There exists a significant unmet need for effective mental health treatment, which is exacerbated for youth of color and lower-income youth. Ex-CBT is considered the leading evidence-based practice for treating patients with anxiety and OCD; however, it was researched and developed on samples of predominantly white middle- and upper-class patients, with limited considerations of what adaptations might be needed for youth of color and lower-income youth. We have an increasing understanding that cultural and contextual factors greatly influence a patient’s identity, experiences with, and response to mental health interventions. To be maximally effective, Ex-CBT likely should account for and be adapted to individual cultures and contexts.

The formative pilot work presented here involves a three-year retrospective chart review of youth who received anxiety or OCD treatment through the Pediatric Anxiety Treatment Center at Hall-Mercer (or PATCH) here in Philadelphia. The chart review consisted of 3099 patient sessions in total (113 clients enrolled in PATCH). Our main goal in reviewing these charts was to learn what strategies clinicians are currently using in mental health treatment. We coded for twenty-four discrete treatment strategies, including direct Ex-CBT strategies like cognitive restructuring or exposures, as well as whenever cultural and contextual factors were discussed, or therapists used case management strategies. During my time with the project, we coded 1,626 sessions and now have 67% of the sessions coded. At the last assessment, we have an average Kappa of 0.735 and 0.934 percent agreement, meaning coders are well within reliability. Once completed, we will use data from the coded charts to examine the relationship between what treatment strategies are used and treatment length, attendance, and dropout. We will also integrate this data with information from concurrently conducted qualitative interviews with clinicians, youth, and parents to guide the development of a toolkit of strategies to improve the cultural responsiveness of services for youth with OCD, anxiety, and related disorders.

Through this work, RESPECT aims to begin closing the gap in our current understanding of how to reduce inequities in youth mental health care and make it more person-centered and culturally responsive.