Improving Satisfaction, Engagement and Clinical Outcomes Among Traditionally Underserved Children Through Cultural Formulation
Overview
- Phase
- N/A
- Intervention
- Not specified
- Conditions
- Disruptive Behavior
- Sponsor
- Florida International University
- Enrollment
- 89
- Locations
- 1
- Primary Endpoint
- CFI Fidelity Instrument
- Status
- Completed
- Last Updated
- 3 years ago
Overview
Brief 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.
Investigators
Eligibility Criteria
Inclusion Criteria
- •Child with elevated behavior problems
- •Child is between ages 2-7 years (inclusive)
- •Family seeking services at one of the University of Miami PCIT-Community Connect Centers
Exclusion Criteria
- •Parent is actively abusing illegal substances
- •Child is younger than 2 years of age
- •Child is older than 7 years of age
Outcomes
Primary Outcomes
CFI Fidelity Instrument
Time Frame: Post Intake Assessment (Week 0)
The CFI Fidelity Instrument assesses fidelity to the CFI (i.e. adherence and competence) in the CA+CFI group and potential cross-condition contamination in CA condition. Independent evaluators masked to condition, study design, and study hypotheses coded recordings of all assessments. This analysis was utilized to assess for feasibility of the pilot study and was mistakenly entered into the system as a primary outcome variable. This measure is not used to determine the effect of an experimental variable on participants in the study. Statistical analyses for this measure were only descriptive.
Satisfaction With Intake Questionnaire
Time Frame: Post Intake Assessment (Week 0)
The Satisfaction with Intake Questionnaire is a 7-item measure developed for use in the current study to assess parent and clinician satisfaction with their intake assessment. This measure assesses how well the patient/clinician felt the clinician understood the family's problems, cultural background, how their culture may influence their problem, and how much the parent trusts the clinician. Items are rated on a 5-point Likert style scale ranging from 1='not at all' to 5='very much', with higher scores representing higher satisfaction. Each item has a minimum of 1 and maximum of 5. Items were not summed. Two items were analyzed separately for the main outcomes: linear regressions tested condition effects on caregiver and provider satisfaction, and the extent to which the provider understood the caregivers' values or what is important to them.
CFI Clinician Questionnaire
Time Frame: Post Intake Assessment (Week 0)
The CFI Clinician Questionnaire is a 4-item measure developed designed to assess clinical utility of the CFI. Items are rated on a 5-point Likert style scale ranging from 1='not at all' to 5='very much'. Each item has a minimum score of 1 and a max of 5. Items include the extent to which conducting the CFI influences content and quality of information obtained in the intake, realtionship with the caregiver, treatment planning, and differential diagnosis. Higher scores indicate higher levels of clinical utility of the CFI. The measure was given only to the CA + CFI condition. This analysis was utilized to assess for initial utility of the CFI and was mistakenly entered into the system as a primary outcome variable. This measure is not used to determine the effect of an experimental variable on participants in the study. Statistical analyses for this measure were descriptive and only examined for the experimental group.
Secondary Outcomes
- Therapy Attitudes Inventory(Post Treatment (anticipated average: Week 14))
- Working Alliance Inventory-Short Form Revised(Post Treatment (Anticipated average: Week 14))
- Engagement(Change from Baseline (Week 0) through post treatment)
- Everyday Discrimination Scale(Post Intake Assessment (Week 0))
- Parental Attitudes Toward Psychological Services Inventory(Post Intake Assessment (Week 0))
- Treatment Response(Change from Baseline (Week 0) through post treatment (anticipated average: Week 14))
- Everyday Stressors Index(Post Intake Assessment (Week 0))
- Eyberg Child Behavior Inventory(Change from Baseline (Week 0) through post treatment (anticipated average: Week 14))
- Multigroup Ethnic Identity Measure- Revised(Post Intake Assessment (Week 0))