Standardized Clinical Observation: Catalyst for Culturally Responsive Engagement

描述（由申请人提供）：低收入少数民族参与者参与以家庭为基础的干预破坏性行为提出了重大挑战。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，但这在少数民族家庭的研究中很少受到关注。在这项研究中，我们研究是否使用文化增强的观察反馈范式增加参与低收入少数民族家庭提到学前破坏性行为诊所。使用序列设计，研究的第一阶段侧重于方法开发，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）从不同的临床医生和父母那里收集定性数据，以反映文化能力的不同观点;（c）将关于文化能力的定性信息纳入观察反馈程序，方法是编制文化上敏感的代码，以配合联合意见;（d）开发一个编码系统，以评估临床医生的能力（文化能力和联盟建设）以及在这些反馈会议期间观察到的父母参与情况。第二阶段使用了上述随机对照试验中开发的文化增强反馈程序，比较了这种反馈对临床医生能力和家庭参与的影响。拟议研究的具体目标如下：目标）：开发和试点文化增强的观察反馈的标准化范例和目标II：进行随机试验，以测试文化增强的观察反馈对父母-临床医生参与和临床医生文化能力的影响。将检查文化增强的观察反馈程序对标准反馈的额外影响，包括这种增强的程序是否提高了临床医生的文化能力。在干预背景下的观察方法的创新应用可能会阐明重要的家庭和临床医生的治疗影响，影响家庭的能力，卓有成效地参与干预和查明可修改的障碍，参与少数民族家庭。

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.