How does culture fit into de-implementation? A scoping review of empirical research

Research indicates that racially and ethnically minoritized populations are more likely to receive low-value services in comparison to White populations. It is crucial to de-implement (i.e., replace or discontinue use of) these practices to make room for more effective alternatives and reduce disparities in outcomes. However, there is limited understanding of how, when, and why practices are de-implemented. De-implementation has been shown to improve client outcomes through a variety of mechanisms, such as improved service quality. This scoping review had two aims. First, we examined empirical articles related to de-implementation to determine whether culture (the practitioner's or client's values and beliefs) and race/ethnicity were assessed or reported. Second, we examined how these factors were considered throughout the de-implementation process. A total of 20 empirical studies were identified. Results suggested there is a gap in the literature regarding how culture and race/ethnicity may impact de-implementation and ensuing outcomes. We translated research across settings to highlight the importance of considering culture and race/ethnicity when engaging in de-implementation. Lastly, we provide suggestions for future research and discuss implications for practitioners. This article reviews the literature on the de-implementation of low-value, ineffective, or harmful practices in schools and other contexts that serve children and adolescents. Results indicated that the de-implementation literature has thus far failed to fully include culture, race, or ethnicity into the process. Incorporating culture, race, and ethnicity, into the de-implementation process, might promote positive and equitable outcomes for populations of color.