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Enhancing capacity to provide cultural relatability in the in-home mental health service experience for urbanized and minoritized youths through workforce development strategy: a promising practi...

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Enhancing capacity to provide cultural relatability in the in-home mental health service experience for urbanized and minoritized youths through workforce development strategy: a promising practi...

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Content DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 1

ENHANCING CAPACITY TO PROVIDE CULTURAL RELATABILITY IN THE IN-HOME
MENTAL HEALTH SERVICE EXPERIENCE FOR URBANIZED AND MINORITIZED
YOUTHS THROUGH WORKFORCE DEVELOPMENT STRATEGY: A PROMISING
PRACTICE STUDY
By

Marlon W. Gray

A Dissertation Presented to the
FACULTY OF THE USC ROSSIER SCHOOL OF EDUCATION
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
DOCTOR OF EDUCATION

December 2019

Copyright 2019 Marlon W. Gray
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 2
DEDICATION

FIRST AND ABOVE ALL, I WOULD LIKE TO THANK GOD ALMIGHTY FOR WITHOUT
HIS HAND UPON MY HEART AND LIFE, I AM NAUGHT.

TO ALL OF THE SOLDIERS IN THE EPIC BATTLE FOR SOCIAL JUSTICE, NOT JUST
FOR SOME, BUT FOR ALL, THIS DISSERTATION IS RESPECTFULLY DEDICATED.

DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 3
ACKNOWLEDGEMENTS
This dissertation is especially dedicated to my son, Carter Wellesley Gray, the light of my
life and the fuel behind all that drives me. You are the heart, nerve and sinew that serves my turn
long after they are gone, and so I can always hold on, even when there is nothing in me except
the will which says to them “Hold on!” I do all that I do in hopes of inspiring you to dream, do,
and share your experiences with the world in your own special way. Onward and upward,
always! Daddy loves you! (Mostest, bestest, greatest – I win!)
To my mother, Elizabeth Ann Gray, who, herself, has been a career student and now a
teacher herself for supporting my curiosity as a child and showing me that every day offers a
learning opportunity for the seizing.
To my father, Beresford Egerton Gray, for providing me a shining example of what it is
to be a man of faith and family while grooming me for the aggressive and competitive arena that
is business and entrepreneurship.
To my family at (E-CFT)... While I can say “work family,” we have been through enough
to consider ourselves family at this point. Thank you for dealing with me (and my many moods)
during this process and holding down the fort down together - as one. Your ability to work and
innovate as one is extremely impressive and demonstrative of the magic that is possible when we
dare to dream, remain unafraid during times of uncertainty, and remain humble through triumph.
The amazing work is always just ahead of us. Let’s keep this beautiful ship moving at full
steam!
To Mario McCoy and Charles Michael Washington, my fellow Trojans and Brothers in
Alpha Phi Alpha Fraternity, Inc., for your fraternalism in demonstrating manly deeds,
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 4
scholarship, and love for all mankind in how you conduct yourselves daily and in how you both
have supported me in my life and endeavors outside of USC.
To my dissertation panel, Drs. Crawford, Mazza, Tobey, Murphy and Pearson for
pushing me to do my best work. Each and every one of you have supported me in a myriad of
ways, whether individually or as a group from Zoom meetings to text messages to phone calls to
emails to face-to-face meetings on campus as I was trying to get this all to make sense to myself
first before presenting it to others. I can only hope that in this process I have made you proud
along the way.
To the entire Cohort 8 AKA “The CoHeart” for an amazing experience in learning and
laughing together. When things got confusing or tough, we banded together and got down to
business. We dug our heels in deep, stood strong, and fought on like only Trojans can. I’m
looking forward to witnessing all of the greatness that we all are about to bring to this world.

DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 5
TABLE OF CONTENTS
Dedication 2
Acknowledgements 3
List of Tables 8
List of Figures 9
Abstract 10
Chapter One: Introduction to the Problem of Practice 12
Importance of Addressing the Problem 14
Purpose of the Project and Research Question 14
Organizational Context and Mission 15
Organizational Performance Goal and Current Performance 16
Organizational Performance Status 16
Description of Stakeholder of Focus 18
Overview of the Promising Practice in Review 18
Definitions 19
Chapter Two: Review of the Literature 24
The Role of Environment and Socioeconomic Status in the Problem 24
Low Utilization of Available Services 25
Trauma and Stigma Through the Lenses of Urbanized and Minoritized Blacks and Latinxs 26
Workforce Pipeline 28
Knowledge, Motivation, and Organization Framework 29
Knowledge and Skills 30
Motivation 34
Organization 37
Conceptual Framework 42
Understanding the E-CFT Practice 45
Chapter Three: Methodology 46
Data Collection 46
Participating Stakeholders 48
Criteria and Rationale 48
Sampling Recruitment Strategy and Rationale 49
Data Recording Protocol 50
Ethics 50
Limitations and Delimitations 51
Chapter Four: Findings 53
Participating Stakeholders 53
Overview of Results and Findings 54
Quantitative Data Results and Findings 55
Summary of Participating Stakeholders 58
Knowledge Results 59
Finding One 59
Finding Two 60
Motivation Results 61
Finding One 61
Finding Two 62
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 6
Organizational Results 63
Quantitative Analysis Conclusion 64
Qualitative Data Results and Findings 64
Summary of Participating Stakeholders 65
Research Question One 66
Finding One 66
Finding Two 67
Finding Three 68
Finding Four 69
Conclusion 70
Research Question 2 70
Finding One 70
Finding Two 73
Conclusion 76
Research Question Three 77
Finding Two 80
Conclusion 80
Synthesis 81
Chapter Five: Recommendations 82
Description of Stakeholder Groups 82
Knowledge Solutions 85
Increase Knowledge of Steps to Clinical Licensure (Declarative) 85
Increase Knowledge of Timelines and Milestones to Clinical Licensure (Procedural) 86
Assist With Resiliency (Metacognitive) 87
Motivation Solutions 87
Increase Value of Cultural Relatability (Utility Value) 90
Enhance Confidence in Ability to Achieve Clinical Licensure (Self-Efficacy) 91
Improve Interest in Addressing the Performance Gap (Utility Value) 92
Shared Vision of Family Voice and Choice (Cultural Model) 96
MLCs Have Access to Clinical Licensing Preparation Resources (Cultural Setting) 97
Integrated Implementation and Evaluation Plan 99
Level 4: Results and Leading Indicators 100
Level 3: Behavior 101
Level 2: Learning 104
Level 1: Reaction 107
Evaluation Tools 108
Data Analysis and Reporting 109
Summary 110
Recommendations for Further Research 111
References 112
Appendix A Quantitative Survey Questions and Likert Scale Values 121
Appendix B Quantitative Survey Results 132
Appendix C Qualitative Interview Questions 147
Appendix D Qualitative Interview Code Book 149
Appendix E Immediate Evaluation Of Kirkpatrick Levels 1 & 2: Quiz and Answer Key 166
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 7
Appendix F Immediate Evaluation of Kirkpatrick Levels 1 & 2: Instructor and Observer
Survey 168
Appendix G Blended Evaluation of Kirkpatrick Levels 1, 2, 3, & 4. 169

DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 8
LIST OF TABLES
Table 1: Knowledge, Influences, Types, and Assessments for Knowledge Gap Analysis 33
Table 2: Motivational Influences and Assessments 36
Table 3: Organizational Influences and Assessments 41
Table 4: Sampling Strategy and Timeline 50
Table 5: Description of data collection tool. 54
Table 6: Summary of Knowledge Influences and Recommendations 83
Table 7: Summary of Motivation Influences and Recommendations 89
Table 8: Summary of Organization Influences and Recommendations 95
Table 9: Outcomes, Metrics, and Methods for External and Internal Outcomes 101
Table 10: Critical Behaviors, Metrics, Methods, and Timing for Evaluation 102
Table 11: Required Drivers to Support Critical Behaviors 103
Table 12: Evaluation of the Components of Learning for the Program 106
Table 13: Components to Measure Reactions to the Program 107

DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 9
LIST OF FIGURES
Figure 1: Interactive conceptual framework. 44
Figure 2: Demographic data – gender. 55
Figure 3: Demographic data - race/ethnicity. 56
Figure 4: Demographic data - age range. 56
Figure 5: Demographic data - childhood locale. 57
Figure 6: Demographic data - clinical discipline. 57
Figure 7: Demographic data - experience as an in-home clinician. 58
Figure 8: E-CFT monthly supervision attendance as compared to NJ-SSC requirements. 60

DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 10
ABSTRACT
Mental health care in the United States is both important and expensive. In many
instances, those with the least amount of access to quality mental health care services also face
other social inequities. The government has addressed this issue in a myriad of ways, some
effective, others not. The outpatient development model creates a barrier to access for those who
cannot afford a vehicle or face missing income opportunities both short-term and long-term to
make their mental health appointments. The wraparound model, which includes in-home
professional and paraprofessional mental health services has closed this barrier to access
significantly but application of this model has also created another barrier to access. In New
Jersey, children and families who are challenged with mental health needs and fall at or below
the poverty line are afforded special Medicaid coverage to provide in-home services. Their
neighborhoods, however, are often considered to be too unsafe or otherwise undesirable by
qualified providers who are often either privileged themselves and/or not familiar with these
areas. The result is a widening gap in service provider availability for this population as mental
health providers refuse to work in these locations.
Most of the providers willing to work in these urbanized and predominantly minority
neighborhoods are often individuals who were raised in these same neighborhoods and are also
generally Black or Latinx. The issue is that many of these providers, however, often lack the
proper credentials, specializations or workforce entry opportunities required to properly address
the needs of these children and families through the in-home service model in a manner similar
to that of their non-urbanized and non-minoritized counterparts. The result is an equity issue in
the lack of quality mental health care that is linguistically or culturally matching for and relatable
to urbanized and minoritized children and families in need. The manner in which New Jersey
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 11
authorizes these services is generated also severely limits the use of providers without certain
credentials, leaving many of these children and families helpless and with no viable or
sustainable care options whatsoever.
There is a gap in the number of clinically licensed credentialed minority mental health
providers in New Jersey. If this problem is to be addressed in urban areas within New Jersey
such as Jersey City, Camden, and the locale of focus for this study, Newark, then the New Jersey
State System of Care (NJ-SSC) and certain key stakeholders, such as care management
organizations (CMOs) would have to be open to changing their positions on how services are
authorized to allow more culturally and linguistically competent providers to gain the
opportunity to develop clinical skills, develop clinical specialties, and achieve the adequate
credentialing to provide equity in the provision of mental health services to all children – not just
those who live in the “right” neighborhoods.
The objective of this transformative mixed-method study is to examine how many
urbanized and minoritized families in Newark, New Jersey, are truly impacted by this lack of
culturally and linguistically relatable mental health services by focusing on problems of practice
that adversely impact diversity in the in-home mental health provider workforce in New Jersey.
The goal of this study is to highlight innovative and promising practices that can be eventually be
implemented not just in the locale of focus, but across New Jersey in other areas like Newark,
and possible in other cities across the country. The logical assumption is that, if this issue can be
adequately addressed where there is greatest need, then it can be understood and addressed
anywhere.

DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 12
CHAPTER ONE: INTRODUCTION TO THE PROBLEM OF PRACTICE
Children’s mental health needs and the quality of the services available to address those
needs are important issues for each community and its stakeholders to understand. Mental health
challenges have implications on how a child performs at home, in academic settings, and in the
community (Edwards, Holden, Felitti, & Anda, 2003; Repetti, Taylor, & Seeman, 2002). When
inadequately addressed or altogether ignored, mental health challenges can become pervasive as
a child matures into adulthood (de Girolamo, Dagani, Purcell, Cocchi, & McGorry, 2012;
Edwards et al., 2003). In New Jersey, a system of care management referred to as the New
Jersey State System of Care (NJ-SSC) is charged with developing a suite of service lines and a
resource pool of approved service providers to assess mental health needs and provide clinical
interventions through those service lines. Effective interventions often consider biological,
psychological, and social factors in the assessment and treatment of mental health disorders
(Repetti et al., 2002). For some consumers of mental health services in New Jersey, the
aforementioned considerations are not comprehensive enough on their own.
Research indicates that, while the onset of symptoms for most mental health disorders
occurs earlier in life, effective treatment measures are not typically initiated until long after the
primary disorder had time to persist and has possibly led to other disorders (de Girolamo et al.,
2012). Howell and McFeeters (2008) pointed out this trend tends to affect Black and Latinx
children more than their Caucasian counterparts as these communities seek or use mental health
resources lower rates. This leads to questions as to why this trend occurs within urbanized
communities home to minoritized children and families more frequently. It is important to
understand the barriers to receptiveness and long-term effectiveness of all mental health services
delivered (Alvidrez, 1999; Edwards et al., 2003). For urbanized and minoritized youth, these
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 13
barriers include the child and family’s need for cultural competency, travel and opportunity costs
of engaging in treatment, and consideration for child and family preference in provider ethnicity
and gender, which have implications on quality of reporting, reception and collaboration between
providers and consumers (Brach & Fraserirector, 2000; Guevara et al., 2005; Howell &
McFeeters, 2008). In Newark, New Jersey, an urbanized area covered by the state’s children’s
system of care (CSOC), the many minoritized children and families who reside there typically
prefer to work with providers with whom they feel more culturally connected, but the options
few, thus presenting one of two options: settle for less than desired or do without (E. Rowe,
personal communication, October 15, 2017).
This paper addresses the problem of the shortage of culturally and ethnically relatable
providers of culturally and linguistically competent in-home mental health services for
unrepresented or underrepresented and minoritized youth of low socioeconomic status (SES) in
Newark, New Jersey. The Centers for Disease Control (CDC), a federal agency charged with
increasing the health security of the United States, reports children are more likely to be
diagnosed with a mental or behavioral disorder if they are poor, live in a neighborhood that lacks
amenities, and/or have an otherwise limited support system (CDC, 2017). Threats to mental
health in the city are aggravated by the fact that an estimated 29.1% of the population lives in
poverty, homelessness, or inadequate housing, (Caracci, 2006; U.S. Census Bureau, 2017).
Research suggests educational and social problems stemming from unmet childhood mental
health needs can contribute to socioeconomic and societal disparities in adulthood (Howell &
McFeeters, 2008).
To effectively provide mental health services in an urbanized area, service provider
organizations need to understand and counter the attitudinal and cultural barriers to effective
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 14
treatment search and utilization by recruiting, selecting, and training more culturally and
linguistically competent and culturally relatable direct care staff (Gudiño, Lau, Yeh, McCabe, &
Hough, 2009). This issue is important to address because the Child Health Act (2000), which
coordinates research, prevention, and intervention for conditions with a disproportionate impact
on the quality lives of children, ensures equal access to mental health and other health services
for all children. Furthermore, the CSOC of New Jersey employs the wraparound service model,
an evidence-based child and family team process designed to improve outcomes for children
with mental health challenges at home, in school, and in the community (Department of Children
and Families [DCF], 2017; Gudiño et al., 2009). The value of wraparound is family voice and
choice (DCF, 2017). Without addressing all barriers to effective mental health treatment of
minoritized youths in urbanized areas, this value cannot be adequately defended, creating
disparity.
Importance of Addressing the Problem
The problem of practice within the New Jersey State System of Care (NJ-SSC) as it
affects CMOs and in-home provider agencies is important to address. While much of the
literature cites the need for further research, there is an argument that needs to be examined and
re-constructed to develop a comprehensive solution. The change, when addressed, will have
long-term implications on mental health, equity and equality for urbanized and minoritized youth
in general.
Purpose of the Project and Research Question
This transformative mixed-method study of a promising practice focuses on wraparound
in-home service provider, Essex Children and Families Together, Inc. (E-CFT). The stakeholder
of focus is the master’s level clinician (MLC). Participation from this particular stakeholder
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 15
group has an impact on various children and family subgroups receiving in-home therapeutic
services, but the focus on this study ties this stakeholder to the goal of addressing the problem of
practice. Under examination are E-CFT’s recruiting, selection, training, and advocacy guidelines
and processes pertaining to creating in-home workforce entry and development opportunities for
this stakeholder group. The purpose of this study was to examine how utilization of MLCs can
increase cultural matching and relatability capacity when serving urbanized and minoritized
youth. The research questions for this study are as follows:
1. How are the MLC in-home provider development practices of E-CFT defending the
organization’s core value of family voice and choice in services options?
2. What are the knowledge, motivation, and organizational influences affecting the
fulfillment of the family voice and choice option as it pertains to cultural relatability to
the in-home clinician?
3. What are the recommendations for replication of E-CFT’s organizational practices with
the MLC stakeholder group from a knowledge, motivational, or organizational
standpoint?
Organizational Context and Mission
Based in Newark, E-CFT is a state-approved provider of a wide variety of professional
and paraprofessional support services to children with developmental disabilities and/or intense
behavioral or mental health challenges and their families. These services include youth
mentoring, in-home paraprofessional support, after-school supervision, and intensive in-home
family therapy. E-CFT serves children from ages 4 to 21. Established in 2015, E-CFT is a
learning organization designed to create opportunities for current and aspiring clinicians to
develop and grow their skills through a series of rotations across support roles and mental health
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 16
populations. At its core, E-CFT functions as a learning organization whose mission is to create
necessary and sustainable change in all communities through innovative thinking in program and
workforce development and reinvestment in the community (E-CFT, 2018). E-CFT currently
employs 30 individuals on site and contracts with 200 mental health providers.
Organizational Performance Goal and Current Performance
By 2021, E-CFT will close the provider gap for families of low SES who are urbanized
and minoritized and have largely unmet cultural and linguistic needs. Data on how many
families are currently being served were collected to learn how many who request a provider
who is culturally similar and/or speaks their language actually receive such a provider and the
level of service they receive. The organization’s global goal is to ensure that at least 75% of
families who make such a request are satisfied with, at minimum, a clinically licensed provider.
An intermediate goal is for E-CFT to advocate to the state for master’s degree holders in the
areas of social work, psychology, or counseling who have completed initial licensure to receive
opportunities in Newark under special supervision requirements toward their clinical licensure.
A performance goal is to recruit, select, and train 50 highly capable individual providers through
a special supervision program to create workforce opportunities for MLCs and aspiring clinicians
at the paraprofessional level for placement in Newark within the next three months.
Organizational Performance Status
As a state-contracted mental health provider, E-CFT has accountability to the state, its
fiscal agent, DXE Technologies, and the New Jersey Medicaid Program which all work in
concert to fund and monitor the services provided. Burke (2004) described the accountability
type that exists among the aforementioned agencies and E-CFT as bureaucratic. In this model of
accountability, rules serve as levers, financial auditing systems are the programs that protect the
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 17
stakeholder group, regulations hold E-CFT accountable, and there are consequences for violation
of these rules or regulations, all with the goal of efficiency and system stability (Burke, 2004;
Firestone & Shipps, 2005).
It is important for E-CFT to also realize another key stakeholder for which the
organization and other like organizations are accountable: the children and families served.
Consistent with the wraparound model’s goals of cultural competence, E-CFT’s organizational
goals include understanding and responding to the cultural and linguistic needs of families, but
research on wraparound fails to adequately define how this translates into outcomes (Gudiño et
al., 2009; Rosanbalm et al., 2016). With a current enrollment of over 500 children and families,
mostly of low SES, the wraparound service model creates challenges. In Newark, there are
several neighborhoods where residents fall at or below the poverty line. These neighborhoods
are predominantly Black (African, African American, Haitian, West Indian) at 50.2% or Latinx
(Latin American, South American) at 36.0% (E. Rowe, personal communication, October 15,
2017; U.S. Census Bureau, 2017).
The first wraparound principle of family voice and choice becomes hard to uphold when
options are out of alignment with family vision (E. Rowe, personal communication, October 15,
2017). In many instances, consumers request to work with an in-home therapist who is of the
same or similar background (E-CFT, 2019). With shortages in clinically licensed staff in Essex
County in general, it can become challenging to honor family voice as it pertains to a culturally
and linguistically competent or relatable provider who is also willing to work in low-SES
neighborhoods, and most families are made to wait to receive services or receive no services at
all (E. Rowe, personal communication, October 15, 2017).
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 18
Description of Stakeholder of Focus
Master’s level clinicians, for the purposes of this study, are individuals with a master’s
degree in social work, counseling, or psychology. By NJ-SSC guidelines, individuals must not
only have completed their master’s program, but also have completed the initial licensing
application and acceptance process for their discipline, which includes a licensing exam (NJ-
SSC, 2018). After becoming an MLC, the individual must complete a certain number of
supervised field hours, pre-determined by discipline, by a licensed professional with clinical
licensure in that discipline who is approved to supervise MLCs seeking clinical licensure.
Overview of the Promising Practice in Review
In a three-pronged approach, E-CFT recruited, selected, and trained a series of MLCs,
many of them culturally representative of the areas experiencing shortages, scaffolded them with
additional training opportunities and clinical supervision beyond the recommended rate of
supervision of once a month, and marketed to local CMOs. E-CFT highlighted the problem, laid
out its solution, and asked for their support of the initiative via support of MLC referrals. The
response was varied in different counties based on their view of MLCs and preference for
clinically licensed clinicians, which is one of the roots of the problem. As MLCs were provided
opportunities and backed with a core support structure to assist them in performing as well as
licensed clinicians from other agencies, buy-in from local CMOs slowly increased.
The approach in review has applications to various populations and subgroups within
them, but the focus of this study is the promising practice to help attract, produce, and develop
21 MLCs who could meet family voice and choice in cultural relatability with their provider in
Newark and surrounding areas. Currently, E-CFT is on pace to increase this number by another
50 within the next 2 to 3 years, and recommendations will be made on how provider
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 19
organizations can implement a similarly effective approach for populations in which disparities
exist in terms of provider representation.
Definitions
This section defines several terms used in this study. The following terminology is
relevant and important to the research.
Clinical supervision: Clinical supervision refers to a pedagogical experience in which an
aspirant for a clinical license or someone performing social or therapeutic services experiences
mentoring, feedback, direct instruction, and metacognition with the guidance of a licensed
clinician approved to provide such experience (Bogo & McKnight, 2008; Asakura & Maurer,
2018). In the context of this study, clinical supervision refers directly to the learning activities
associated with the stakeholder group of focus in achieving the next level of clinical licensure
under an approved supervisor who practices in the same discipline. These activities include field
hours, discussing ethics, gaining guidance on documentation, and preparation for the next
licensing exam.
Clinical supervision requirements by stakeholder discipline vary. A licensed social
worker (LSW) requires a minimum of two years or 1,920 face-to-face field hours under the
direct supervision of an approved LCSW (New Jersey Division of Consumer Affairs, 2019). A
licensed associate counselor (LAC) requires a minimum of 3 years and 4,500 hours of face-to-
face field service, or 3,000 if the individual has a 60-credit master’s degree, completed under the
supervision of an approved Licensed Professional Counselor (LPC; New Jersey Division of
Consumer Affairs, 2019). A Psy.D. requires 1,750 postdoctoral hours of field work completed
under the supervision of an approved Psy.D. supervisor within a 3-year period for consideration
for licensing. This includes no less than 1,000 direct contact hours with service recipients and no
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 20
less than 550 associated with administrative tasks such as record keeping and consultation (New
Jersey Division of Consumer Affairs, 2019).
Upon licensing, the former supervisee will earn the credential of their former supervisor.
Cultural relatability: The central concept of this study to develop cultural relatability for
urbanized and minoritized families receiving intensive in-community interventions in Newark.
Lacking a definition for this term, the word must be broken down to its roots for its used to be
better understood. Merriam-Webster defines “relatable” as able to be related to, possible to
understand, like, or have sympathy for because of similarities to oneself or one's own
experiences (Relatable, n.d.). Merriam-Webster defines “-ability” as a morphemic noun suffix
indicative of the tendency, fitness, or capacity to act or be acted upon in a specific way (-ability,
n.d.). Coupled together “relatability,” for the purposes of this study, is used to mean the
capacity or tendency to understand and sympathize due to similarities based on one’s own
experiences. Specifically, “cultural relatability” speaks to a relationship founded on the shared
tendency to understand, directly relate to, and sympathize with experiences of a member of a
specific ethnic group based on one’s own experience in having membership in the same or a
similar group. This term offers stronger meaning in conversations about traumatic experiences
and the resultant cultural barriers to effective mental health treatment within cultural groups and
subgroups.
Doctor of Psychology - 3 year permit (Psy.D.): an individual who holds a doctorate in
psychology (Psy.D.) and passed initial national and state licensing exams to become recognized
by the State Board of Psychology Examiners as a doctor in psychology (Psy.D.).
Intensive in-community (IIC): Intensive in-community is a solution-focused, analytical,
and needs-based clinical intervention (PerformCare, 2019). This solution is commonly provided
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 21
at home or in the community with the clinician traveling to see the service recipient. In some
systems, this service is referred to as intensive primarily due to the fact that clinicians generally
provide therapeutic services in the child and family’s home.
Licensed associate counselor (LAC): an individual earned a master’s degree in
counseling (MA/MS) and passed an initial licensing exam to become recognized by the State
Board of Marriage and Family Therapists as a LAC.
Licensed social worker (LSW): an individual who earned a master’s degree in social work
(MSW) and passed an initial licensing exam to become recognized by the National Association
of Social Workers and their state’s social work board of examiners.
Master’s level clinicians (MLCs) and clinical supervision: There are three types of
clinicians who will be categorized as MLCs by their educational and credentialing tracks: social
workers who hold a credential of social work (LSW), counselors who hold a credential as LACs,
and psychologists who hold a credential of Doctor of Psychology (Psy.D.) and serve patients
under a 3 year permit.
Urbanization and minoritization: For the purposes of this study, the children and families
of focus are referred to as both urbanized and minoritized. To gain an appreciation of the
children and families to whom this research is designed to assist and where and how they live, it
is important to understand the concepts of urbanization and minoritization. The word urbanize is
a transitive verb that describes the end condition of a person or thing that is being or was acted
upon in such a way that results in them becoming urban in characteristic. Urban refers to, is
characteristic of, or otherwise constitutes inner city (Urban, n.d.).
Linguistically, when “-ize” is added to any noun or adjective, the result is a word that
suggests that particular noun or adjective is being acted upon in a manner that causes
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 22
resemblance, conformation, transformation, or the condition of being subjected to a lack of
freedom to act or forced submissiveness (-ize, 2018). Minoritized is not actually recognized as a
word in the dictionary, but the use of this blended term offers an interesting concept for
consideration with regard to the experiences of people who can be considered ethnic minorities
in the United States. For instance, the Merriam-Webster Dictionary defines minority as “a part
of a population different from others in some characteristics and often subjected to differential
treatment” (Minority, n.d., para. 1) Applying this same linguistic logic, blending the word
“minority” with the suffix “-ize” to create the transitive verb minoritize aims to generate an
interest and awareness in both the historical and modern-day social injustices experienced by the
population the study aimed to advocate for as well as the systemic differential treatment, lack of
freedom to equitably act upon it, and, potentially, a subsequent forced submissiveness in the
form of internalized oppression.
The system of care, its partners, language, and relationships: Provider agencies like E-
CFT and CMO are intermediaries between the provider agency and families, but also the New
Jersey State System of Care (NJ-SSC) houses all data related to child and family services
provided in the state. Their duties include reviewing service requests from CMOs and
authorizing provider agencies to provide services and be paid for those services through the New
Jersey Medicaid Program.
Wraparound: Wraparound is a team-based approach to providing mental health care for
youths with serious emotional, behavioral and developmental challenges (PerformCare, 2019;
Suter & Bruns, 2009). In this team approach, the child and family team consists of a series of
both formal and informal supports. Formal supports include resources like family and friends,
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 23
whereas informal supports include resources such as the family’s care manager and associated
services agencies. The care manager, an informal support, coordinates services.

DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 24
CHAPTER TWO: REVIEW OF THE LITERATURE
Mental health services in urban areas are, at times, opposed by children and families who,
due to socioeconomic disparities and underrepresentation in systems of care or service, distrust
systems designed to help (Alvidrez, 1999; Brach & Fraserirector, 2000; Howell & McFeeters,
2008). The general perception is mental health services are unavailable because those with the
highest qualifications either will not work in the areas with the greatest need or cannot connect
with children and families because they are seen as not having the same cultural background,
culture, or understanding (Alvidrez, 1999; American Psychological Association [APA], n.d.).
According to the APA (n.d.), mental health practitioners tend to identify outside of racially
and/or ethnically minoritized and urbanized populations, which creates resistance from those in
need. The conceptual model of wraparound suggests that interventions offered with cultural
competence should, theoretically, increase the ability of behavioral health services by utilizing
clinicians who can deliver appropriate services to diverse populations (Brach & Fraserirector,
2000; DCF, 2017). A key consideration in the patient experience is a firm understanding and
appreciation of their culture, environment, and SES.
The Role of Environment and Socioeconomic Status in the Problem
Various studies have investigated and have made connections in relationships among
SES, location, race, and ethnicity as pertains to mental health services access and utilization
(Avila, Kamon, & Beatson, 2016; Public Health Reports, 2001; Ronzio, Guagliardo, & Persaud,
2006). In a 2006 report in the American Journal of Osteopsychiatry on disparities in urban
mental health, a relevant connection was established among locale, income, and utilization
(Ronzio et al., 2006). The geographic location of providers becomes burdensome when a family
lacks economic resources and work flexibility. Furthermore, as family income and informal
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 25
supports increase, traveling plays a lesser role in the utilization of mental health services (Ronzio
et al., 2006). Conversely, the gap in access widens as families fall near or below the poverty
line. Specifically, racial and ethnic minorities and those of low SES receive lower quality access
to specialized care compared to their more privileged White counterparts (U.S. Department of
Health and Human Services [DHHS], 2011). To redress this disparity, the DHHS (2011)
proposed creating programs to promote diversity in mental health and educate the provider
workforce on cultural competency to enhance understanding of disparities. There is, however, a
strong difference between theory and practice. Despite efforts on workforce education and
diversity initiatives on the part of the state, as it pertains to Newark, low service utilization rates
would indicate that a disconnect still exists and needs to be addressed.
Low Utilization of Available Services
Racial and ethnic minorities are less likely to have access to mental health services, and
those who do receive those services report poor experiences, especially the 24 million adults
categorized as having low English proficiency (DHHS, 2011). From an organizational resource
perspective, low cultural competency and low representation of racial and ethnic minorities in
the provider workforce are key contributors to lower utilization (DHHS, 2011; Avila et al.,
2016). The challenge that a lack of mental health providers with cultural competency creates is
that, once in the field of service, providers who have spent less time with a racially and
ethnically diverse population experience a high degree of difficulty connecting with members of
those populations (Avila et al., 2016).
Without the increased cultural competency proposed by the DHHS, providers may
unintentionally display bias, thus hindering provider/patient relationships by strengthening
barriers to information-sharing and lowering receptiveness to recommendations (Avila et al.,
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 26
2016). This only highlights the disparity in behavioral health services. On one side, access is
limited and, on the other, connections are more easily compromised due to racial and ethnic
divides and mistrust. This problem has not gone ignored by policymakers in New Jersey, but,
especially when considering areas like Newark and that CMOs are challenged with operating
within their regulations, more can be done to address this need. Examples of more than can be
done include more closely examining the workforce pipeline and launching initiatives to promote
mental health providers of color in the workforce with the experience and credentials required to
tackle the issue more effectively.
Trauma and Stigma Through the Lenses of Urbanized and Minoritized Blacks and Latinxs
Research suggests underutilization of mental health services and systems by urbanized
and minoritized individuals who experience ongoing discrimination (Alvidrez, 1999; Champine
et al., 2018). This experience of discrimination can cause both physical and physiological
reactions that affect mental health and social functioning, such as chronic stress, depression, and
substance abuse (Champine et al., 2018; Williams, 2000). Gary (2005) suggests a double
stigmatization experience for this population in their membership in socially marginalized group
and their respective culture’s misconceptions about mental illness. Black and Latinx
communities share a commonality in that each has a series of subgroups with multiple possible
social identities, thus making each member unique (Champine et al., 2018). It is, therefore,
important to understand the common stressors within each group, but also appreciate the fact that
there are deeper intersecting identities amongst members.
Research suggests generational trauma, systemic oppression, persistence of negative
stereotypes and the resultant attitudes and negative self-evaluations they generate are amongst
the most common reasons for underutilization of mental health services within the urbanized
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 27
Black community (Gudiño et al., 2009; Williams et al., 2000). Resiliency established through
enduring ongoing racism and lack of trust are recurring themes in research-based explanations of
why Black families prefer options such as church and family to address mental health issues,
especially with their children (Bell-Tolliver et al., 2009; Good-Cross, 2011). Champine et al.
(2018) cited anxiety over judgement or failure to understand parenting skills or styles of
discipline were predictors of utilization of mental health services due to challenges in trusting
clinicians. The authors continue to report that satisfaction in the mental health service
experience amongst Black parents occurs more frequently when they trust that the clinician is
genuinely demonstrating knowledge and understanding of the family and their culture. In a focus
group of 12 Black mental health therapists regarding roots of preference for working with
culturally relatable providers, Good-Cross (2011), one participant suggested the perception of
trust amongst Black recipients of mental health care comes from a feeling of cultural familiarity
with the therapist and found that engagement increased based on that factor, even if the provider
him or herself did not feel that same connection.
In the Latinx community, the stressors and stigma are different at their roots. Challenges
with being non-English speaking, being undocumented, and general misconceptions about
mental health are common explanations for why Latinx parents turn to either faith or family to
address mental health challenges, if not denying their existence altogether (Champine et al.,
2018). Reyes et al. (2017) cited acculturation as a major stressor to both the parents and child,
namely the parents fighting to hold on to traditions from their country of origin while the child,
growing up in America, is trying to adopt the ways of his or her peers. In seeking mental health
treatment, anxieties and fears can be eased by working with a clinician who understands the
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 28
particular Latinx subgroup to which the family belongs, their faith, and language (Champine,
2018; Faye, 2005).
Workforce Pipeline
The Sullivan Commission (2004) and Wielen et al. (2015) indicated there are barriers to
entry which minorities face in the healthcare field, especially mental health. Research
disseminated by the Sullivan Commission (2004) highlights these barriers at three points in
education: K-12, higher education, and healthcare professional education. Specifically, the
commission indicated minority students pursuing health careers who have excelled in
postsecondary and secondary education face their largest career advancement barriers at the
point of professional education specific to their specialty (Sullivan, 2004, p. 72). New Jersey,
like many states, however, is in the position to address the workforce and quality of care issue
simultaneously (Wielen et al., 2015, p. 1039). Current research suggests more investment in
understanding neighborhood needs, plus promoting programs to address knowledge, motivation,
and organizational needs challenge and correct this disparity (Sullivan, 2004; Wielen et al.,
2015). While the minority mental health provider pipeline contributes to the shortage and
problem, research appears focused primarily on knowledge and motivational gaps with little
discussion regarding organizational or systemic needs that can address this specific problem.
This section consists of a review of literature relevant to the problem of the shortage of
adequately credentialed and culturally relatable in-home mental health service providers for
urbanized and minoritized children in Newark, New Jersey. Given the implications that
unaddressed childhood mental health concerns have on adult development and performance at
home, school, and in the community, it is important to understand the role of provider credentials
and culture as they pertain to treatment effectiveness. This section examines the role of the New
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 29
Jersey State System of Care (NJ-SSC), the governing body for the in-home mental health
program across the state. Also included in this section are a review the role of master’s level in-
home mental health clinicians followed by an explanation of the knowledge, motivation, and
organizational influences’ lens used in this study. Finally, the connection between culturally
relatable providers and service utilization is made by examining the consumers of in-home
mental health services in Newark, New Jersey, and the knowledge, motivation, and
organizational influences associated with their utilization of these services in highlighting the
promising practice of E-CFT.
Knowledge, Motivation, and Organization Framework
The first step in problem solving for an identified organizational challenge is to perform
an assessment in which the problem itself can be better understood. A gap between current
outcomes and desired outcomes per an organization’s mission, vision, values, and performance
goal is an organizational challenge. Failure to achieve the desired standard constitutes a
performance issue which the organization must address to achieve its goals. A framework is a
conceptual structure or series of ideas and beliefs that help frame a problem in such a way that
solutions may be identified and implemented (Collins, 2018; Framework, n.d.). Using a
problem-solving framework allows the researcher to decide which data to gather and how to
organize and interpret them in a way that addresses the problem effectively and efficiently.
Clark and Estes (2008) designed an organizational performance problem-solving model to
assesses performance problems related to knowledge, motivation, or organization (KMO). The
purpose of this section is to briefly introduce the KMO problem-solving framework (Clark &
Estes, 2008).
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 30
When organizations fail to perform in any particular area, the cause of the problem is
either rooted in individuals’ knowledge and skills, their motivation to perform, or issues within
the organization such as culture, policies, procedures, or resources (Clark & Estes, 2008, p. 43).
In conducting analysis of organizational performance issues, Clark and Estes (2008) argued
researchers or organizations should essentially ask whether all members of the organization have
the appropriate level of KMO resources required to attain the organization’s goals. The authors
added that all three of these elements must be in alignment to achieve the goals (Clark & Estes,
2008). When knowledge, motivation, and organization are not aligned, this problem-solving
framework helps in identifying root causes to develop a solution that gets these elements closer
to the alignment required for goal achievement.
Knowledge and Skills
Contemporary organizational behavior research suggests creating an environment rich in
feedback and coaching can enhance the acquisition of knowledge and skills, thus increasing
employee performance by heightening intrinsic motivation to learn and apply the learning (Clark
& Estes, 2008; Mone & London, 2018). Collectively, these elements can increase an
organization’s production of an autonomous workforce capable of high-level performance and
increase the organization’s overall performance (Mone & London, 2018; Pink, 2009; Shujahat,
Ali, Nawaz, Durst, & Kianto, 2018). Clark and Estes (2008) suggested that, to properly diagnose
and treat employee performance related issues, we must first know how to associate those issues
with the either one or a combination of elements of the KMO root cause. Elements associated
with knowledge have to take into consideration employees’ prior learning experiences and how
current training and learning experiences shaped their knowledge base, especially in innovative
organizational models (Clark & Estes, 2008; Shujahat et al., 2018). Furthermore, innovation
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 31
requires the understanding and management of knowledge as it translates into intrinsic
motivation, which is a factor that studies suggest propels innovative organizations (Pink, 2009;
Shujahat et al., 2018).
Knowledge influences. There are six levels of cognitive processes that influence
knowledge acquisition and retention that subsequently develop one of four knowledge systems:
conceptual, factual, metacognitive, and procedural types (Dima, Cantaragiu, & Gilmeanu, 2012;
Rueda, 2011). Those six levels are remembering, understanding, applying, analyzing,
evaluating, and creating (Dima et al., 2012). Conceptual knowledge creates meaning as it
represents the “what” of knowledge and leads to better retention and application of that
knowledge as it is based in the understanding of classifications, theories, and models (Dima et
al., 2012; Rueda, 2011). Factual knowledge is more fundamental and is more about
remembering facts such as people, places, and dates (Dima et al., 2012; Rueda, 2011).
Metacognitive knowledge is considered to be “thinking about thinking” and involves a general
awareness of the reality that we are actually thinking (Dima et al., 2012; Mayer, 2011).
Procedural knowledge is the “know how” associated with performing a particular task (Dima et
al., 2012). This section focuses on the conceptual, procedural, and metacognitive aspects of
learning as they apply to MLCs’ efficacy within an organization that promotes cultural
competency and relatability within its workforce.
M as ter ’ s level clinicians need to understand supervision requirements. Master’s level
mental health clinicians in the state take on one of two paths: variations of counseling like
psychology, marriage and family therapy, educational counseling or social work. In addition to a
60-credit hour master’s degree from an accredited institution of higher learning, candidates must
also pass a state and, sometimes, national exam as well as complete supervised hours to gain
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 32
acceptance to the initial level of clinical licensure. The conceptual knowledge principles
associated with their level of licensure and that of the next level is important both for the
clinician and the organization. In this context, it is important that clinicians originate from
urbanized and minoritized areas and that the organization challenge disparities in ethnic
representation within a workforce designed to serve those same urbanized and minoritized areas.
The conceptual portion of this knowledge gap is not a “how to,” but more of a representation of
the “what to” of knowledge (Dima et al., 2012). Clinicians are taught the procedural aspects of
school and supervision, the knowledge they obtained needs to be translated into the transition
from initial to terminal licensure. For that to occur, application of the required skills would need
to be understood in theory to pass clinical licensing exams and supported continuously through
education and mentorship.
M as ter ’ s level clinicians need to understand licensing requirements. Holders of a LAC
or LSW master’s credential also need to be familiar with the steps associated with the application
for testing and licensing as an LPC or LCSW. This represents the procedural knowledge need,
which is the actual “how to” of clinical license credentialing (Dima et al., 2012). The steps to
clinical licensure require completing the necessary supervised field service hours and identifying
a supervisor with the appropriate credentials for the board to which the applicant is applying. The
applicant must receive authorization from that board to train under the supervision of this
individual. For example, an applicant seeking LPC licensure cannot be supervised by an LCSW.
M as ter ’ s level clinicians need to develop the resiliency to stay the course.
Understanding of and appreciation for the road behind and the road ahead can provide one with
the resiliency required to persist through full clinical licensure. During the reflective process of
clinical supervision, a session in which the MLC reflects upon his or her experiences and
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 33
receives coaching and advice on how to mov forward to clinical licensure is critical. This
reflects the metacognitive portion of the MLCs’ learning. In this process, the clinician is
reflecting on past experiences to shape future experiences (Dima et al., 2012; Dreison, White,
Bauer, Salyers, & McGuire, 2018). Table 1 shows the goals associated with these learning needs
per the goals of the organization of focus.
Table 1
Knowledge, Influences, Types, and Assessments for Knowledge Gap Analysis
Organizational Mission
E-CFT is a learning organization that strives to continuously support children, families, and
communities through providing innovative and sustainable empowerment and therapeutic
programming. Our mission is to provide opportunities for clinicians to develop the skills essential to
provide high-quality therapeutic support for any child and family anywhere.
Organizational Global Goal
As a learning organization, part of whose mission is to challenge disparities in urban mental health
services, E-CFT’s global is to develop 50 clinically licensed providers of color to meet the cultural and
linguistic needs of children and families receiving in-home mental health services in Essex County,
New Jersey by December 2021.
Stakeholder Goal
By December 2021, 50 master’s level providers will have graduated from a special intensive training
track to become licensed clinicians in the county of Essex.
Knowledge Influence Knowledge Type
(i.e., declarative
(factual or
conceptual),
procedural, or
metacognitive)
Knowledge
Influence
Assessment
Learning Solution
Principle
Proposed
Solution
MLCs need to
understand the
importance of
supervision toward
clinical license
requirement.
Declarative
(Conceptual)
Rate of
compliance with
required
supervision.
Learning is
increased when
learners are clear
on requirements
to achieving
milestones and all
milestones
associated with a
particular long-
term goal.
Providers will be
reminded of and
made to
acknowledge the
written
requirements for
clinical licensure
as per outlines set
by their own
disciplinary
boards.

DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 34
Table 1, continued
Knowledge Influence Knowledge Type
(i.e., declarative
(factual or
conceptual),
procedural, or
metacognitive)
Knowledge
Influence
Assessment
Learning Solution
Principle
Proposed
Solution
MLCs need to
understand the
importance of gaining
timely and
appropriate clinical
supervised hours
toward their chosen
discipline’s clinical
license requirement.
Declarative
(Procedural)
Length of time
between initial
(LAC/LSW)
licensure to
clinical
(LPC/LCSW)
licensure.
Learning is
increased when
the mission,
vision, and why
they are important
is communicated,
especially in
highlighting how
they are an
integral part of
the solution.
During
onboarding,
MLCs will be
educated on the
supervision
requirement as it
pertains both to
their clinical
discipline and the
organization’s
mission.
MLCs need to reflect
on their career path
and consider its
trajectory while
building the
resiliency to push
forward to clinical
licensure.
Metacognitive Directed by the
reflective process
of clinical
supervision.
Learning is
increased when
learners take
moments of
introspection for
the purposes of
unpacking prior
learning
experiences and
shaping future
operational
experiences,
while
appreciating the
value of learning
through those
experiences.
MLCs will be
required to
participate in
regular intervals
of supervision in
which they will
receive coaching
and supportive
leadership to
become more
effectively
autonomous.

