplines. Perhaps, in the struggle to develop a unique identity and establish ourselves within the field of mental health we have isolated ourselves and enclosed the parameters of an ideologically expansive systemic framework. In addition to establishing research training and collaborations within MFT, we encourage researchers to look outside our discipline for mentoring and research relationships.

Table 1

A Systemic MFT Research Paradigm Based on the Contextual Premise of the Existence of Cultural and Ethnic Disparities

It is also important to underscore the need to be cognizant of the fluctuating nature of what constitutes mental health disparities and the variety of ways disparities impact communities. It is imperative that MFT researchers be aware of transitions occurring across such categories as diagnoses, demographics, incidence, severity, and access and utilization patterns in mental health for different populations. We strongly advocate for the development of programs of research that translate into the delivery of mental health services that are designed and tailored to meet the specific needs of populations of color.

Table 2

Guiding Questions and Recommendations for MFT Researchers and Practitioners

We conclude by presenting a list of broad questions and recommendations that we believe could be useful for researchers focusing on the development of effective family-based programs (see Table 2 and Table 3). We propose parallel questions for MFT clinicians to consider because we believe that, although much work is needed to advance research and clinical practice with communities of color, therapists could benefit from translating some of the current standards implemented by successful culturally informed researchers in their clinical practice. Although much research is needed to advance our understanding of the specific ways efficacy and effectiveness can be attained in preventive and clinical interventions with individuals, families, and communities across ethnic groups, we are encouraged by some of the work that is being undertaken across the country by scholars committed to improving the status of mental health and general family functioning. We remain optimistic regarding future research in this area given the confluence of seasoned and newly emerging scholars in the field and the heavy emphasis federal, state, and philanthropic funding agencies are now placing on seriously addressing cultural dimensions in family-based research.

Table 3

Recommendations for Building a Culturally Informed Program of Research

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William L. Turner and Elizabeth Wieling

University of Minnesota

William D. Allen

Healing Bonds

William L. Turner, PhD, and Elizabeth Wieling, PhD, Department of Family Social Science, University of Minnesota; William D. Allen, PhD, private practice, Healing Bonds, Minneapolis, Minnesota.

Address correspondence to William L. Turner, Department of Family Social Science, College of Human Ecology, 290 McNeal Hall, 1985 Buford Avenue, St. Paul, Minnesota, 55108. E-mail: wlturner@che.umn.edu

Copyright American Association for Marriage and Family Therapy Jul 2004

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