Improving Satisfaction, Engagement and Outcomes Among Traditionally Underserved Children Through Cultural Formulation
Condition: Disruptive Behavior
MeSH terms: Problem Behavior
Study type: Interventional

Summary: 
      The project at the center of this proposal will leverage a pilot randomized design to examine
      initial feasibility and preliminary effects of augmenting usual mental health evaluation
      procedures with a structured person-centered assessment tool that specifically considers the
      cultural context of patient mental health problems (i.e., the Cultural Formulation Interview;
      CFI) on parent satisfaction, engagement and clinical child outcomes in the treatment of early
      child behavior problems. Additional analyses will explore whether traditional barriers (e.g.,
      stigma, ethnic identity, and daily stress) moderate the effects of the CFI on satisfaction,
      engagement and treatment outcomes.
    

Detailed description: 
      This project is leveraging a pilot randomized design to evaluate initial feasibility and
      preliminarily examine whether augmenting assessment procedures for child behavior problems
      with the CFI improves satisfaction with assessment procedures and treatment, parent
      engagement in subsequent behavior parent training, and ultimately clinical child outcomes.
      Exploratory analyses will further consider whether traditional barriers to care moderate
      outcomes. The 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 will be randomized at baseline to receive either
      the standard diagnostic and clinical assessment (CA) or CA+CFI.

      Specifically, the investigators are interested in assessing study feasibility. Feasibility of
      recruitment and randomization, study retention, and condition integrity will be monitored.
      Additionally, clinician reports of CFI feasibility, acceptability and clinical utility will
      be examined. An additional main outcome will be initial satisfaction directly after the
      interview. It is hypothesized that families in the CA+CFI group will report higher levels of
      initial satisfaction than the CA group. A secondary goal is to assess preliminary effects of
      administering the CFI on treatment satisfaction, engagement and clinical child outcomes.
      Parents and therapists will report on their satisfaction with treatment. Engagement outcomes
      will be measured via: (a) initial session attendance, (b) drop out rate (c) session
      attendance rate, (d) homework completion rate, and (e) therapeutic alliance. Clinical
      outcomes will be measured via parent ratings of child behavior problems and parent time to
      skill mastery. It is hypothesized that CA+CFI families will demonstrate improved
      satisfaction, engagement and clinical outcomes relative to CA families. Further exploratory
      analyses will examine individual differences in effects related to traditional barriers to
      care. Exploratory analyses will examine stigma, ethnic identity, and daily stress as
      moderators of the effects of CFI administration on satisfaction, engagement and clinical
      outcomes. It is hypothesized that CFI effects will be particularly strong for families who
      experience greater traditional barriers to care.
    

Intervention name(s): Clinical Assessment and CFI; Clinical Assessment
Intervention type(s): Behavioral; Behavioral
Intervention description(s): CA and CFI families will participate in the Cultural Formulation Interview prior to their standard intake.; CA families will participate their standard intake procedures.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Randomized control trial in which participants are randomly assigned to either receive a diagnostic and clinical assessment plus the cultural formulation interview (CA and CFI) or the diagnostic and clinical assessment (CA).
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Other
Keywords: Cultural assessment; Engagement; Diverse Populations