Date of Award

6-1-2015

Document Type

Campus Access Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Clinical Psychology

First Advisor

Ester R. Shapiro

Second Advisor

Nickki Pierce Dawes

Third Advisor

Miren Uriarte

Abstract

High prevalence and severity of child mental health disorders has resulted in federal and state initiatives emphasizing community-based, in-home, family-centered care, but limited research explores how these services are delivered in culturally meaningful ways while considering research on effective practice. This qualitative study utilized a transdisciplinary approach to community science (Wandersman, 2003) and Evidence Based Practice (EBP) (Satterfield et al., 2009) while considering ecologically valid cultural adaptation of clinical interventions to explore how diverse child clinicians, working In-Home in community settings, and family caretakers of children from culturally diverse, racial/ethnic minority backgrounds, view culturally meaningful, effective services. Analyses of interviews conducted with child clinicians (n=12) and family caretakers (n=8) used Thematic and Situational Analyses (Clarke, 2005) to identify major themes. Child clinician themes included: (1) In-Home Therapy (IHT): Rethinking Assessment, regarding culturally sensitive, family-centered flexibility of time and space respecting the home's intimacy and transparency, establishing relationship/alliance grounded in family goals and cross-contextual/multi-systemic assessment evaluating family-environment fit; and (2) Putting In-Home Therapy into Practice, regarding sociocultural/contextual factors associated with complex realities and demands of implementing interventions and impacting the family-child clinician partnership/alliance. Family caretaker themes included: (1) Caretaker World of Experience and Search for Services, regarding culturally congruent conceptualization of needs and goals, culturally meaningful resources and strengths enhancing resilience, and experiences accessing/utilizing services; and (2) Caretaker-IHT Partnership Affordances across Ecologies of Adversity and Resilience, regarding how experiences of partnering with the IHT clinician/team enhanced culturally meaningful perception of and access to realistic resources and services (Withagen et al, 2012). The family caretaker-clinician partnership transformed family-environment affordances by co-creating new understandings of resources aligned with child/family culturally and developmentally meaningful goals and sense of purpose. Ecological/cultural contextualization of interventions and care began with clinician's own cultural knowledge/reflexivity in relation to culturally-diverse, ethnic/racial minorities, practicing cultural humility, self-awareness and flexibility in offering assessment/intervention strategies while adapting these in response to cultural/ contextual dimensions of family experiences, perceptions, needs and preferences. Family-clinician partnerships were central to joining with, and learning about, diverse families in real-world meaningful settings, while recognizing and responding to sociocultural/contextual complexities associated with family needs and goals.

Comments

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