Symposia
Treatment - Other
Amanda Sanchez, Ph.D.
Assistant Professor
George Mason University
Philadelphia, Pennsylvania
Jason Jent, Ph.D.
Associate Professor
University of Miami Miller School of Medicine
MIami, Florida
Neil Kishan Aggarwal, MD
Assistant Professor
Columbia University Department of Psychiatry
New York, New York
Denise Chavira, Ph.D.
Professor
University of California Los Angeles
Los Angeles, CA
Stefany Coxe, Ph.D
Associate Professor
FIU
Miami, FL
Jon Comer, PhD
Associate Professor
Florida International University
Miami, Florida
Dainelys Garcia, PhD
Assistant Professor
Mailman Center for Child Development
Miami, Florida
Martin LaRoche, PhD
Associate Professor
Boston Children's Hospital at Martha Eliot, Harvard Medical School
Boston, Massachusetts
Objective: Disparities in child mental health service engagement and outcomes for minoritized youth suggest that traditional evidence-based treatments (EBTs) do not systematically consider cultural and contextual factors. Preliminary research supports broadening standard mental health assessment to include evaluation of patient cultural factors to improve the cultural responsiveness of EBTs and reduce mental health care inequities. However, controlled studies have not been conducted in the context of children’s mental health care. This study examines the effects of person-centered cultural assessment improve engagement in child mental health services.
Method: Participants included families (N=89; 89% racial/ethnic minority) receiving services for child externalizing problems. Prior to intake, caregivers were randomized across two parallel conditions to receive either Assessment as Usual (AAU) or AAU augmented with the Cultural Formulation Interview (CFI+AAU), a brief caregiver interview of cultural factors affecting their child’s problems and help-seeking. Clinician reported utility and clinical experiences utilizing the CFI were assessed via open ended questions and a clinical interview.
Results: Clinicians reported strong clinical utility and high satisfaction with the CFI. Following assessments, CFI+AAU caregivers (relative to AAU caregivers) reported feeling better understood by their provider, and providers reported better understanding CFI+AAU families’ values and how culture affects their problems. Engagement outcomes found CFI+AAU families were significantly more likely than AAU families to subsequently complete the first phase of treatment. Further, among families receiving services in Spanish, CFI+AAU, relative to AAU, was associated with significantly higher engagement. In addition, clinicians reported barriers and facilitators to implementing the CFI and incorporating it into treatment planning.
Conclusions: Results underscore the initial utility and effectiveness of utilizing a person-centered cultural assessment to reduce inequities in mental health care. Further, clinical recommendations and implications for the inclusion of person-centered cultural assessment to improve the fit and appropriateness of EBTs for minoritized families will be discussed.