implemented by interventionists (including teachers) for work with urban and reservation youth during in-school, after-school, and community-based programs for American Indian youth. AILS is thought to be broad enough to address concerns across diverse American Indian tribal groups yet respectful of distinctive and heterogeneous cultural beliefs and practices. The program received support in 2007 from three suicide prevention projects, funded by the Substance Abuse and Mental Health Services Administration, to train American Indian interventionists on a wide-scale basis, to complete an early adolescent version of the intervention, and to create an implementation guide. Efforts to evaluate AILS in an urban Indian education program are currently under way.

Box 11-2). Bernal, Bonilla, and Bellido (1995) provide a framework for developing culturally sensitive interventions that calls for consideration of language, persons, metaphors, content, concepts, goals, methods, and context.

On the other hand, research has indicated that, although cultural or other adaptations made by practitioners that reduce dosage or eliminate critical core content can increase retention by up to 40 percent, they also reduce positive outcomes (Kumpfer, Alvarado, et al., 2002). For example, efforts to create and disseminate best-practice components of the Nurse-Family Partnership Program failed to produce the same results as the controlled trial replications (Alper, 2002; Olds, 2002). While research on dissemination of tested and effective prevention programs appears warranted, more research to identify the active ingredients of those programs is required before adaptation and dissemination of best practices distilled from these programs are warranted.

In general, there has been a dearth of research on cultural, racial, and ethnic issues involved in interventions aimed at preventing mental, emotional, and behavioral (MEB) disorders (U.S. Public Health Service, 2001a) and even less research on the effectiveness of specific prevention strategies when implemented in a population other than that originally targeted by a trial. However, several models are being used to examine the extent to which program adaptation can be used to address the unique cultural needs of communities. Castro, Barrera, and Martinez (2004), for example, describe a hybrid approach to modifying the content and delivery of an existing prevention program. This area needs more research, as few empirical studies have examined alternative strategies.

One method of enhancing cultural sensitivity and cultural relevance is

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