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

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


  • Project Summary/AbstractEconomically disadvantaged and ethnic/racial minority children are more likely to suffer from disruptivebehavior problems than their middle-to-upper-income Caucasian counterparts, yet they are less likely toreceive quality care and are more likely to drop out of treatment services. Disparities in the reception of andengagement with mental health services suggests that standard mental health practices may not properlyconsider the unique issues and cultural context of child mental health problems in traditionally underservedfamilies. Professional guidelines suggest that providing more culturally responsive services is one importantmethod for increasing engagement in underserved population, however research on this front is quite limited. Abroader patient-centered assessment of relevant cultural factors into evidence-based practices might yieldimproved care and maximize family engagement among traditionally underserved families. Initial researchfocused on adult populations has suggested that incorporating the Cultural Formulation Interview (CFI), a briefcultural 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 toimproved 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 conductedin the context of adult patients, and has yet to examine the potential for the CFI to improve treatmentengagement in the context of children's mental health services. Further, studies on the CFI have onlyexamined its impact on initial engagement and satisfaction with assessment services; research has yet toconsider the effects of the CFI on prolonged engagement or clinical outcomes. Importantly, minority andeconomically disadvantaged families are disproportionately impacted by cultural, attitudinal, and stress-relatedbarriers to care (i.e. stigma, ethnic identity, and daily stress). Research has yet to examine how these barriersmay predict which families are more likely to benefit from the inclusion of the CFI. The current pilot study isbeing conducted within a large South Florida mental health network serving predominately low-income minorityfamilies obtaining parent training for early child behavior problems. Participating families (N=50) will berandomized 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 examinewhether traditional barriers to care (i.e. stigma, ethnic identity, and daily stress) moderate the effects of the CFIon satisfaction, engagement and clinical outcomes (Aim 3). 

date/time interval

  • May 1, 2018 - August 31, 2020

sponsor award ID

  • 5R36MH116677-02



  • Adult
  • Applications Grants
  • Area
  • Assessment tool
  • Behavior
  • Caring
  • Caucasians
  • Child
  • Child Behavior
  • Child Mental Health
  • Client satisfaction
  • Clinical
  • Clinical assessments
  • Commun
  • barrier to care
  • career development
  • child mental health service
  • clinical diagnostics