Motivation
Expectancy value theory. Expectancy value theory explains the correlations among an
individual’s “can do” spirit or sense of self-efficacy, their prioritization of a task or perceived
value thereof, and to what level they perform (Eccles, 2006; Trautwein et al., 2013). Knowledge
and/or skill acquisition, mastery in application of that knowledge or those skills, and the
autonomy to act with that underlying knowledge and skill set reinforce sense of self-efficacy and
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 35
further engage an individual into taking interest and ownership over their own expectations of
performance when it comes to goal achievement (Eccles, 2006; Pink, 2009). Simply stated,
individuals must both believe they can complete a task successfully and be motivated, whether
intrinsically or extrinsically, to carry out the task (Eccles, 2006; Pink, 2009). Research suggests
sustainability of heightened levels of performance arise from intrinsic motivation, meaning a
motivation that originates from within an individual (Pink, 2009). With this type of motivation
generating the value and underlying sense of urgency for an individual, the expectancy portion
becomes important as the individual needs to feel confident in his or her ability to perform to
actually attempt to perform (Bandura, 2000; Pink, 2009; Rueda, 2011).
Value and utility. Without sufficient value placed on the importance of a particular task
or problem, an individual’s performance level or efforts toward completing that task are
adversely impacted (Eccles, 2006). Furthermore, if an individual questions their ability or
control in producing desired outcomes, they are more likely to place less value on tasks and
potentially disengage (Bandura, 2000; Pink, 2009). Lack of effort, persistence, and overall
engagement may indicate poor motivation and burnout (Dreison et al., 2018; Pink 2009). Not
only do MLCs require the intrinsic motivation to address the problem, but they must also believe
they can be effective actors in solving the problem. Thorough understanding of the problem and
belief in the importance of their own role in the solution is required for MLCs to develop
resiliency and consider solving the problem an urgent matter.
Self-efficacy. Self-efficacy can explain the relationship between vocational value and
performance by understanding how individuals autonomously will their way into the shaping of
their own future experiences within a given context (Bandura, 2000; Dreison et al., 2018; Pink,
2009). A heightened sense of self-efficacy as it pertains to one’s ability to perform
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 36
autonomously can enhance intrinsic motivation and increase an individual’s performance
capacity (Pink, 2009). Reflection is a critical reinforcement for self-efficacy as it affords an
opportunity for one to evaluate and appreciate past experiences as a means of learning (Pintrich,
2003). However, the reflective process sometimes needs to be expertly guided as negative
perceptions of past performance can inhibit one’s belief in one’s own abilities, which can slow or
halt performance (Bandura, 2000; Dreison et al., 2018).
Self-efficacy and performance. Self-efficacy must be reinforced by ongoing autonomy
support and guidance (Dreison et al., 2018). Dreison et al. (2018) noted the importance of
reflective practices, such as clinical supervision, in strengthening and maintaining self-efficacy
was examined in an attempt to understand the root causes of mental health care provider burnout.
In the organizational goal of producing culturally competent and relatable providers, a strong
organizational requirement is a robust supervision structure designed to diagnose and remedy
clinician burnout or at least keep it from becoming a distraction to the organization itself. This
requires that clinicians develop the individual capacity to provide services (Wielen et al., 2015).
Table 2
Motivational Influences and Assessments
Organizational Global Goal
As a learning organization, part of whose mission is to challenge disparities in urban mental health
services, E-CFT’s global is to develop 50 culturally relatable and clinically licensed providers of color to
meet the cultural and linguistic needs of children and families receiving in-home mental health services in
Essex County, New Jersey by December 2021.
Stakeholder Goal
By December 2021, 50 Master’s level providers will have graduated from a special intensive training track
to become licensed clinicians in the Essex County.
Assumed Motivation Influences Motivational Influence Assessment
Utility Value – MLCs need to appreciate the impact
that cultural reliability has on urbanized and
minoritized children and families.
Post-training survey to MLCs regarding their
understanding of the factors influencing the
current problem of practice.

DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 37
Table 2, continued
Assumed Motivation Influences Motivational Influence Assessment
Attributions – MLCs, as agents of the CSOC need to
internalize and process the failure that is represented
by low service utilization ratios, high rate of family
separation, and juvenile incarceration as it pertains to
low quality of cultural reliability within the CSOC
provider workforce.
Master’s level provide response to sharing of
CSOC family survey data as it pertains to key
issues recognizable to CSOC from Essex County
minoritized and urbanized families.
Self-Efficacy – MLCs must feel confident in their
ability to complete their clinical hours and pass the
appropriate licensing exams.
Likert scale type assessment in while MLCs
report their level of comfort with critical sections
of licensing exams associated with their clinical
discipline.
Goal Orientation – MLCs need to maintain a high
level of interest in the problem and understand their
role in the solution thereof.
MLCs will provide verbal reports in group
setting during scheduled supervision sessions
every two weeks.

Organization
The organizational component of the Clark and Estes’ (2008) KMO framework describes
issues ranging from inadequate facilities to ineffective or inefficient policies and procedures
which can hinder performance toward the organization’s goals. When workflows are out of
alignment with organizational structure or strategy, the organization will experience barriers to
progress and success, even if the areas of knowledge and motivation are strong (Clark & Estes,
2008). As such, it is essential to understand the elements of the organizational structure which
can serve as barriers to performance. Two elements for consideration in the analysis of
organizational challenges are cultural models and cultural settings. Gallimore and Goldenberg
(2001) defined cultural models as the shared understanding of how the world works, or ought to,
and cultural settings as whenever two or more people come together to accomplish something.
This section focuses on the promising practices of E-CFT aimed at challenging and overcoming
the organizational barriers that previously contributed to the shortage of clinically licensed and
culturally relatable in-home mental health clinicians to serve the needs of urbanized and
minoritized youths.
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 38
Cultural models. Cultural models incorporate behavioral, cognitive and affective
components to develop a deeper understanding of the dynamics behind individual influence and
performance. (Gallimore & Goldenberg, 2001; Schein, 2016). Cultural models set a standard for
what is valued and ideal within a shared environment in a way that is often invisible, yet
influential to the development of organizational norms, policies, and practices. (Clark & Estes,
2008; Gallimore & Goldenberg, 2001; Rueda, 2011). Elements of cultural models can either
contribute to or impede an organization’s performance toward its stated goals. For the purposes
of evaluating the promising practice of E-CFT, the focus is on two contributing elements of the
cultural model pertaining to the MLC as the stakeholder: shared understanding of the value of
family voice and choice.
The family voice and choice principle is the cornerstone of the wraparound approach to
mental health services for children in New Jersey (DCF, 2017). Family voice and choice entails
having families lead the therapeutic approach to empowerment with the assistance of formal and
informal supports (Bergquist, 2013; DCF, 2017). Decisions on interventions, service frequency,
and whether to engage in therapeutic services are all subject to family voice and choice.
Preference in provider, whether based on credentials, race, or ethnicity, is another consideration
for families enrolled in the wraparound system of care. In the case of the urbanized and
minoritized youths in Newark, New Jersey, where the availability of terminally licensed and
culturally relatable clinicians is very low, one has to question the ability of the system to defend
the value of family voice and choice.
Onboarding at E-CFT communicates the organizational vision to provide therapeutic
supports to all children and families in need of them regardless of where they reside. This
training includes education on the wraparound process and approach to therapeutic support. It
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 39
also includes education on the role of each provider as it pertains to the vision of the
organization, which has implications on human resource management, namely recruitment and
selection. Gusdorf (2008) stated that recruitment refers to attracting individuals with the
appropriate qualifications to apply for positions within an organization and trimming the pool of
interests based on organizational needs and goals. The author defined selection as identifying
individuals from that pool of candidates to best suit an organization’s needs and goals (p. 7).
Achievement of E-CFT’s goal of closing gaps in the ability to uphold the wraparound principle
of family voice and choice requires that all providers understand that value of voice and choice,
envisioning themselves as a part of the defense of that value and buy into the overall vision.
Recruitment and selection protocol allow for pools of candidates who, if hired, are more likely to
support this organizational goal.
Trusting the organization to guide professional development. E-CFT considers itself a
learning organization. A learning organization is a prescriptive organizational form in which
purposeful activities are taken on within an ecosystem that fosters collective learning at the
micro, meso, and macro levels (Kim & Callahan, 2013). According to Kim and Callahan (2013),
this learning supports ongoing performance improvement and the ability of an organization to
remain agile. Master’s level clinicians require years of direct practice and supervision to develop
clinical acumen while strengthening capacity and resolve (Golia, 2015; Kouzes & Posner, 2012).
Guidance from experienced practitioners is not just essential for MLC development, but a
requirement for clinical licensure in each state. Under the guidance and supervision of
experienced practitioners who assist MLCs as they navigate rotations across patient populations,
the skills and creativity required for this autonomous role can be developed (Golia, 2015; Jeong,
McLean, McLean, Yoo, & Bartlett, 2017; Ling, 2017). Master’s level clinicians at E-CFT
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 40
demonstrate trust that the organization will both provide the supervision required and invest in
their development of a diverse clinical skill set.
Cultural settings. Cultural settings involve the more visible representations of the
cultural model and its development within the environment in which individuals collaborate to
create value (Clark & Estes, 2008; Gallimore & Goldenberg, 2001). The cultural setting
provides the context in which the cultural model itself operates. For the purpose of evaluating
the promising practice of E-CFT, the focus will be on two contributing elements of the cultural
setting as it pertains to MLCs as the stakeholder.
Access to clinical supervision to guide field skill development. Being a mental health
clinician requires education and field experience to make the right decisions in the field,
especially under duress. The reflective and didactic process of clinical supervision for MLCs
assists in developing a base of knowledge and skills that make for a competent, ethical, and
efficacious clinician (Golia, 2015; Morrison & Hostetter, 2006). Clinical supervision provides
those supervised with supportive leadership to builds confidence. Kouzes and Posner (2012)
stated self-confidence makes for the development the inner strength and inner trust required to
manage through uncertainty, persist through opposition, and make difficult decisions (p. 263).
Given that in-home clinical care requires these skills, clinical supervisors are one of the most
powerful assets an MLC can access. Master’s level clinicians at E-CFT are paired with clinical
supervisors at the early onset of the professional relationship and remain with that supervisor
through sponsorship for clinical licensure.
Access to clinical licensing exam preparatory tools. While the results of a clinical
licensing exam do not necessarily reflect the abilities of the clinician, preparation for the
examination can be a reflection of a poor master’s program or poor clinical supervisor (Beard,
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 41
2005; Thyer, 2011). The results of a failed exam can be taxing. Aside from the mental anguish
or the sense of embarrassment, a candidate must wait a required amount of time before retaking
the exam.
Table 3
Organizational Influences and Assessments
Organizational Mission
E-CFT is a learning organization that strives to continuously support children, families, and communities
by providing innovative and sustainable empowerment and therapeutic programming. E-CFT’s mission
is to provide opportunities for clinicians to develop the skills essential to providing high-quality
therapeutic support for any child and family anywhere.
Organizational Global Goal
As a learning organization, part of whose mission is to challenge disparities in urban mental health
services, E-CFT’s global is to develop 50 culturally relatable and clinically licensed providers of color to
meet the cultural and linguistic needs of children and families receiving in-home mental health services in
Essex County, New Jersey by December 2021.
Stakeholder Goal
By December 2021, 50 Master’s level providers will have graduated from a special intensive training
track to become licensed clinicians in Essex County.
Assumed Organizational Influences Organization Influence Assessment
Cultural Model Influence 1: There is a firm
understanding of the value of family voice and
choice amongst E-CFT administration and clinicians
as it pertains to preferences in provider ethnicity.
Survey or Interview Questions regarding
understanding of the family voice and choice
principle and how it applies to child and family
preferences.
Cultural Model Influence 2: MLCs trust that E-CFT
will provide the clinical support required for their
development and eventual licensure.
Surveys regard the level of trust that MLCs have
in E-CFT administrators and the organization
itself as it pertains to their development.
Cultural Setting Influence 1: MLCs at E-CFT have
Licensed Level Clinician who are dually licensed as
supervisors to guide them through field experiences
in preparation for clinical licensure.
Interviews regarding MLC level of comfort with
their clinical supervisors and their supervision.
Cultural Setting Influence 2: MLCs have access to
clinical license test preparation resources.
Surveys or Interview questions regarding MLC
experience with the organization in preparation
for the exams.

This experience is one that some clinicians rebound from, as it tests persistence while
threatening their aspirations for clinical practice (Thyer, 2011). It is incumbent on the
organization to understand each clinician’s licensing path, whether they are pursuing the Board
Certified Behavior Analyst (BCBA), LCSW, LPC, or Psy.D. credential. E-CFT recruits doctoral
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 42
level supervisors to assist with clinical test preparation and pays for practice exams for its
clinicians.
Conceptual Framework
Conceptual frameworks paint the larger picture of a study in which the researcher acts as
the artist. Specifically, a conceptual framework identifies and depicts concepts, themes, factors,
and/or ideas within a study (Maxwell, 2013). In depicting these elements, the researcher also
makes associations between them to provide a graphic representation of the concept presented
and an understanding of the lens through which the researcher looked at the problem in question.
Maxwell (2013) explained that conceptual frameworks contain four key elements: knowledge
attained through researcher experimentation, existing theory and research, researcher
exploration, and thought experiments. The point of the conceptual framework brings the KMO
influences mentioned previously, which were presented as silos, together to show their
relationships with one another. The figure associated with this study’s conceptual framework
demonstrates how the knowledge and motivation of MLCs at E-CFT interact with the
organizational attributes of E-CFT.
Family voice and choice, as an element of E-CFT’s cultural model, is explained and
tested for at the training phase of the human resource management cycle. Having this value
shared by MLCs allows E-CFT to advance toward its goal through interaction with the
knowledge influences on MLCs. Another element of the cultural model is trust that MLCs
require to buy into the concept of E-CFT as a learning organization that genuinely supports and
can guide their professional development. According to Kim and Callahan (2013), the learning
that takes place in a learning organization should support ongoing performance improvement and
the organization’s continued agility. Master’s level clinicians require years of direct practice and
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 43
supervision to develop clinical acumen while strengthening capacity and resolve (Golia, 2015;
Kouzes & Posner, 2012). This cultural model strengthens knowledge, skills, and motivation for
MLCs as they work toward clinical licensure, thus demonstrating a link and alignment with
knowledge, motivation, and organization.
A learning organization is a prescriptive organizational form in which purposeful
activities are taken on within an ecosystem that fosters collective learning at the micro, meso,
and macro levels (Kim & Callahan, 2013). The cultural setting, in this case, is that ecosystem.
The cultural setting offers the environment in which the cultural model operates and evolves
(Clark & Estes, 2008; Gallimore & Goldenberg, 2001). In the E-CFT cultural setting, MLCs
receive the resource of clinical supervision with highly skilled licensed clinicians how are
eligible to sponsor them for clinical licensure. The reflective and didactic process of clinical
supervision assists in developing a base of knowledge and skills that make for a competent,
ethical, and efficacious clinician (Golia, 2015; Morrison & Hostetter, 2006).
The second element of the cultural setting is the clinical licensing exam support
resources, including mentors and practice tests. Knowledge and motivation are influenced in a
cultural setting where the emphasis is on the acquisition of knowledge through mentoring and
support as MLCs approach the clinical licensing exam. This effort must be sustained to be
effective, and, therefore, it is incumbent on the organization to ensure the effort remains a
priority. All factors considered and executed, E-CFT should have higher success in its goal to
address the issue of workforce shortages that make for challenges to the voice and choice value
for urbanized and minoritized youths.
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 44

Figure 1. Interactive conceptual framework.
The interactive conceptual framework, (Figure 1) depicts the cultural setting in which the
cultural models of E-CFT operate and represents the interaction between KMO elements. The
organizational component of the Clark and Estes’ (2008) KMO framework describes issues
ranging from ineffective or inefficient policies and practices to resource inadequacy that can
hinder performance toward the organization’s goals. When the aforementioned elements are out
of alignment with organizational structure or strategy, the organization will experience barriers
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 45
to progress and success (Clark & Estes, 2008). The figure shows how E-CFT fits inside NJ-SSC
and how its promising practice furthers the shared organizational goal among NJ-SSC, E-CFT,
and MLCs to provide family voice and choice. Inside of the E-CFT portion of the figure, the
organizational aspects of cultural models and settings are associated with their influence on
MLCs’ knowledge and motivation.
Understanding the E-CFT Practice
The purpose of this promising practice study is to gain a better understanding of how E-
CFT addresses the problem of the gap in cultural and ethnic representation amongst licensed
clinicians available to serve urbanized and minoritized youths in Newark, New Jersey, through
the wraparound service model. This section referenced and synthesized available literature
through the lens of Clark and Estes’ (2008) KMO framework to help identify KMO influences to
address this gap. Focusing on MLCs as the key stakeholder group, the literature supported
understanding of their role to address this issue as well as the cultural models and settings
required to drive performance toward organizational goal achievement. The next section
presents the methodological approach to this study.

DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 46
CHAPTER THREE: METHODOLOGY
The methodological approach to transformative mixed-method research starts with an
idea and continues with the gathering of information that identifies the purpose and supports that
purpose (Creswell & Creswell, 2018; Mertens, 2015). Creswell and Creswell (2018) identified
this type of methodological approach as explanatory sequential: quantitative data collected first,
then building into the interview to further tease out themes from data to facilitate research
assertions. In this study, qualitative surveys were used to assess child and family preferences as
it pertains to the cultural relatedness. These data provide insight as to what needs to be measured
to better understand E-CFT’s ability to meet child and family needs. The result of this new-
found insight is the development of a plan to collect data for the quantitative phase of analysis
(Creswell & Creswell, 2018; Locke, Silverman, & Spirduso, 2010). The qualitative portion of
this study demonstrates the importance understanding this issue. Using open-ended questions
allows the researcher to recognize patterns, common causes, and make reasonable predictions for
future outcomes (Creswell & Creswell, 2018; Merriam & Tisdell, 2016). The quantitative
portion supports the qualitative findings by highlighting relationships through figures (Creswell
& Creswell, 2018). This problem-solving framework, as Creswell and Creswell (2018)
highlighted, can be costly and time-consuming, as the researcher is essentially conducting two
studies. For a study this important, however, the breadth and depth that this approach offers
were both promising and fitting.
Data Collection
Creswell and Creswell (2018) stated that data collection involves interrelated activities
that represent the processes and engagement of organizations and include locating a site or
individuals, gaining access and building a rapport, sampling purposefully, collecting data,
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 47
recording information, exploring relevant issues, and storing data (Creswell & Creswell, 2018).
Various stages of data collection are common to all research approaches and will be
implemented thoroughly and precisely throughout this study.
The site and setting of this study were selected for the location convenience to the
researcher. The researcher is close in proximity to the potential participants in this study which
will include both urbanized and minoritized children and families that live in the metro area of
Newark, New Jersey.
To complete data collection for this stakeholder group, this researcher is employing a
method called intermixing. Johnson and Christensen (2015) described this method as one in
which more than one data collection method is at work in a research study. Data regarding MLC
perceptions of the family voice and choice will be collected for this study by way of a
quantitative surveys and qualitative interviews.
Surveys are a non-experimental quantitative design approach that provides numeric
representations of attitudes, opinions, or trends within a sample of a particular population
(Creswell & Creswell, 2018). A large enough sample size of this target population exists to gain
representation within E-CFT itself, therefore justifying the use of a survey. The sample, if
representative of enough within the organization, may indicate that there could be a more
substantial portion of the population outside of E-CFT, which has implications on NJ-SSC and
other provider organizations like E-CFT. The qualitative portion of data collection by way of
semi-structured individual interviews and focus groups takes the data gathered from the
quantitative phase and begins to explain the how and why (Creswell & Creswell, 2018).

DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 48
Participating Stakeholders
Participants in this study were MLCs. Within this group, there are three types of
clinicians categorized by their educational and credentialing tracks: LSWs, LACs, and Psy.Ds.
Although E-CFT employs clinicians in many capacities, participants within the stakeholder
group of focus work within the wraparound model of care and provide in-home services.
Specifically, participants met the aforementioned pre-requisites and serve urbanized and
minoritized children and families. Participants answered quantitative surveys, and a smaller
group of them were interviewed. Data pertained to MLCs’ knowledge of the problem space, their
motivation to address the problem individually, and their perceptions of organizational assets and
barriers in addressing the problem.
Criteria and Rationale
As the focus of this study pertains to children and families receiving therapeutic services
through the wraparound model of treatment, participants provided in-home clinical services to
NJ-SSC enrolled families
Secondly, in Newark, there are several neighborhoods where residents fall at or below the
poverty line and where residents are predominantly Black (E. Rowe, personal communication,
October 15, 2017; U.S. Census Bureau, 2017). This population is the focus of the problem as
research indicated cultural barriers to mental health service engagement and utilization due to
factors such as mistrust within these communities (Alvidrez, 1999).
Third, participants had to have performed clinical supervision with E-CFT for the
aforementioned time period. Research indicates clinical supervision is the optimal space for
development of clinical knowledge and specialty, as it facilitates the transfer of field experience
into knowledge (Asakura et al., 2018; Saltzburg et al., 2010).
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 49
Sampling Recruitment Strategy and Rationale
E-CFT formally announced the survey to a closed group of providers who were likely to
meet all required criteria. E-CFT conducted interviews during the required time for supervision.
Because MLCs registered for clinical hours through E-CFT are required to schedule their
supervision dates online, E-CFT created individual time slots for supervision and participation in
the focus group for interested MLCs to select.
E-CFT, as a part of regular practice, communicates with MLCs either through field
support or clinical supervision. As such, it was not be difficult to disclose the purpose of the
survey and request participation from this stakeholder group. This assumption follows Johnson
and Christensen’s (2015) concept of non-random convenience sampling in that potential
participants are expected to be available, are considered likely to participate, and can otherwise
be easily recruited into the sample.
Given the sample size that the initial phase draws from and the potential economic strain
that may come of requesting too much time from participants, the research team found it to be
more ethically responsible to focus on a smaller group and offer a token of appreciation for
further participation. This group is considered to be non-random and a warm audience that
would already have had interactions with the organization either through the field service process
or the course of regular clinical supervision. The researcher will provide ethical tokens of
appreciation for all participants. The data from Phase 1 was shared with these individual
interviewees for the purpose of exploring potential root causes that can better explain the more
substantial body of data collected in Phase 1.

DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 50
Table 4
Sampling Strategy and Timeline
Method
Sampling
Strategy
Number of
Stakeholder
Population
Number of Proposed
Participants from
Stakeholder Population
Start and End
Date for Data
Collection
Interviews Purposeful 12 8 August 2019 –
September 2019
Documents Purposeful NA NA June 2019 –
September 2019
Surveys Purposeful 50 40 July 2019 – July
2019

Data Recording Protocol
Interviews were conducted by a third-party research assistant approved by the
institutional research board due to this investigator’s role within E-CFT leadership. Interviews
were conducted and recorded with participant consent through the use of the Zoom platform.
Interviewees had the option of recording with or without video, but, for the purposes of
transcription for further analysis, audio was required. Following each interview, the interviewer
transcribed the interview, thoroughly check the accuracy of the transcription, then discard the
recording. Transcripts will be maintained through the remainder of the study.
Ethics
The safety and confidentiality of the information provided by participants were of the
highest priority. This researcher is ethically obligated to protect the information provided in this
study and provide all human subjects with full disclosure of the purpose of the study and the
usage of the information obtained (Merriam & Tisdell, 2016). The researcher, in accordance
with suggestions made by Merriam and Tisdell (2016), planned this study with consideration of
the risk of harm, right to privacy, the prerequisites of proper informed consent, and mitigation of
any potentially deceptive practices that could affect participants. To ensure voluntary
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 51
participation with full understanding of the purpose and goal of the study, an extensive and
linguistically relevant informed consent document was explained and acknowledged prior to
being sent to family teams, including the actual recipients of service and the providers. Above
all, participants were clearly informed of their right not to participate and advised of the fact that
they could elect to do so without penalty.
This researcher took additional ethical considerations w due to the researcher's
relationship with the organization of focus. The researcher has an ownership interest in the
organization of focus, which opens the study to the high possibility of bias. All researchers are
required to explain their biases, dispositions, and assumptions regarding the research being
conducted (Merriam & Tisdell, 2016). To minimize this bias, this researcher retained the
services of a third party to collect raw data for further interpretation. Glesne (2011) stated that
creating distance between the researcher and the researched does not make for more accurate
data collection. This researcher also had the ethical obligation to ensure the data accurately
reflected the lives of those researched for whom he is assuming the role of advocate for change
(Glesne, 2011). The ethical challenge in this study was ensuring not only the safety and privacy
of all participants but also ensuring the validity of the research was not impacted by the
relationship between the researcher and researched.
Limitations and Delimitations
A participant’s level of truthfulness in responding to interviews and surveys is difficult to
measure. That said, the most this researcher felt could be done is that the environment and
conditions under which interviews and surveys were conducted were comfortable enough for the
participant to gain confidence in his or her ability to speak and respond freely and truthfully.
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 52
Question construction was carefully crafted as not to lead the participant in any way. The goal
was to collect data that paint as accurate a picture as possible for examination.
As this innovative approach and promising practice of E-CFT lacks comparative data
from like organizations as proof of the existence of the problem addressed, no basis for
comparison in KMO practice exists. That said, E-CFT is establishing urgency regarding what it
views as a problem and is communicating its view that there is a problem. Participants in this
study may assist in remedying the problem.
Another limitation is that, due to this researcher’s leadership position within E-CFT, this
researcher had to ensure responses were free of influence or coercion. In fact, the researcher
fully removed himself from this end of data collection and employed the services of an outside
researcher to facilitate the surveys and interviews to be later reviewed between said research
team and this investigator for analysis.
The rigor that a quality study requires includes taking the appropriate delimiting
measures to counterbalance limitations. Delimiting choices for this study include focusing on
MLC actively providing services to NJ-SSC enrolled families in Essex County and those who
identify as minorities themselves. Triangulation among surveys, interviews, and
documentation/artifact review delimited this study. Electronic delivery of surveys to target
participants ensured privacy to promote truthfulness in responses and increase ease of access to
data. Through acknowledgment of limitations inherent in this study, this researcher believed the
data accurately reflected the intentions of the study.

DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 53
CHAPTER FOUR: FINDINGS
The purpose of this chapter is to explain the findings of this explanatory sequential
mixed-method study that explores a promising practice by organization E-CFT that aims to close
the gap in cultural relatability between urbanized and minoritized families receiving wraparound
services and their providers.
The data analyzed in this section seek to answer the following research questions:
1. How are the MLC in-home provider development practices of E-CFT defending the
organization’s core value of family voice and choice in services options?
2. What are the knowledge, motivation, and organizational influences affecting the
fulfillment of the family voice and choice option as it pertains to cultural relatability to
their in-home clinician?
2. What are the recommendations for replication of E-CFT’s organizational practices with
the MLC stakeholder group from a knowledge, motivational, or organizational
standpoint?
Participating Stakeholders
Participants were MLCs, the stakeholder of focus in examining this promising practice.
Within this stakeholder group, there are three types of clinicians categorized by their educational
and credentialing tracks: social workers, counselors, and psychologists. Participants were mental
health clinicians who work within the wraparound model of care and provide in-home services.
Specifically, participants met the pre-requisites and serve urbanized and minoritized children and
families in Newark, New Jersey. The scope of participation was quantitative surveys followed
by interviewing of a smaller group of MLCs informed by the data and refined based on emerging
themes from the prior interviews. An overarching question guided this study: How can in-home
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 54
wraparound provider agencies utilize MLCs to develop a workforce that better defends family
voice and choice as it pertains to urbanized and minoritized families in Newark who are seeking
to work with providers who are culturally relatable?
Table 5
Description of data collection tool.
Instrument Targeted
Respondents
Actual Respondents Response Rate
Survey 45 31 68.89%
Interviews 10 6 60.00%
Document Review 3 3 100%

Data collection, as mentioned in Chapter Three followed the explanatory sequential
research method in which quantitative data were collected by way of surveys and qualitative data
were collected by way of individual interviews. To triangulate the data collected, this researcher
utilized documents and artifacts. Merriam and Tisdale (2016) defined documents and artifacts as
written, visual, digital, and physical materials relevant to the study. The documents used in this
study were non-consumer identifying E-CFT quality assurance notes, wraparound model
definitions from the CMO that oversees child and family services in Newark and policy briefs
from NJ-SSC.
Overview of Results and Findings
The data had the purpose of assessing MLC development practices and the implications it
may have on the ability to provide increased availability of culturally relatable in-home
clinicians. Utilizing the conceptual KMO framework (Clark & Estes, 2008), MLC knowledge,
motivation, and reports of organizational support were captured for the purposes of supporting
evidence of a promising practice at E-CFT. This data not only may explain how E-CFT
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 55
developed 21 licensed level clinicians from 2016 to 2019, but also how E-CFT is pursuing its
performance goal of producing 50 culturally relatable licensed level clinicians to serve urbanized
and minoritized children and families in Newark by December 2021. The next series of sections
will report the findings for knowledge, motivation, and organizational influences for this study
based on the quantitative and qualitative phases of data collection triangulated with the support
of the documents reviewed during this study.
Quantitative Data Results and Findings
As mentioned in Chapter Three, the Qualtrics platform was utilized to facilitate the
collection of data through a survey. Data cleaning occurred in Microsoft Excel to provide
numerical values which are used in this section to provide graphic representations of the data
collected. Seven-point Likert scales were used to gain deeper insight as to participants feelings
regarding the questions. This section will discuss key questions and associated findings from
this phase of data collection. Appendix A provides a full list of the 36-question survey, which
took an average time of 6 minutes and 34 seconds to complete. Figures 2 through 7 provide
graphic representations of the demographic data collected to represent participant characteristics.

Figure 2. Demographic data – gender.
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 56

Figure 3. Demographic data - race/ethnicity.

Figure 4. Demographic data - age range.
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 57

Figure 5. Demographic data - childhood locale.

