In April, the HEDCO Institute released findings from our first review on school-based depression prevention programs for K-12 students. Understanding the benefits of these programs on youth outcomes such as mental health, student well-being, and educational achievement, is important given that depression is one of the most common mental health challenges facing students today, affecting nearly 5 million youth. If you haven’t yet read those findings, you can read the overview here and the full technical results here, but a brief spoiler – we found, on average, students in depression prevention programs had less severe depression symptoms compared to students in control groups.

More research is needed to build a body of evidence for culturally specific depression prevention programs

One of the most frequently asked questions we receive about the review is: “But will these programs work for my school, with my student population?” More specifically, many educators are interested in programs that are culturally specific. Yet in this review, only 31% of reviewed studies reported the race and ethnicity of their student sample, and just 33% offered information on cultural tailoring of their programs. Because of this, we were not able to evaluate whether depression prevention programs were more or less effective for students from different racial or ethnic backgrounds or based on the cultural specificity of interventions. But this is an especially critical issue because youth from racially or ethnically marginalized communities are more likely to have unmet mental health needs and less likely to receive timely and appropriate mental health services.  

Cultural adaptation of interventions can help address racial and ethnic disparities

Taking existing interventions and adapting them for different student populations is an important method for tailoring interventions for students from diverse racial and ethnic backgrounds. This process of cultural adaptation or cultural tailoring can occur at multiple levels of an intervention. For example, cultural adaptation of a program may alter who delivers an intervention or where the intervention is delivered. Adaptation might also attend to the cultural sensitivity of program materials, for example, language, imagery used, or the adaptation of how different skills or psychoeducation are framed, and finally, to the adaptation of core components of an intervention.

Given the opportunity for school-delivered prevention programs to address the unique needs of students from diverse racial and ethnic backgrounds, we’ll focus this post on depression prevention programs that are making steps toward intentional design for students, individuals, and families from historically marginalized communities. First, we describe two promising programs: Rise Above and Strong African American Families – Teen.

Rise Above is a depression prevention program intentionally designed for Latina/o youth

Online programs have been proposed as one solution to reduce barriers to depression prevention program access for adolescents, and web-based programs can often be easily integrated into school settings. One such program, Rise Above or Siempre Sale el Sol is an online depression prevention program specifically designed for Latina/o youth. Cultural tailoring included choice of language (Spanish or English), infusion of cultural values such as personalismo and use of cultural metaphors to improve engagement with program content and skills practice. In this intervention, the content, concepts of depression, and descriptions of treatments for depression were all presented using cultural rationales to increase engagement and relevance of the program for Latina/o adolescents. To date, this program has been qualitatively evaluated by mental health clinicians who provide services to the Latina/o/x population. Although this study was not eligible for inclusion in our review, this intervention offers a promising approach for beginning to build broader, culturally relevant, and accessible services to support the mental health of Latina/o/x youth. 

Strong African American Families – Teen is a family-centered prevention program that effectively prevents depression in teens

SAAF-T is another example of a culturally specific intervention designed to prevent negative outcomes and support the positive development of African American adolescents. Some key examples of culturally intentional design include teaching parents flexible racial socialization guidance that can assist them in helping their teens navigate experiences of discrimination and for teaching adolescents about ways to respond to racism. This program also explicitly incorporates African American cultural values into sessions.

Although SAAF-T was originally designed as a treatment, more recent research has documented that delivery in adolescence can serve as prevention against depression symptoms, substance use, and delinquency for nearly two years following completion of the program. Program developers note that the manualized nature of the program may support the implementation of SAAF-T in schools, but to our knowledge this program has not yet been tested in schools and was not included in our overview as a result. Educators can read more about the evidence base of SAAF-T here.       

Culturally tailored programs

Though many of the programs in our review didn’t account for adaptations for different student populations, we’ll highlight two studies that outlined cultural adaptations or testing with students from diverse racial and ethnic backgrounds.

The Resourceful Adolescent Program-Adolescent (RAP-A), endorsed by the California Evidence-Based Clearinghouse as a well-supported program, is a depression prevention program included in our recent review. RAP-A has undergone cultural adaptation and can serve as an example of the essential steps that researchers can take to ensure that programs address the cultural and contextual relevance for diverse students.

Specifically, this program has been culturally adapted for Indigenous youth in Australia. Program developers involved the voices of Aboriginal communities in Australia in the adaptation process, compiling recommendations from those communities who had implemented the un-adapted version of RAP-A in their schools. Adaptations included supporting the cultural match between students and program deliverers (Indigenous tutors and education assistants delivering the intervention to Indigenous students), and modifications to the interpersonal and cognitive components of the program. The RAP-A adaptation for Indigenous youth has been evaluated and shown to be effective across four secondary schools in rural Australia.

It is fundamental for researchers to evaluate programs to understand potential variability in benefits for students from different racial and ethnic backgrounds and to ensure those programs are not causing harm. One program reviewed by the HEDCO Institute was the Penn Resiliency Program. Although this program was not designed to be culturally specific, it has been tested and shown effective in preventing depression in samples of students entirely composed of youth who identified as Latina/o and Black, with positive effects for Latina/o students, specifically. For school professionals interested in learning more about the Penn Resiliency Program, including its evidence base, you can find more information here.

In sum, these programs highlight important efforts to ensure that communities of color have access to effective and culturally relevant depression prevention services. Yet findings from the depression prevention overview discussed here show that significantly more work is needed to ensure that culturally specific programs are being developed and tested in partnership with students, families, and communities who have been historically marginalized. This work should be accompanied by efforts aimed at addressing risks at individual and systemic levels to address structural inequities that contribute to the persistent racial disparities in mental health and service receipt among youth.

- By Maria Schweer-Collins, PhD, Research Assistant Professor, HEDCO Institute for Evidence-Based Educational Practice 

HEDCO Institute Blog 1 - May 31, 2023