Adaptation of Preventive Interventions for a Low-Income, Culturally Diverse Community

To describe essential elements in the adaptation of a prevention approach with a high-risk urban sample, chosen to contrast sharply with the primarily middle-class sample in which it had been originally tested. Key elements of a preventive intervention for families with parental depression were adapted for use in the new context. A sequence of alliance-building events was implemented, involving engagement at three levels: community, caregivers, and family. The prevention approach was modified to include an expanded approach to defining depression and resilience; greater flexibility on the part of the clinician; more intensive engagement between clinician and family, with a focus on immediate daily concerns; as well as awareness of cultural issues and responsiveness to the subject's experience of violence. Core principles of helping family members to discuss the effects of depression and adversity on family life were affirmed.