Figure 6. Demographic data - clinical discipline.
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 58

Figure 7. Demographic data - experience as an in-home clinician.
Summary of Participating Stakeholders
As the figures indicate, total MLC participation for the survey was 31. Out of the 31, 24
were female and 7were male. Eleven participants were Black and seven were Latinx. There
were 11 Caucasian participants, one biracial participant and one participant who identified as
Other.
The age range category was dominated by MLCs who identified as being between the
ages of 25 and 34, as there were 22 of them. Seven clinicians identified as being between ages
35 and 44 and two were between 45 and 54. Out of this group of participants, 19 identified as
having grown up in urban areas while nine indicated having grown up in suburban areas and
three identified as having grown up in rural areas.
Clinical disciplines were almost evenly matched with 15 participants identified as being
on the counseling track as compared to the 16 who identified as social workers. It is important to
note no participation from Psy.Ds. In terms of in-home clinician experience one participant
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 59
identified as having been 0 and 2 years of experience, 10 identified as having between 2 and 5
years’ experience, and one indicated an experience level beyond 10 years.
In summary, considering the 45 eligible participants, 31 responses is considered
relatively representative. The fact that Black and Latinx participants between 25 and 34 with
experience of 0 to 2 years, and urban upbringing were largely dominant in representation has
indications as to the recruitment strategies of E-CFT.
Knowledge Results
Finding One
Learning is increased when learners are clear on the requirements to achieve each
milestone associated with a long-term goal. This knowledge area is critical to the goal of
assisting MLCs achieve the level of licensure to assure that urbanized and minoritized families
have access to culturally relatable in-home clinicians with skill levels and credentials similar to
that of their non-urbanized, non-minoritized counterparts. In an assessment of this area of
knowledge, which is measured by the rate of clinical supervision attendance, 14 participants
reported meeting the mandatory NJ-SSC (2019) documented requirement of one supervision
session per month. The remaining 17 exceed the NJ-SSC requirement, as presented in Figure 8.
This 100% rate of compliance with this representative group of E-CFT MLCs is further
supported by 22 strongly agree and 9 agree responses to the statement “I fully comply with
clinical supervision requirements.” The mean for this data set was 1.29, indicating a central
tendency for respondents to respond that they strongly agree with this statement. The standard
deviation of .46 indicates that the data points were clustered around the mean or expected value
for this response. The data collected from the two questions associated with this area of
knowledge influence is reflective of the fact that not only participants know their clinical
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 60
supervision requirements, but also that most are following the recommendations of E-CFT
(2019) to attend supervision between 2 to 4 times a month to better aid development. Figure 8
illustrates the difference between NJ-SSC MLC requirements and E-CFT MLC
recommendations. The process of clinical supervision helps MLCs bridge the gap between
theory and practice while developing the competencies and attitudes necessary for their clinical
future (Castex et al., 2018; Salzburg et al., 2010).

Figure 8. E-CFT monthly supervision attendance as compared to NJ-SSC requirements.
Finding Two
Learning is increased when the mission, vision, and why they are important is
communicated, especially when highlighting them as an integral part of the solution. This
knowledge area is critical to the goal of assisting MLCs in achieving the level of licensure to
assure that urbanized and minoritized families not only have access to culturally relatable in-
home clinicians, but also those with skill levels and credentials similar to that of their non-
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 61
urbanized, non-minoritized counterparts. In an assessment of this area of knowledge, which is
measured by the length of time between them achieving MLC status to reaching licensed
clinician status is measured, 93.3% of participants indicated that they either strongly agree
(70%) or agree (30%) that they felt capable of achieving clinical licensure within the next two
years. The mean of 1.43 indicates a central tendency for respondents to respond between
strongly agreeing and simply agreeing with this statement with a slightly increased tendency to
strongly agree. The standard deviation of .86 indicates that the distribution of the data points for
responses to this question clustered closely to the mean. The data collected from the question
associated with this area of knowledge influence gives indication of E-CFT’s ability to advance
toward the performance goal of having developed 50 clinically licensed clinicians by December
2021. Passing standardized examinations, a requirement for clinical licensure and in-field
experience and pedagogy service to prepare social workers from all walks of life to achieve
clinical licensure (Castex et al., 2018; Saltzburg et al., 2010).
Motivation Results
Finding One
Learning, motivation, and development of a positive attitude are all enhanced when
learners internalize the rationale for why the learner should value the task (Eccles, 2006;
Pintrich, 2003). When MLCs find value in the experience that the children and families have in
the therapeutic process and the roots, they will be motivated toward enhancing this experience in
any way that they can. Consistent with the wraparound value of cultural competency in service
delivery (PerformCare, 2019), all participants agreed the role of culture places a critical role in
how children and families experience treatment. Out of 31 respondents, 87.1% strongly agree.
The remaining 13% of participants were split evenly between agreeing and somewhat agreeing.
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 62
The mean of 1.19 reflects the central tendency for MLCs to hold this sentiment. The standard
deviation of .54 shows that responses generally fell close to the expected value. When clinicians
appreciate the experiences of the children and families that they serve, in this case urbanized and
minoritized families, they are better able to adjust their approach to working with those children
and families. Organizations like E-CFT should ensure their clinicians, especially MLCs they are
training, are understanding of the experiences of the children and families they are working with.
Finding Two
Learning and motivation is positively influenced by setting high goals, allowing
autonomy, and providing feedback (Dreison et al., 2018; Eccles, 2006; Pajares, 2006). MLCs
feeling efficacious as they pursue clinical licensure through gaining field experience under
clinical supervision has positive indications of their level of ability to persist through and achieve
clinical licensure. In an assessment of this area of motivation, which was measured in a series of
7-point Likert scale responses, 90% of participants reported they agree that feel confident in their
ability to successfully complete the licensing process in accordance with the organization
performance goal of 2 years. Among the responses, 56.7% of participants strongly agree, 26.7%
agree, and 6.7% somewhat agree. The remaining 10.0% of participants either do not agree or
disagree (6.7%) and disagree (3.3%). The mean and standard deviation for this response was
1.77 and 1.19, respectively, which indicates that the responses were somewhat polarized with a
small, but important segment of respondents either indifferent or disagreeing. When asked about
their level of confidence in their ability to pass the licensing exam for their respective discipline,
all participants agreed with the statement that they are with 20 (64.5%) doing so strongly, seven
(22.6%) simply agreeing and the remaining 4 (12.9%) in slight agreement. The mean and
standard deviation for this data set were 1.48 and .72, demonstrating a central tendency to
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 63
strongly agree with this statement with responses generally clustering around this response,
mostly in agreement. MLCs growth by way of field service experience and the pedagogical
practice of clinical supervision is a critical element behind their persistence in achieving the field
hour requirements and passing the licensing exam. Enhancing support for MLC learning helps
challenges the barriers that create barriers to clinical licensure (Castex et al., 2018).
Organizational Results
Finding One
MLCs need to understand the social justice implications of their work. Cultural issues
like race and historical experiences of prejudice and discrimination associated with membership
to an ethnically minoritized population have influential roles in treatment (Bernal & Saez-
Santiago, 2006; Cardemil & Battle, 2003). The statement, “I feel that traumatic experiences like
violence in community, school, or domestic settings, abuse or neglect, and racial discrimination
are experienced at a higher than average rate by urban minorities” was met with a rate of
agreement of 90.4% distributed at 58.1% respondents strongly agreeing, 22.6% agreeing, and
9.7% somewhat agreeing. The mean for this data set was 1.77, which indicates a central
tendency for MLCs to agree with this statement. The standard deviation of 1.20 shows a more
scattered distribution of data points from the expected value, including the 3.2% of respondents
who disagreed with this statement and the 6.5% that neither agree nor disagree with this
statement. When knowledge, motivation, and organization are in alignment, performance
potential is enhanced (Clark & Estes, 2008). In this case alignment with the organization on the
part of MLCs increases capacity to work toward this problem space.

DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 64
Quantitative Analysis Conclusion
The quantitative data collection and analysis phase of this research study found
congruence between many of the assumed knowledge, motivation, and organizational influences
regarding MLCs and their role in the larger organizational goal of closing the gap in culturally
relatable service provider availability. It also uncovered an area of cultural setting within the
influence of organization. Resources such as job aids, templates and quality of training videos
rated low in quantitative data collection and analysis. In the survey question associated with this
assumed organization influence, 60% of respondents responded in the affirmative (30% strongly
agree, 20% agree, 10% somewhat agree), while 40% ranged from neither agreeing or disagreeing
and disagreeing (20% neither, 6.7 somewhat disagree, 13.3% disagree). This recommendation
will be outlined in Chapter Five to highlight how organizations, like E-CFT can improve the
utilization of MLCs to fill gaps in availability for populations like the one in review, urbanized
and minoritized youths in areas like Newark. The data collected and analyzed in this phase of
research was used to inform the line of question in the qualitative phase of this study, shown in
Appendix C.
Qualitative Data Results and Findings
As mentioned in Chapter Three, individual semi-structured interviews were conducted
for the qualitative phase of this research study. Due to this researcher’s relationship to the
organization, E-CFT, a third-party research assistant outside of E-CFT was retained. The
interviews took place on the Zoom platform, where participants had the option to be interviewed
with video, audio only, or not at all. All participants opted for either the video or audio
recordings. The interviewer made and communicated observations of facial expressions during
video interviews. The interviewer allowed the interviewee to direct the course of the
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 65
conversation, being mindful to assure the interviewee that responses were confidential. As the
interview participants would speak, the interviewer would ask questions to gain more in-depth
explanations of the points being made by each participant. From this process, themes emerged
that spoke to knowledge, motivation and organizational influences that gave insight in the
recruitment, selection, training and support practices of E-CFT as well as the alignment of MLCs
with E-CFT’s organizational goals of developing MLCs and closing the gap in the availability of
culturally relatable service providers for urbanized and minoritized families in Newark and like
areas. Amongst these themes are the concepts of family voice and choice and the subtheme of
meeting the family where they are, supervision as a pedagogical experience that provides
procedural knowledge, but also metacognition and motivation, and cultural relatability as both an
opportunity and a limitation.
Summary of Participating Stakeholders
During this phase of data collection and analysis, eight participants were scheduled for
participation in a semi-structured interview which examined areas from the knowledge
associated with wraparound in-home clinical work and the NJ-SSC system of care itself, to
motivations influencing decision of clinical disciplines and field service decisions, to
assessments of E-CFT’s level of support in many areas. Themes, which will be reported in the
following sections, quickly emerged and the interviewer reported reaching a point of saturation
after five interviews. Six participants were interviewed, four of whom were LSWs and two were
LACs. Profiles for participants in the qualitative phase of this research study were as follows:
Participant 1 was a Latinx Female with an LSW and urban upbringing, Participant 2 was
a Caucasian male with a LAC and urban upbringing, Participant 3 was an African American
female with an LSW and urban upbringing, Participant 4 was a Caucasian female with an LSW
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 66
and country upbringing in Poland, Participant 5 was a Caucasian female with an LSW and
suburban upbringing, and Participant 6 was a Latinx female with a LAC and urban upbringing.
Appendix C shows the questions asked in the semi-structured interviews which took an average
of 44 minutes and 30 seconds for each participant to complete.
Research Question One
How are the MLC in-home provider development practices of E-CFT defending the
organization’s core value of family voice and choice in services options?
Finding One
Individuals working with children and families should be genuinely interested and
dedicated to the work they are doing. Without enough value placed on the importance of a task
or problem, an individual’s performance efforts are likely to be adversely impacted (Eccles,
2006). In her interview, Participant 4, who identified as a Latinx female who was raised in an
urbanized area, stated her motivation for providing therapeutic services comes from a very
personal place: “I had a social worker when I was in the hospital for most of my youth. I had a
social worker and she was great, and I was like “Wow, I wanna be like her.” When describing
her drive, she added,
But just knowing that there are other possibilities out there is something that always
motivates me so that I can motivate other people. Like that’s something that, I mean, as a
social worker, you’re motivated and rewarded by seeing the change in other people when
they have their realization that things don’t have to stay the same, that’s what motivates
me with just my clients in general, is that they don’t have to stay. If they feel like they’re
in a sucky place, they don’t have to stay in that sucky place.
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 67
When asked the same question regarding her motivation toward the counseling line of
work, Participant 6 said,
I always wanted to help people. At the time, I didn’t know what it was called, but that
human rights and social justice issues are so important and how they factor into helping
people. So, when I found social work it was kind of like the best of the combination.
Regarding motivation to provide in-home clinical services in Newark, she said, “My motivation
is that I’m from Newark, so I want to help the people from my city, show them that, okay,
there’s someone on your side here.” Participant 2 described his motivation as “to help more
underprivileged families and children” and “to work with people on their struggles and just the
classic things like empathy, and just being able to understand, a knack for understanding what’s
going on in people’s interior life.” Motivation is enhanced when the individual values the task
(Eccles, 2006). Participants value the service that they service that they provide, which is a
recruiting strategy of the organization (E-CFT, 2019).
Finding Two
Having a person-organization fit has positive implications on the overall partnership
experience between that person and the organization. Included in this experience is fulfillment
for both parties. For the person, fulfillment comes in the form of job satisfaction, and, for the
organization, performance. Activating and building upon personal interest can increase
motivation. (Schraw & Lehman, 2009). Participant 2 stated, “I just have a good feeling about the
organization and where they are going, and so that’s why I chose [E-CFT].” Participant 1 stated,
“I feel like this organization is one of a kind. Even from my interview, it was just kind of
immediately supportive, honestly because with other organizations that I’ve worked with, it’s
been very all about the money.” She added, “We don’t just serve our families because we are
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 68
bored, but our intention is to make a difference, and I feel like that’s what [E-CFT] is about.”
Having members within the organization who are engaged with the organization and its mission
is a key ingredient in the organization’s recipe for success. An effective way to advance the
organization in its pursuit of its mission and vision is to recruit and select such individuals.
Finding Three
It is essential that MLCs have a strong understanding of the wraparound approach to
treatment so that they can effectively deliver services to children and families in the NJ-SSC.
Wraparound, whose primary value is family voice and choice, is a team-based approach to
providing mental health care for youths with serious emotional, behavioral and developmental
challenges (PerformCare, 2019; Suter, 2009). The NJ Department of Children & Families (DCF)
(2019) define family voice and choice as a principle that “demonstrates respect for and builds on
the value, preferences, beliefs, culture, and identity of the child/youth and family.” All
participants conveyed knowledge of this key principle in the wraparound model. Regarding her
knowledge of family voice and choice, Participant 3 said,
I would say kind of just allowing them to have a chance to express themselves, their
needs, their concerns, as well as choosing whether or not they want to continue with
whatever services that are given outside of being pushed or mandated to do the voice
pretty much to choose whether or not they agree with it or not.
When asked the same question, Participant 4 offered the following definition:
As a clinician you always have to remember that you can provide the service, but also
you have to empower the client to help themselves and help them realize that they do
have a voice and are able to advocate for themselves.
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 69
Participant 5 described honoring the family voice and choice principle as appreciating that
families “have the right to autonomy.” When placing the concept in context, she offered the
concept of a traumatized recipient of therapy and the importance that voice in choice in matters
that seek to ensure that the clinician “doesn’t look like the abuser in case that’s triggering the
person.” Understanding family voice and choice allows MLCs to deliver services that are
reflective of the values of the wraparound model. MLCs need to know this principle intimately
to properly defend it.
Finding Four
MLCs should understand the service experience from the perspective of children and
families they serve. Research by the National Institute of Health (2018) suggests cultural
matching is of more interest to ethnic minorities than their White counterparts as race and
ethnicity is of more concern. Additional bodies of research suggest clinician ethnicity is among
the top features that urban minority families assess due to a perception of connection, trust, and
understanding (Goode-Cross, 2011; Ward, 2005). Participant 1 mentioned the concept of
“connection” in talking about cultural matching. She said, “families in more urban communities,
minorities, whatever, they feel the need to have a connection because of their lack of
connection(s). So that connection piece is always something that makes (them) more
comfortable.” Participant 6 added, “They just might feel more comfortable initially and
throughout the whole process. The level of trust and openness would be positive throughout.” It
is important to note this does not apply to all urbanized and minoritized families, but culture can
influence how urbanized and minoritized families engage in and perceive their mental health
service experience. It is essential to recruit, select, and train MLCs who understand this, not just
urbanized and minoritized families, but for all populations.
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 70
Conclusion
E-CFT is recruiting, selecting, and training MLCs who are intrinsically motivated to
serve children and families and able to engage with E-CFT’s mission, vision, and values, which
include honoring family voice and choice. Through the process of clinical supervision,
according to the qualitative data associated with this research question, the importance of culture
in providing in-home services is discussed as a means of increasing MLCs’ knowledge base.
From this increase in knowledge, metacognition as to the experience of the children and families
served is prompted to further learning and development.
Research Question 2
What are the knowledge, motivation, and organizational influences affecting the fulfillment of
the family voice and choice option as it pertains to cultural relatability to their in-home clinician?
Finding One
It is important that clinicians consider the experience of the children of families they
serve, especially in the wraparound model where they are often in their home. All six
participants offered insight as their perceptions of the in-home experience both in general and for
urbanized and minoritized families in areas like Newark. Participant 2 said in-home services can
be “a little bit of a humbling experience.” He elaborated by saying,
Then, inviting a stranger into your house I think can be vulnerable. Depending on the
situation, if it’s whatever, so they’re really showing themselves as a family. You’re
allowing a stranger in and really letting them see you as a family.
Participant 6 offered a similar perspective: “I think in the beginning it’s uncomfortable, and
you’re coming into [their] house.” She continued,
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 71
The parents that I’ve seen through E-CFT, they’re definitely appreciative, because
they’re usually in a position where they don’t know what to do with their kid anymore.
Well, you come in and, yeah, at first it’s like, “Oh my God, this stranger’s here.” but then
it’s like, “Okay, I see that this stranger who is now getting to know us is really trying to
help my kid.
Participant 1 described the experience as “awkward.” She explained that, sometimes, it is the
family’s first time with NJ-SSC, sometimes it is their millionth, and their attitudes are kind of the
same: “You’re walking into my home. You’re telling me how to raise my child.” Participants
understand the potential discomfort that families experience with having a therapist come into
their home, their personal space. MLCs must allow knowledge of the potential experience for
children and families to inform their approach to working with children and families in the NJ-
SSC wraparound system of care. In-home wraparound service for urbanized and minoritized
children and families in areas like Newark come with unique barriers as compared to their non-
urbanized and non-minoritized counterparts.
It is critical that MLCs understand and appreciate the unique challenges to engaging
urbanized and minoritized families through in-home wraparound services. All participants
highlighted challenges that urbanized and minoritized children and families may face.
Participant 4, a Caucasian female, stated,
They’re some families that are, of course, in more urban areas that they may not feel
comfortable having someone coming into their homes… just the stigma that comes with
social worker and things like that. And I feel like that just we as clinicians just need to
know how to approach that, you know, not make them feel uncomfortable, not to make
them feel like they’re in trouble or anything, but show that we’re here as an asset to help.
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 72
Participant 2, a Caucasian male, stated,
Because I’m a White male, middle class, I come from that background, working into an
urbanized environment, whether it be an African American neighborhood or Hispanic
neighborhood, whatever it may be, it definitely has a different dynamic because I’m like,
I’m not quite an insider there. I think it has a power dynamic in a sense that I’m coming
from a more privileged place. I’m the one coming into their home and trying to fix them,
and so there may be some of that dynamic.
From the perspective of Participant 3, an African American female,
Well, the more urbanized areas will probably be more resistant to it because more than
likely, unfortunately a lot of families would be under more mandated, like, you know,
they have to go through it or this is [service] is required or whatever. And so, I feel like
they’re a bit more resistant to it just because it just seems like, again, the negative stigma
so they don’t want anyone coming into their home or trying to find something and so
they’re a bit more resistant, I feel like, compared to the non-urbanized areas.
This quote brings up an important point for triangulation. According to the Division of Child
Protection and Permanency (DCP&P; 2015) 91% of child protective cases in New Jersey involve
people of color. Participant 6, a Latinx female, offered a similar perspective as Participant 3 in
terms of responsiveness of court mandated clinical services through child protective services. “I
find that the family is appreciative, unless it’s through DCP&P, they are asking for help.” In
general, Participant 6 feels that engagement of urbanized and minoritized families generally
takes time.
At first, they may be distrusting, so to speak, because they may not think that they get the
same [quality of] services that these people in other suburban areas get. They feel like
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 73
they’re marginalized and “Are you really here to help me or are you just here to be here
and be a nuisance” so to speak. But, ultimately, I think that if you take the time, I think it
just takes a little longer to build that rapport sometimes.
Research suggests a strong preference for cultural relatability by families provides and instant
sense of understanding that shortens this period of rapport building with urbanized and
minoritized youths (De Girolamo et al., 2012; Goode-Cross, 2011). It is important to recruit,
select, and train an MLC workforce able to consider the experiences of the different children and
families that they will encounter.
Finding Two
Trust and understanding are essential components of a quality therapeutic relationship.
Trust and understanding and the perception thereof emerged as a theme in the interviews. Also
emergent in the interviews and not previously considered in the study is the perspective that the
MLCs conveyed regarding the cons of cultural relatability. The following three subsections will
explain the elements of this finding.
Cultural matching can offer children and families a sense of trust and
understanding. It is important that clinicians understand the benefits of cultural matching.
Urbanized and minoritized consumers of mental health services are generally more concerned
about the race and ethnicity of their clinician due to perception of trust and understanding
(Goode-Cross, 2011; NIH, 2018). During the interviews five participants conveyed this
sentiment. Participant 3 stated, “Someone who is within the same culture can pick up right away
and can understand what the family is going through.” As an example, she shared her
acculturation experience as a first generation Haitian American:
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 74
If they’re struggling with maybe a child, why is it an issue that the child refuses to take
assistance from the family, and for them culturally that’s something that parents have
grown up to that the child was always depending on them. And, maybe, in the American
culture, that’s something that’s different because they’re pushed to be independent. And
so, for culture, that really relies itself on dependency of the child on the parent, it can be
really hard to understand that, but someone who’s within the culture can see, “Oh yeah
it’s normal for you to rely on your parents, even if you’re 18. It’s something culturally
that we do.”
Participant 1 talked about the value of sharing a meal in the Latinx culture and the fact
that someone outside of the culture is less likely to understand that it may be considered
offensive to reject the offer of a meal in a Latinx host’s home:
So, when I first started in the field, right, I think we’re taught boundaries. Right? You’re
supposed to be like, “no, no” rigid, rigid, rigid person and maintain boundaries, and I
think that it’s okay. Like when you’re dealing with different cultures, I think it’s totally
fine to just be like, “Yeah, I’ll eat your meal,” and it can be such a clinical experience
too. Sharing a meal can tell you so much about a family.”
Being culturally similar to a child and family can increase comfort for urbanized and minoritized
families. Fulfillment of family voice and choice includes conceptual knowledge of cultural
norms, a knowledge that is most readily available by individuals who are within the culture and
therefore culturally relatable to the children and families that they serve.
Cultural matching as limiting for child and family. It is important that MLCs
understand the limitations behind having cultural relatability to the children and families that
they serve. Participants all conveyed the sentiment that cultural relatability in a therapeutic
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 75
relationship can assist in limiting the child and family from seeing other worldviews or
socializing with individuals who do not culturally match them. During the interviews, four
participants highlighted both pros and cons. Participant 2 used the term “missed opportunity”
when describing instances where families rely solely on cultural relatability. Participant 1
repeatedly mentioned the concept of families becoming “stuck” and “in a bubble” that she
attributed to “comfort” and “fear.” Maintaining the theme of missed opportunities, Participant 2
said,
You’re missing out on a possible therapeutic avenue that might be there, so there’s an
ability to flesh out cultural differences and to have a curiosity to connect that way, it can
open up their experience of different cultures as well.
Participant 6 pointed out that culturally relatability can lead to a situation that is, “close-minded
and in a box because if we all just work with the people that are like-minded, we don’t really get
another perspective, and so I just feel that’s the downside.” Cultural relatability can have an
adverse effect of aiding children and families to hold onto views about others who do not
identify within their culture and further challenges in understanding and interacting with others
who are not culturally relatable to them. MLCs need to knowledgeable about this side of
cultural relatability and allow it to inform their approach to connecting with and working with
the child and family that they are culturally relatable to.
Cultural matching challenges worldviews. Cultural matching can create an avenue for
conversation that provides an educational experience for children and families who may be
struggling with connecting with individuals from other cultures. Three participants who greatly
highlighted the benefits of cultural matching for families also reported feeling the onus to assist
families in challenging their worldview as a means of socializing and adapting to environments
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 76
where the people that they would encounter would not culturally match them. In response to the
interviewer’s question about what they believe drives these preferences (for cultural relatability),
Participant 1 replied, “I mean, their own personal experiences. Right? Like their trauma. Right?
I, think about trauma all the time and also like, if a family does request like a specific cultural
background, um, I always like to dig into that.” She continued,
Is this because we’re stuck where we’re at? Or is it because it makes us more
comfortable? Like if we’re stuck where we’re at, then ok, let’s see how we can get more
comfortable with just our society in general, because we can’t live in this bubble.
Participant 6 added, “I can communicate the relation, but at the same time can them a perspective
outside of our culture.” As she continued, she again referred to the acculturation process:
Because especially a lot of youth that the clinicians work with are youth that are more
than likely born here. Or even if they weren’t born here, they’re being acculturated here.
And so, there are a lot of things maybe parents may not see or understand, so that’s where
I can step in and kind of put a balance between the cultures.
When MLCs are aware of the benefits and risks of cultural relatability, they can navigate their
connections in a way that empowers their children and families in an inclusive manner. MLCs
should be aware of the growth opportunity that cultural relatability can present for urbanized and
minoritized families who opt to exercise family voice and choice to request a culturally relatable
provider.
Conclusion
To defend the wraparound principle of family voice and choice as it pertains to cultural
relatability with their in-home clinician, the clinician themselves should be aware of the
experiences of the families whose home they are providing services in. In the case of urbanized
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 77
and minoritized families, where DCP&P involvement in the State of New Jersey runs high, the
additional factors of prejudgement, distrust, and the cultural stigma of mental health issues and
receiving help may be in play. It is important that MLCs understand these dynamics and the
benefits and risks of being culturally matched to this vulnerable population. The benefits include
to the family’s perception of feeling understood and the clinician as both less judgemental and
more trustworthy, which can influence service engagement and perception of service experience.
The risks include limiting the child and family’s worldview in a manner that restricts them by not
challenging them to expand their own worldviews and be accepting of the perspectives and
experiences of others who are not culturally identical to them. To mitigate this risk, the MLCs
should know how to navigate their course of treatment to provide education to the child and
family in a way that meets their cultural relatability needs but offers growth opportunities as
well.
Research Question Three
What are the recommendations for replication of E-CFT’s organizational practices with the MLC
stakeholder group from a knowledge, motivational, or organizational standpoint?
Finding One
Clinical supervision is critical to the development of MLCs. Clinical supervision refers
to a pedagogical experience in which an aspirant for a clinical license or someone performing
social or therapeutic services experiences mentoring, feedback, direct instruction, and
metacognition with the guidance of a clinician who is clinically licensed and approved to provide
such experience (Asakura & Maurer, 2018; Bogo & McKnight, 2008). Consistent with the
quantitative findings, which were that all participants were compliant with their supervision
requirements, the qualitative phase of this research found that all participants valued their clinical
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 78
supervision experience. When asked to provide instances in which she felt supported by the
organization, Participant 5 responded, “Having really awesome supervisors has really been a big
difference. Feeling that support even when we are on our own. I think that’s a huge thing.”
Participant 2 talked about the flexibility in the clinical support availability:
I feel like I have a really good relationship with my supervisor. I can call him anytime.
To call him or text him anytime. He’s always gotten right back to me, if we don’t
connect. So, I just feel like, and I’ve never felt like I’ve been a bother to him.
Participant 5 continued the theme of open access to clinical supervision as an organizational
influence:
Sometimes things come up in the in-home therapy that you wish you had a co-worker
right next door to talk to. But I was always able to reach a supervisor, or the clinical
supervisor, to help guide me in that instant and they were always pretty immediate in that
response.
When comparing her supervision experience to that of a similar organization, Participant
4 stated, “I could speak about the agency that I worked with before [E-CFT] and I think (at) that
agency it didn’t feel like having as much support as I do with [E-CFT]”. Providing
organizational resources to support MLCs is beneficial to the growth and development of the
MLC and produces a supportive learning environment. An effective way to foster the
development of MLCs it to envelop them in support.
Clinical supervision experience is more pedagogical and empowering. Contemporary
organizational behavior research suggests that producing an environment rich in feedback and
coaching can enhance the processes of knowledge and skill acquisition while increasing capacity
to perform (Clark & Estes, 2008; Mone & London, 2018). Participants unanimously reported
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 79
that the supervision experience was rich with learning opportunity, support, and convenience.
Regarding the quality of clinical supervision, Participant 6 stated,
My supervisor definitely provides me that guidance that I need. My supervisor provides
me creative strategies that I could use to engage the family, to engage this child. When I
meet with my supervisor having the ability to meet with her whenever I do need
supervision allows me to touch base and her, “What do think this means? What do you
think I can do?” Kind of brainstorm some ideas that would help me to help my clients
more effectively.
When asked about the value of clinical supervision, Participant 4 stated, “Guidance and even just
feedback it was definitely helpful. Because not being able to have someone work through a
problem with you, I feel that probably would get stuck a lot of times.” Three participants (1, 5,
and 6) mentioned the free Nurtured Heart Approach training provided free by the agency.
Participant 5 stated,
They provided a training for the Nurtured Heart Approach and that is something that I
continue to use to this day and find it really successful. And without their letting me
know that they had it and this it is free, it was something that I probably wouldn’t have
gotten into. And I find it really useful as a modality.
Three participants (1,2, & 4) highlighted the fact that supervision is free as a major value add for
them. Participant 2 compared this experience to the common experience elsewhere: “My
supervision plan has been approved through the State, through E-CFT, so they’re providing that,
they’re paying for that. That’s usually something that you have to pay for, or along the way, so
they’re paying for it.” Above all, the interviews revealed a theme of participants’ experiencing
increased confidence in the field as a result of their clinical supervision and support. To develop
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 80
a strong MLC workforce, organizations have to offer increased capacity to aid in MLC
development.
Finding Two
One of the stated key success factors at E-CFT is collaboration (E-CFT, 2019).
Collaboration provides an opportunity for ideas to bounce between team members in a way that
positions each member to engage at levels that can positively influence performance (Clark &
Estes, 2008). “Collaborate” was a prominent word throughout the series of interviews. When
discussing this end of the E-CFT experience, Participant 5 talked about the impact that
collaboration has on her E-CFT experience. “Well having group supervision, I think, is
beneficial because we all bring different things to the table. So, by discussing it in a group you
hear other people’s experiences and feedback.” Participant 2 highlighted his how collaboration
affects his field service in stating, “I usually collaborate with care managers a lot. I think that’s
the biggest thing that I do, is that.” Collaboration further connects the MLCs with their work on
multiple levels. To develop a strong MLC workforce, organizations must promote collaboration
to influence learning, motivation, and connectivity with the organization itself.
Conclusion
E-CFT strives to be a learning organization (E-CFT, 2019). Data indicated MLC
learning and development is occurring in ways that the five participants who have experience in
other organizations like E-CFT have not experienced outside of E-CFT. The key theme in all six
interviews was the idea of clinical supervision as an experience rich with learning and support.
MLCs unanimously reported the supervision and organizational support of E-CFT as being high-
quality between free trainings to add their clinical skill set, to high-level clinical support than is
flexible to meet the clinicians’ needs. From the experience of peer supervision and
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 81
collaboration, MLCs reported feeling more supported and efficacious in their work with E-CFT
and its children and families.
Synthesis
To answer the overarching question of how in-home wraparound service providers’
utilization of MLCs can achieve increased cultural matching and relatability capacity as it
pertains to serving urbanized and minoritized youths, key themes regarding the promising
practices of E-CFT. In operating as a learning organization and investing time and effort into
creating a pedagogical and growth-supportive experience for MLCs that leads to their developing
knowledge and sustaining the motivation necessary to advance to clinical licensure as
wraparound in-home clinicians, E-CFT has advanced 21 MLCs and is on pace to reach 50 by
December 2021. The NJ-SSC monthly supervision requirement is one hour per month (DCF,
2019). MLCs, 54.8% of whom reported exceeding this monthly supervision requirement, found
themselves to feel strongly supported by both the organization and their clinical supervisor.
Interviews indicate that this organizational support fosters growth in knowledge and clinical skill
set and motivation by way of increased self-efficacy. Important findings to also note, from both
a quantitative and qualitative standpoint, are the fact that organizational setting resources such as
job aids, templates and quality of training videos rated low in both phases. In the survey
question associated with this assumed organization influence, 60% of respondents responded in
the affirmative (30% strongly agree, 20% agree, 10% somewhat agree), while 40% ranged from
neither agreeing or disagreeing and disagreeing (20% neither, 6.7 somewhat disagree, 13.3%
disagree). Participants compared this experience to other organizations and cited that this in area
in which E-CFT needs to improve. These data will be used to highlight organizational
recommendations in Chapter Five.
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 82
CHAPTER FIVE: RECOMMENDATIONS
The organizational performance goal is that, by December 2021, E-CFT will close the
provider gap for low-SES families who are urbanized and minoritized and have largely unmet
cultural and linguistic needs. Data regarding how many families within this population are
currently being served will be more extensively collected to see how many families who request
a provider who is culturally similar and/or speaks their language receive such a provider and the
level of service they receive. The organization’s global goal is to ensure that at least 75% of
families who make such a request are satisfied with at minimum a clinically licensed provider.
An intermediate goal is for E-CFT to advocate the state for master’s degree holders in the areas
of social work, psychology, or counseling who have completed initial licensure to be given
opportunities in Newark under special supervision requirements toward clinical licensure. A
performance goal would be to recruit, select, and train 50 highly capable individual providers
through a special supervision program to create workforce opportunities for MLCs and aspiring
clinicians at the paraprofessional level for placement in Newark within the next three months.
Description of Stakeholder Groups
Master’s level clinicians hold an MSW, counseling, or psychology. By NJ-SSC
guidelines, individuals must have a master’s degree and complete the initial licensing application
and acceptance process for their discipline, which includes a licensing exam (NJ-SSC, 2018).
The step after becoming an MLC is to complete a certain number of supervised field hours, pre-
determined by discipline, by a licensed professional who has both achieved clinical licensure
within that discipline and has been designated as an approved clinical supervisor for developing
MLCs seeking clinical licensure.
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 83
Table 6
Summary of Knowledge Influences and Recommendations
Assumed
Knowledge
Influence
Validated as
a Gap?
Yes, High
Probability
or No
(V, HP, N)
Priority
Yes, No
(Y, N)
Principle and Citation Context-Specific
Recommendation
MLCs
(LAC/LSW)
need to
understand the
importance of
gaining
supervision
toward clinical
license
requirement.
(D)
V Y Six levels of cognitive
processes influence
knowledge acquisition and
retention develop one of four
knowledge systems:
conceptual, factual,
metacognitive, and
procedural types (Dima,
2012; Rueda, 2011).

