Improving Satisfaction, Engagement and Clinical Outcomes Among Traditionally Underserved Children Through Cultural Formulation

Florida International University, Miami FL

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Abstract

Project Summary/Abstract Economically disadvantaged and ethnic/racial minority children are more likely to suffer from disruptive behavior problems than their middle-to-upper-income Caucasian counterparts, yet they are less likely to receive quality care and are more likely to drop out of treatment services. Disparities in the reception of and engagement with mental health services suggests that standard mental health practices may not properly consider the unique issues and cultural context of child mental health problems in traditionally underserved families. Professional guidelines suggest that providing more culturally responsive services is one important method for increasing engagement in underserved population, however research on this front is quite limited. A broader patient-centered assessment of relevant cultural factors into evidence-based practices might yield improved care and maximize family engagement among traditionally underserved families. Initial research focused on adult populations has suggested that incorporating the Cultural Formulation Interview (CFI), a brief cultural assessment, as part of the baseline assessment can promote improved medical communication, leading to stronger rapport with the therapist, and overall patient satisfaction. Additionally, using critical culture- related information identified in the CFI to influence treatment planning for a given patient may lead to improved outcomes without the need to adapt a treatment for an entire population of individuals. To date, research on the benefits of augmenting usual mental health assessment with the CFI has only been conducted in the context of adult patients, and has yet to examine the potential for the CFI to improve treatment engagement in the context of children's mental health services. Further, studies on the CFI have only examined its impact on initial engagement and satisfaction with assessment services; research has yet to consider the effects of the CFI on prolonged engagement or clinical outcomes. Importantly, minority and economically disadvantaged families are disproportionately impacted by cultural, attitudinal, and stress-related barriers to care (i.e. stigma, ethnic identity, and daily stress). Research has yet to examine how these barriers may predict which families are more likely to benefit from the inclusion of the CFI. The current pilot study is being conducted within a large South Florida mental health network serving predominately low-income minority families obtaining parent training for early child behavior problems. Participating families (N=50) will be randomized at baseline to receive either the standard diagnostic and clinical assessment (DCA) or DCA+CFI. The dissertation pilot project will evaluate initial feasibility (Aim 1), and preliminary parent satisfaction, engagement in parent training, and clinical child outcomes (Aim 2). Further exploratory analyses will examine whether traditional barriers to care (i.e. stigma, ethnic identity, and daily stress) moderate the effects of the CFI on satisfaction, engagement and clinical outcomes (Aim 3).