Improving Satisfaction, Engagement and Clinical Outcomes among Traditionally Underserved Children through Cultural Formulation

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 cultural context of child mental health problems in traditionally underserved families. Initial research focused on adult populations has suggested that incorporating the brief Cultural Formulation Interview (CFI) as part of baseline assessment can promote improved medical communication, leading to stronger rapport with the therapist, and overall patient satisfaction. To date, research on the benefits of augmenting usual mental health assessment with the CFI has mainly 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 and/or ultimate clinical response. The current study is the first to assess the effects of the CFI on satisfaction, engagement, and treatment outcomes. Families (N=89) receiving behavior parent training for early child externalizing problems within a large South Florida mental health network serving predominately low-income minority families were randomized at baseline to receive either Assessment as Usual (AAU) or CFI+AAU. Results found that therapists and caregivers were more satisfied with the intake interview when they received the CFI. Specifically, caregivers participating in CFI+AAU reported greater satisfaction with their assessment, and reported higher levels of trust in their therapists, than did caregivers receiving AAU. Additionally, therapists reported greater satisfaction with CFI+AAU than AAU, particularly when working with higher stress families. After controlling for interview length, there was trending significance to suggest CFI+AAU families may have been more likely than AAU families to attend their first post-intake treatment session, and CFI+AAU families were significantly more likely to complete treatment than AAU families. Moreover, those in the CFI+AAU group were associated with significantly better treatment outcomes among families reporting high stigma-related concerns about mental health; in contrast families who received AAU reported significantly better outcomes when families reported low stigma-related concerns at baseline. These promising results underscore how a brief cultural assessment can meaningfully aid