YuLin Zhen, Photography Editor

The Yale Child Study Center is piloting a clinical framework to address the impact of racism on mental health care. 

The “Racially Informed Clinical Formulation,” or RICF, is designed to shift clinician training to emphasize engagement with patients from diverse racial backgrounds. The framework provides a holistic approach to examining how racism and cultural factors intersect with a patient’s emotional, psychological and social well-being in clinical evaluations.

“The RICF allows clinicians and supervisors to move beyond merely acknowledging racism, to offering actionable steps,” RICF’s Developer Dr. Cecilia Frometa told the News. “It creates a structure for asking questions around the racial, cultural issues.”

Mental health literature lacks comprehensive frameworks for clinicians to address the impacts of racism, which Frometa believes is one of the biggest gaps in mental health assessment. Frometa explained that traditional methods often overlook the complexities of racial identity and racism’s effects.

The introduction of RICF comes as mental health professionals grapple with disparities affecting communities of color and methods to address them through mental health care. Frometa’s work is also part of a larger shift away from cultural competency as a one-size-fits-all solution. 

Traditional cultural competency training, often based on basic facts or stereotypes, has proven insufficient in addressing deeper therapeutic dynamics. 

Dr. Tara Sanabria Davila, vice chair of diversity, equity and inclusion at the Child Study Center and fellow RICF contributor, pointed out that decades ago, “cultural competency was the idea that you could [take] workshop on someone’s identity and be an expert.” 

Although the training system has moved away from the 16-item interview protocol known as the Cultural Formulation Interview, Davila believes the RICF could “scaffold the Cultural Formulation Interview and ensure that clinicians are always talking about culture and identity.”

The framework encourages thorough discussions about racial identity, experiences with racism and how cultural background influences mental health. It also promotes open conversations about race and systemic oppression, topics often difficult for both clinicians and patients.

Currently, RICF is being tested by YCSC psychiatry, psychology and social work fellows. 

“In previous research, we have found that there are implicit biases among psychiatry providers,” says Dr. Victor Avila-Quintero, a contributor and associate research scientist at the Child Study Center. “RICF aims to reduce this implicit bias.”

Dr. Victor Avila-Quintero, a contributor and associate research scientist at the Child Study Center, said that the previous research found implicit biases among psychiatry providers 

According to Avila-Quintero, the RICF’s developers want to expand the framework.

Frometa hopes that the new framework will eventually become an established tool in mental health. 

“The goal is to expand RICF through the Child Study Center as we continue to refine our curriculum,” Frometa says. “Ultimately, we’re thinking about expanding RICF and making this a national standard.” 

Once the pilot phase is complete, the team plans to publish a paper detailing their findings.

The Yale Child Study Center is the Department of Child Psychiatry for the Yale School of Medicine.