The Racially Informed Clinical Formulation (RICF)

The Racially Informed Clinical Formulation (RICF) clinical interview addresses the impact of racism on patients and examines coping mechanisms within families. It also considers how racial dynamics may affect the therapeutic alliance. The primary goal is to strengthen this alliance between clinicians and the children and families they serve by incorporating clients’ racial identities and experiences into clinical formulations.

Training is required to use the RICF interview, and is currently being piloted internally at the Yale Child Study Center (YCSC). The interview and training were developed by YCSC Assistant Professor Cecilia Frometa, PhD, with significant support for refinement from faculty members and post-graduate associates on the RICF Steering Committee.

The development of a racially informed clinical formulation arose from the recognized need to incorporate the documented impact of racism on mental and physical health into clinical practice. Research has shown that racism significantly affects mental health and various aspects of prenatal and postnatal physical health. Moreover, studies exploring clinicians’ racial attitudes and their influence on treatment outcomes are expanding in depth and quality. Despite these findings, there is still limited evidence that such insights have been systematically integrated into standard practices for case formulation and therapeutic planning in mental health settings.

The clinical approach behind the interview aims to reduce treatment dropouts, increase comfort and involvement in the treatment process, and improve treatment outcomes. Additionally, using the RICF interview as a clinical tool can guide clinicians in selecting specific, evidence-based treatments that help families cope with racism. The RICF is intended to be an integral part of a comprehensive clinical assessment, not a separate diagnostic tool, and should inform the overall treatment plan by incorporating information about the racial experiences of the child and family.

The interview is structured to assess various aspects of racial identity, the impact of racism, and the effectiveness of coping mechanisms. It is divided into six primary domains, each focusing on a different area of the individual’s experiences and responses. By addressing these domains, the clinical tool aims to provide a comprehensive understanding of the effects of racial discrimination on mental health and identify effective coping strategies and interventions.

The core questions of the RICF interview explore how the child and family define their own race and ethnicity, what related adversities they have experienced and how they have dealt with them, what supports and resources they have accessed, and how they see these experiences in relation to their mental health and related services.

The interview also addresses the clinician’s own racial and ethnic identities and biases, and how they may play a role in treatment, along with the clinician’s understanding of the family’s perception of the institution or organization through which care is provided. The RICF interview is currently being piloted through the YCSC and collaborating Yale providers, following explicit training in the use of the clinical tool.

In addition to introducing clinicians and supervisors to the RICF interview, the RICF training course assists participants in developing a deeper awareness of various aspects of diversity, with a particular focus on race and ethnicity. It aims to enhance participants' understanding of navigating and addressing racial and cultural nuances within the therapeutic process, fostering a supervisory approach that is inclusive and culturally responsive. Training is currently only offered internally, with the goal of expanding this and offering it outside of Yale in the future.

A research study is also underway to evaluate the RICF training program that introduces the framework and clinical approach to mental health care providers. Data collected from participants before and after training completion will inform future trainings, with the ultimate aim to improve patient care among minoritized populations.

• Kathleen Malison, BS
• David Reiss, MD