The Process of Cultural Tailoring Posted on June 22, 2008 The question for the field now is, 'How do we adapt existing interventions?,' states Luis H. Zayas (bio).

The focus of this particular meeting, this is the third of three meetings, is precisely the question of, "What do we need to do to adapt existing interventions?" and we've asked presenters to tell us about their experiences adapting the existing interventions for the populations they work with. So we're not asking them for findings, whether it worked or not, but what process did they undertake?

And what we hope to do from these presentations is distill a set of concepts, ideas, approaches, processes, maybe methods by which we can come to some idea about how you go about adapting. So typically you first have to find out something about the community you work in, so a lot of interventionists will go to that community and run focus groups. "So what's important to you, for your children, for yourself? And here's an intervention. It requires that parents do this and kids do that. How does that sound to you?"

You then get back information from the population that you're interested in studying about whether it really works. For example, Kristen McCabe's work is a fascinating example of this kind of work where she was using, she was providing an intervention which included a time-out experience. And the child was placed in a corner.

The Mexican families that she was working with, while the time-out idea was not something that they didn't want, they needed to have it framed in a much more assertive, active manner than a passive one, so you didn't ignore your child. That's too passive. You had to come in and ask your child to sit down, and so the time-out chair was converted into the punishment chair. So those are little adaptations that we need to make. That made it more appealing to the Mexican families that she's working with than the original group on which it was developed, so those are the sorts of things. So you're getting feedback, and then you go back and you tinker with the intervention.

The problem becomes, at what point are you changing the intervention to a point where it's no longer the intervention that you brought in or are using? So we talk about things like core elements, active ingredients. Basically what is the therapeutic effect or what is the therapeutic action of the therapy? And you don't want to tamper with that, so you can adjust it around the edges so it fits your population, but if you take that away, then you don't have an active ingredient. You don't have an effective intervention, and that's where the issues are most dramatic, and we haven't yet figured out, and most developers haven't been able to say, "The active ingredient of this intervention is this," and so we're having trouble with that, so the lexicon of all of this has begun to change.

We talked about adaptation, but that sounded a little too much of a change of the interventions. Now we're talking about tailoring. It's like you go into a store. You find a suit of clothes that you like, and it basically fits you. You're not changing the suit, but you do have the tailor take in here, let out there, suit your needs, so in a sense that's a better analogy to the kind of work we might have to be thinking about and leave adaptation to say a larger, more broad-scale change.

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