Standardized Clinical Observation: Catalyst for Culturally Responsive Engagement

描述(由申请人提供)：低收入少数族裔参与者参与以家庭为基础的干预破坏性行为是一个巨大的挑战。评估时的初步临床经验可能会对他们的参与产生重要影响，但在少数民族家庭研究中，这一点几乎没有受到关注。在这项研究中，我们考察了文化强化的观察反馈范式的使用是否增加了被称为学龄前破坏性行为诊所的低收入少数民族家庭的参与度。研究第一阶段采用顺序设计，重点是方法开发，其中候选人使用混合方法方法来(A)开发将联合视频观察整合到临床反馈程序中的格式，(B)收集来自不同临床医生和家长的定性数据，以反映关于文化能力的不同观点；(C)通过生成伴随联合观察的文化响应代码，将关于文化能力的定性信息整合到观察反馈程序中；以及(D)开发编码系统，以评估在这些反馈会议期间观察到的临床医生能力(文化能力和联盟建设)和父母参与度。第二阶段使用上面在随机对照试验中开发的文化增强的反馈程序，比较这种反馈对临床医生能力和家庭参与度的影响。拟议研究的具体目标如下：目的)：开发和试点文化增强型观察反馈的标准化范式；目标II：进行随机试验，以测试文化增强型观察反馈对家长-临床医生参与度和临床医生文化能力的影响。文化增强的观察性反馈程序相对于标准反馈程序的额外影响将被检验，包括这种增强的程序是否提高了临床医生的文化能力。在干预背景下创新性地应用观察方法，可能会阐明重要的家庭和临床治疗影响，影响家庭有效参与干预的能力，并查明少数民族家庭参与的可改变的障碍。

DESCRIPTION (provided by applicant): Engagement of low-income ethnic minority participants in family-based interventions for disruptive behavior presents significant challenges. Initial clinical experience at the time of assessment may importantly influence their engagement but this has received little attention in studies of ethnic minority families. In this study we examine whether the use of a culturally enhanced observational feedback paradigm increases engagement of low income ethnic minority families referred to a preschool disruptive behavior clinic. Using a sequenced design, Phase I of the study focuses on methods development in which the candidate uses a mixed method approach to (a) develop a format for integrating joint video observations into clinical feedback procedures, (b) gather qualitative data from diverse clinicians and parents to reflect diverse perspectives on cultural competence; (c) integrate qualitative information on cultural competence into the observational feedback procedures by generating culturally responsive codes to accompany the joint observations and; (d) develop a coding system to assess clinician competence (cultural competence and alliance-building) and parental engagement observed during these feedback sessions. Phase II uses the culturally enhanced feedback procedure developed above within a randomized controlled trial that compares the effect of this feedback on clinician competence and family engagement. Specific aims of the proposed study are as follows: Aim): Develop and pilot a standardized paradigm for cultural enhanced observational feedback and Aim II: Conduct a randomized trial to test the impact of culturally enhanced observational feedback on parent-clinician engagement and clinician cultural competence. The additional effects of the culturally enhanced observational feedback procedure over the standard feedback will be examined, including whether this enhanced procedure increases clinician cultural competence. The innovative application of observational methodology within intervention contexts is likely to elucidate important familial and clinician therapeutic influences that effect families' capacity to fruitfully engage in intervention and pinpoint modifiable barriers to engagement in ethnic minority families.