ABSTRACT

Objective

Disparities in child mental health service engagement suggest traditional evidence-based practices do not properly consider cultural and contextual factors relevant for marginalized families. We propose a person-centered approach to improve the cultural responsiveness of services. Preliminary research supports broadening standard assessments to include a person-centered evaluation of patient cultural factors, however, controlled studies have not been conducted in the context of children’s mental health care.

Methods

Participants included families (N = 89; 89% racial/ethnic minority) receiving services for child externalizing problems. Prior to intake, caregivers were randomized to receive either Assessment as Usual (AAU) or AAU augmented with the Cultural Formulation Interview (CFI+AAU), a brief caregiver assessment of cultural factors affecting their child’s problems and family help-seeking.

Results

Implementation data showed strong provider fidelity and clinical utility. 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. Caregiver satisfaction was rated highly overall, yet providers reported being more satisfied with the assessment when the CFI was incorporated. 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 treatment attendance, homework completion, and treatment response.

Conclusions

The results underscore the utility of incorporating a brief cultural assessment in pretreatment assessments. To improve the cultural responsiveness of services, efforts may do well to promote the uptake of person-centered approaches such as cultural assessment into usual care. Registered at clinicaltrials.gov (NCT03499600).

中文翻译：

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以人为本的文化评估可以改善儿童心理健康服务的参与和结果

摘要

客观的

儿童心理健康服务参与度的差异表明传统的循证做法没有适当考虑与边缘化家庭相关的文化和背景因素。我们提出以人为本的方法来提高服务的文化响应能力。初步研究支持扩大标准评估范围，包括对患者文化因素进行以人为本的评估，但是，尚未在儿童心理保健的背景下进行对照研究。

方法

参与者包括接受儿童外化问题服务的家庭（N = 89；89% 种族/族裔）。在入学之前，看护者被随机接受通常评估 (AAU) 或 AAU 增强文化形成访谈 (CFI+AAU)，这是对影响孩子问题和家庭寻求帮助的文化因素的简短看护者评估。

结果

实施数据显示出强大的提供者忠诚度和临床实用性。评估后，CFI+AAU 护理人员（相对于 AAU 护理人员）表示感觉自己的提供者更好地理解了，而提供者则表示更好地理解了 CFI+AAU 家庭的价值观。护理人员满意度总体评价很高，但提供者表示，在 CFI 纳入后，他们对评估更加满意。参与结果发现，CFI+AAU 家庭随后完成第一阶段治疗的可能性明显高于 AAU 家庭。此外，在接受西班牙语服务的家庭中，相对于 AAU，CFI+AAU 与显着较高的治疗出勤率、作业完成情况和治疗反应相关。

结论

结果强调了在治疗前评估中纳入简短的文化评估的效用。为了提高服务的文化响应能力，可以很好地促进在日常护理中采用以人为本的方法，例如文化评估。在 ClinicalTrials.gov 注册 (NCT03499600)。