New Clinical Framework Addresses Racism, Enhances Mental Health Care

An innovative clinical tool designed to address the pervasive impact of racism on mental health has been developed and is currently being piloted at the Yale Child Study Center (YCSC) through training on the use of the Racially Informed Clinical Formulation (RICF) with a cohort of clinical trainees and their supervisors. The clinical approach behind the tool is intentional about supporting clinicians in considering and including experiences of racism and involves a strategic effort to systematically integrate patients' racial identities and experiences into clinical assessments and treatment plans.

The RICF clinical tool consists of a structured interview for mental health clinicians working with children and families that features eight key questions exploring themes related to racial and ethnic experiences. The questions guide clinicians and their supervisors in initial and ongoing mental health assessment of children and families, focusing on identity, adversity, and coping mechanisms.

This interview process can, in turn, help to understand the ways in which racial and ethnic identities sometimes influence experiences and interactions with mental health services. Clinicians are also able to gain insight into the unique challenges faced by the child and family—along with related supports and strategies—which may impact their mental health and overall well-being.

The core questions of the RICF 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 (e.g., the YCSC or other Yale providers).

The premise is that integrating these elements into a comprehensive clinical formulation allows clinicians to develop more nuanced and accurate treatment plans, tailoring care to address the unique challenges faced by individuals affected by racism. The RICF tool emphasizes the importance of clinicians reflecting on their own biases and the broader context of care, ensuring a holistic and effective approach.

According to the lead author of the RICF, YCSC Assistant Professor Cecilia Frometa, PhD, a goal of the pilot initiative underway at the center is to bring meaningful change across several disciplines—including social work, psychology, and psychiatry—by fostering a shared language and increasing comfort among clinicians and supervisors when addressing racial issues. "The RICF has the potential to significantly improve mental health care. It addresses a critical gap in our current practices and ensures that we are providing truly inclusive and effective care for all patients,” Frometa explains.

A steering committee consisting of YCSC faculty members and postgraduate trainees has played a vital role in supporting the expansion and ongoing development of the RICF tool. Along with Frometa, steering committee members include Laurie Cardona, PsyD, Tara Davila, LCSW, Michael Bloch, MD, MS, Angeli Landeros, MD, Victor Avila-Quintero, MD, Katie Malison, and David Reiss, MD, who together guide the next steps for the RICF to ensure its continuous refinement and effectiveness.

"Traditional mental health assessments often overlook the profound impact of racial experiences. RICF allows clinicians to gain a deeper understanding of their patients' lives, leading to more empathetic and effective care," adds Landeros, highlighting the tool’s transformative potential.

Beyond the current pilot, the committee plans to expand and refine RICF to better serve diverse populations and enhance mental health care outcomes. By establishing a standardized method for addressing racial issues, the RICF initiative aims to make a lasting impact on the quality of mental health care for all individuals, regardless of their racial background. “As the mental health field continues to evolve, the RICF tool marks a promising step toward achieving more equitable and effective treatment,” adds Frometa.