While the classification of psychiatric disorders has been critiqued for failing to adequately account for culture, the inclusion of the Cultural Formulation Interview (CFI) in the DSM-5 has been viewed as a promising development for the inclusion of cultural factors in diagnosis and treatment of mental illness. In this study, we assess the appropriateness, acceptability, and clinical utility of the CFI among outpatients in a Mexican psychiatric hospital. Our assessment included observations of psychiatric residents' application of the CFI with 19 patients during routine outpatient visits, along with pre- and post-CFI interviews to determine providers' and patients' views of the CFI. The CFI was generally well received by providers and patients, viewed as a way of building trust and increasing providers' understanding of contextual factors influencing mental illness, such as social support. However, the CFI questions specifically related to "culture" were of limited effect and both patients and providers did not view them as useful. We discuss implications for the clinical assessment of cultural factors influencing mental health and illness and for the incorporation of the CFI in Mexican clinical settings.
Advocacy is considered a core competency within the field of counseling psychology, however more attention is needed to the training and assessment of advocacy competence for counselors-in-training. This study utilized Ratts and Ford's (2010) Advocacy Competencies Self-Assessment survey to measure self-perceived advocacy competence of master's and doctoral students within counseling (Council for Accreditation of Counseling and Related Educational Programs-accredited) and counseling psychology (American Psychological Association-accredited) programs. An exploratory factor analysis suggested 3 underlying factors in self-reported advocacy competence: Alliance Building and Systems Collaboration, Action and Assessment, and Awareness Building. Master's and doctoral students displayed marginal differences in Advocacy Competencies Self-Assessment scores with doctoral students scoring slightly higher in the Awareness Building factor. Respondents' perceived level of advocacy importance was a significant predictor of advocacy competence. Program characteristics (advocacy-related resources and opportunities to engage in advocacy activities) were also significant predictors of perceived competence. We propose a developmental model of advocacy competency acquisition as a basis for future research on assessment and training of advocacy skills.
In this paper, we describe two critical events in clinical supervision between two counseling psychology trainees of color and a White supervisor that demonstrate the need and effectiveness of a supervisory approach that challenges the psychotherapeutic status quo, particularly within the context of our current sociopolitical climate. Using case materials and our reflections, we highlight the significant contributions of relational safety as espoused by a critical postcolonial supervision framework (Hernández & Mc-Dowell, 2010) in cultivating trainees' development as culturally congruent practitioners. This approach confronts hegemonic values of psychotherapy and integrates the cultural worlds of clients, clinicians, and supervisors. We conclude with practical suggestions for building relational safety within the supervisory relationship and future research avenues. Public Significance Statement Authors provide two case examples to exemplify the usefulness of challenging the cultural embeddedness of current psychotherapeutic practice and training when working with trainees of color and culturally diverse clients. This critical postcolonial and resilience-based approach specifically centers on developing strong, authentic, and caring therapeutic and supervisory relationships. This perspective to supervision and therapeutic practice facilitated the integration of clinicians' whole cultural selves and the development of innovative and culturally congruent practices with diverse clients.
Mental health treatment utilization on college campuses remains disproportionately low among underrepresented (UR) students (i.e., racial/ethnic minorities, first-generation college students, and students from low-income families). Additionally, UR students report that factors including stigma, long wait times, and costs are barriers to accessing treatment. Given these trends, new methods to bolster the utilization of counseling services among UR college students are needed. Concurrently, there is a call for psychology training programs to increase their efforts in preparing health service psychologists to work with culturally diverse populations including UR students. Psychology training clinics may be an additional resource on campuses that can be useful in meeting both of these needs. We present a program evaluation of 4-year partnership between a counseling psychology department training clinic and an academic division serving UR students at a large Midwestern university. Two quantitative metrics, including service utilization hours by UR students (2,020) and direct service hours accrued by clinical trainees (1,266), highlight the benefits of the partnership. A social justice framework and implications for training programs interested in developing similar partnerships are discussed. Public Significance StatementThis program evaluation describes a formalized partnership between a psychology training clinic and an academic division supporting underrepresented (UR) college students. The partnership, developed within a social justice framework, increased the mental health treatment utilization rates of UR students while also increasing supervised clinical training opportunities for psychology doctoral students in working with diverse clients.
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