Methods In Contextualizing the Mental Health and Help-Seeking Experiences of Racially and Ethnically Diverse Individuals: The Culturally Infused Engagement (CIE) Interview

Introduction

Despite decades of attention to racial and ethnic disparities in mental health, engagement in formal mental health services continues to be a structural and cultural challenge for racially and ethnically marginalized clients, whose mental health experiences are shaped by multilevel socio-ecological systems, including structural, cultural, community-level, and interpersonal factors. Ethnic and sociocultural differences between racially and ethnically marginalized clients and their therapists can result in numerous barriers, including clinician cultural misunderstanding, culture-based alienation, mistrust, cultural stigma of mental health, and incongruence in cultural versus contemporary Western views of mental health. In response to this challenge, we developed and evaluated the utility of the Culturally Infused Engagement (CIE) interview, a clinical assessment designed to complement existing clinical assessments by assessing varied client cultural contexts and explanatory models in the assessment of client engagement in treatment, with a sample of 60 Asian American and Latine young adults.

Method

The CIE interview was developed as a semi-structured interview that directs clinicians in formulating a culturally responsive case conceptualization anchored in the ecological contexts of racially and ethnically diverse individuals. The interview is intentionally structured to facilitate the accurate contextualization of client’s mental health experience – it begins with an initial section focused on assessing salient system contexts of the client (e.g., racial/ethnic identities, familial contexts, ethnic culture, structural racism and oppression), followed by (b) a section examining the client’s multidimensional explanatory model of illness and distress. Trained interviewers conducted CIE interviews with 60 Asian American and Latine young adults, and transcripts were analyzed using template analysis to identify themes related to the help-seeking process.

Results

The following themes related to the domains of the help-seeking process were identified: (a) in conceptualization of mental health, which included mental health disorders and culturally construed distress, (b) causes of mental health, (c) views of individuals with mental health problems including stigmatized views and culturally appropriate distress, (d) others’ responses to mental health problems, such as stigmatization and benevolence, and (e) help-seeking approaches that included alternative sources of help and mental health services. Across these domains, participants’ identities, familial contexts and experiences of structural oppression shaped how they conceptualized their mental health problems and approaches to help-seeking. This highlights the utility of the CIE interview in assessing individuals’ mental health experiences as contextualized within their respective ecological contexts (i.e., their social identities, social positions and cultural contexts).

Conclusion

Our findings support the CIE interview as a culturally attuned assessment that effectively captures contextualized experiences and notions of mental distress for ethnically and racially diverse individuals, dimensions that are often omitted in traditional clinical assessments. By elevating the clinical reality of individuals’ lived experience of mental distress, the CIE interview identifies dimensions of help-seeking that have particular relevance for racially and ethnically diverse individuals, which have important implications for treatment engagement and planning. Further, the CIE interview can be used as a clinical tool that guides and enhances clinical education and training for social work practitioners.