The Racially Informed Clinical Formulation (RICF) Pilot Project

With an overarching goal of improving mental health care for children and families, the Racially Informed Clinical Formulation (RICF) aims to reduce dropout from mental health services, increase comfort and involvement in therapy, and improve outcomes.

The RICF interview is a clinical tool that consists of a structured set of questions for mental health clinicians to reflect upon in supervision, exploring themes related to racial and ethnic experiences, attitudes, and beliefs. The primary aim is to strengthen the relationship between clinicians and the children and families they serve in order to provide responsive and respectful care.

Training is required to use the RICF interview, which 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 a recognized need to address the impact of discrimination on child and family health, and to incorporate this into clinical practice. Research has shown that experiences of racism significantly affect mental health and various aspects of prenatal and postnatal physical health, and studies exploring the influence of clinician attitudes, beliefs, and biases on treatment outcomes are expanding in depth and quality. Yet, these findings and related insights have not been systematically integrated into standard practices for case discussion and planning in mental health settings.

Thus, the clinical approach behind the RICF aims to address unidentified racial bias that a caregiver might bring to a clinical care setting, along with mental health impacts on children and families who feel unfairly treated related to racial discrimination. The formulation process also examines coping mechanisms within families and considers how dynamics related to beliefs and biases may affect the relationship between a clinician and a patient. Use of the RICF interview as a clinical tool can guide clinicians in selecting the best and most appropriate treatments, interventions, or approaches to help children and families who have been impacted by racial discrimination

The interview is structured to address various attitudes and beliefs about race, as well as some of the impacts of racial discrimination and the effectiveness of strategies that can be used to manage related stress. It is divided into six primary domains, each focusing on a different area of individuals’ experiences and responses. By addressing these domains, the clinical tool aims to spark insight into and understanding of the effects of racial biases on the clinician-patient relationship as well as the impacts of experiences of discrimination on mental health.

The core questions of the RICF interview explore how individuals—both clinicians and the families they serve—define their own race and ethnicity, any related discrimination they have experienced and how they have dealt with this, how they see these experiences in relation to their mental health and related services, and how these factors may play a role in the clinician-patient relationship. Interview responses are reviewed and reflected upon jointly with a clinician and their supervisor.

n addition to introducing clinicians and supervisors to the clinical interview, framework, and clinical approach, the RICF training course assists participants in developing a deeper awareness of diversity in is various forms, with a focus on race and ethnicity. It aims to enhance participants' understanding of navigating and addressing bias and cultural nuance within the therapeutic process, fostering a supervisory approach centered on respect, responsiveness, and inclusivity.

RICF training is currently only offered internally at the YCSC, with the goal of expanding and offering it outside of Yale in the future. Data collected from participants before and after training completion is used to evaluate the process and inform future training efforts, with the ultimate aim to improve mental health care provided at the YCSC and beyond.

• Kathleen Malison, BS
• David Reiss, MD