The six levels are
remembering, understanding,
applying, analyzing,
evaluating, and creating
(Dima, 2012).

Factual knowledge is more
fundamental as it more about
remembering facts (Dima,
2012; Rueda, 2011).

Identify specific behavioral
objectives for learning (Daly,
2009)
Provide MLCs
(LAC/LSW)
information on the
written
requirements for
supervision
toward clinical
licensure as per
outlines set by
their own
disciplinary
boards.

DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 84
Table 6,continued
Assumed
Knowledge
Influence
Validated as
a Gap?
Yes, High
Probability
or No
(V, HP, N)
Priority
Yes, No
(Y, N)
Principle and Citation Context-Specific
Recommendation
MLCs
(LAC/LSW)
need to
understand the
importance of
gaining timely
and appropriate
clinical
supervised
hours toward
their
discipline’s
clinical license
requirement.
(P)
V Y This represents the procedural
knowledge need, which is the
actual “how to” of the clinical
license credentialing process
(Dima, 2012)

Self-regulation strategies
enhance learning and
performance (APA, 2015:
Dembo & Eaton, 2000;
Denler, et al., 2009)
Provide MLCs an
infographic as a
job aid that
outlines their
supervision
requirements as it
pertains both to
their clinical
discipline and the
organization’s
mission.
MLCs need to
reflect on their
career path and
consider its
trajectory while
building the
resiliency to
push forward to
clinical
licensure. (M)
V Y During clinical supervision,
the clinician reflects on past
experiences to shape future
experiences (Dima, 2012;
Dreison et al., 2018).

Metacognitive knowledge is
“thinking about thinking” and
involves a general awareness
of the reality that we are
thinking (Dima, 2012; Mayer,
2011).

Use of metacognitive
strategies facilitates learning
(Mayer, 2011)

To develop mastery,
individuals must acquire
component skills, practice
integrating them, and know
when to apply their learning
(Schraw & McCrudden,
2006)

Private, specific, and timely
feedback enhances
performance (Shute, 2008)
Provide MLCs
will be required to
participate in
regular intervals
of supervision in
which they will
receive coaching
and supportive
leadership to
become more
effectively
autonomous.
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 85
Knowledge Solutions
Increase Knowledge of Steps to Clinical Licensure (Declarative)
The results of this study indicate 93.6% of participants have benefitted from experiencing
enhancement of their declarative knowledge (factual) as it pertains to their specific path to
clinical licensure achievement. This includes knowledge of the what type of field service
supervision satisfies their licensing board’s clinical supervision requirements as well as what
credentials that clinical supervisors require to adequately assist them in achieving clinical
licensure. The recommendation for the knowledge gap is rooted in behavioral theories of
learning. Daly (2009) stated implementation strategies that identify specific behavioral
objectives for learning facilitate actual learning. A recommendation for addressing this
knowledge is for E-CFT to provide information for clinicians of each discipline that outlines and
clearly explains their path to clinical licensure. The desired behavior is that clinicians not only
improve their skills but pursue clinical licensure as they do so.
There are six levels of cognitive processes that influence knowledge acquisition and
retention that subsequently develop one of four knowledge systems: conceptual, factual,
metacognitive, and procedural types (Dima, 2012; Rueda, 2011). Those six levels are
remembering, understanding, applying, analyzing, evaluating, and creating (Dima, 2012). In this
case, the declarative (factual and conceptual) knowledge systems are targeted to address this
knowledge gap by empowering MLCs to better understand what is required of them to achieve
the goal of clinical licensure, evaluating their process based on the model, and creating pathways
to achieve their goal. Factual knowledge is more fundamental and in nature as it more about
remembering facts such as people, places, dates, and things such as incorporation date, founder
names, or organizational mission (Dima, 2012; Rueda, 2011). The evidence confirms better
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 86
knowledge of the “what to do’s” of clinical licensure and the benefits both to the clinician and
organization provides a valuable performance benefit.
Increase Knowledge of Timelines and Milestones to Clinical Licensure (Procedural)
The results of this study indicate that 96.7% of participants received stronger advisement
on establishing a realistic timeline to achieve full clinical licensure in a timely manner. The
theory at the base of this recommendation is information processing system theory. A
recommendation for addressing this knowledge is for E-CFT to provide timeline infographics for
MLCs of each discipline that allows them to track how they are progressing toward licensing
between acquiring and logging appropriate supervised hours, how to prepare their licensing
applications, and finally how to submit their application for licensing board approval.
Dima (2012) describes procedural knowledge as the “how to” associated with achieving a
task. In this case, the “how to” is clinical licensure. Providing this “how to” assists the MLCs
with visualizing a path to successfully achieving clinical licensure. Goldstein (2007) stated many
beginning clinicians experience challenges preparing for their licensing process. Furthermore,
clinicians who are from educationally and economically disadvantaged backgrounds experience
a disproportionate amount of difficulty in this process, which has implications on workforce
entry and advancement (Gastex et al., 2018). Given the organizational goal to create more
ethnically and culturally relatable clinicians to serve urbanized and minoritized populations, this
empirical research finding is of interest to E-CFT. The evidence from interviews affirms the need
for a visual job aid to assist MLCs in better preparing themselves for the clinical licensing
process.

DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 87
Assist With Resiliency (Metacognitive)
The results of this study indicate al participants rely on the reflective process of clinical
supervision to assist them with developing metacognitive knowledge and the overlapping
motivational influence area of self-efficacy. The recommendation to address this knowledge gap
is rooted in information processing theory but contains elements of behavioral theories of
learning. Mastery is achieved by acquiring requisite basic knowledge, placing them into
practice, and utilizing metacognitive strategies to enhance learning how and when to apply
knowledge (Baker, 2011; Schraw & McCrudden, 2006). A recommendation for addressing this
knowledge need is for E-CFT to provide increased supervision, whether weekly or bi-weekly,
instead of the current NJ-SSC requirement of monthly, to better assist clinicians with developing
their identities as clinicians, developing interest in specialities, and learning where and how best
to utilize their clinical skill sets.
Clinical supervision is the process in which the clinician is reflecting on past experiences
for the purpose of shaping future experiences with guidance from a mentor (Dima, 2012;
Dreison, White, Bauer, Salyers, & McGuire, 2018). Tuckman (2009) stated implementations
that include immediate feedback and reinforcement strengthen learning. This recommendation
speeds up the feedback that MLCs need for their development and allows them to immediate
place knowledge attained through metacognitive process back into practice for further
development.
Motivation Solutions
Clark and Estes’ (2008) Knowledge, Motivation, and Organization problem-solving
framework guided this research study. The framework itself suggests that gaps in organization
performance are either a function of the lack of knowledge, motivation, and/or organization
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 88
resources or a misalignment of the KMO influences (Clark & Estes, 2008). Motivation generally
describes the desire, interest, and persistence in achieving a goal or completing a task. In an
academic context, Rueda (2011) and Clark and Estes (2015) defined motivation as the internal
process that energizes the individual, instigates and sustains activity toward a goal. Research
suggests that out of the “big three” of the KMO conceptual framework, motivational influences
are perhaps the least understood due to lack of specialists familiar with that area of study (Clark
& Estes, 2015). Specific to this study and the research question of how organizations can better
utilize MLCs to promote cultural relatability within the mental health workforce service
urbanized, minoritized, and generationally traumatized populations, the question of motivation
seeks to answer the following question: What are the motivational needs of MLCs as they strive
for clinical licensure?
While there are many factors at work that combine to become the motivation of the
individual, in answering this question, this study examined four areas in particular: Utility Value,
attribution, self-efficacy, and goal orientation. All the motivational factors were validated as
high priority and organized by level of relevance and under the assumption that the previous gap
in question needed to be assessed and resolved before assessing and attempting to make
recommendations to resolve the next motivational factor.
Specifically, the research sought to discover whether MLCs valued the organizational
goal of closing the gap in question. If true, this would constitute what Boon et al. (2016) would
constitute as person-organization fit, or congruence between the person and organization in terms
of mission. The authors point to the research finding that this type of relationship has
implications on employee attitude and behavior. Next, after assessing person-organization fit,
which has possible implications for organizational, recruitment, selection and training protocols
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 89
of the organization, the study focused on whether the MLCs believe they can further the
organization’s mission in their service to children and families. The next area of motivation
studied examined whether MLCs feel efficacious as they pursue each milestone in the clinical
licensing requirements and valued their role in the solution to the problem of practice. Finally,
the study examined whether MLCs possessed a goal orientation associated with mastery or
performance in alignment with E-CFT organization mission and vision.
The following table, Table 7, outlines these motivational factors as they were researched,
cites research principles that apply to the area of motivation being examined, and makes
evidence-based recommendations on solutions to the motivational gap.
Table 7
Summary of Motivation Influences and Recommendations
Assumed
Motivation
Influence

Validated
as a Gap
Yes, High
Probabilit
y, No
(V, HP, N)
Priority
Yes, No
(Y, N)
Principle and Citation Context-Specific
Recommendation
MLCs need to
consider the impact
that cultural
reliability has for
urbanized and
minoritized children
and
families as useful.
(UV)
V Y Rationales that include a
discussion of the importance
and utility value of the work or
learning can help
learners develop positive values
(Eccles, 2006; Pintrich, 2003).

Learning and motivation are
enhanced if the learner
values the task (Eccles, 2006).

Provide MLCs
rationale for the
usefulness of their
professional
development as it
pertains to
satisfying the
cultural relatability
needs of urbanized
and minoritized
families.
MLCs need to
believe in their
capability to affect
change necessary to
address the stated
problem of practice.
(SE)
V Y Activating and building upon
personal interest can increase
learning and motivation
(Schraw
& Lehman, 2009).
Provide MLCs
attributional
retraining to
reinforce MLCs’
beliefs in their skill
sets and assist with
persistence through
adverse field
experiences.
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 90
Table 7, continued
Assumed
Motivation
Influence

Validated
as a Gap
Yes, High
Probabilit
y, No
(V, HP, N)
Priority
Yes, No
(Y, N)
Principle and Citation Context-Specific
Recommendation
MLCs must feel
confident in their
ability to complete
their clinical hours
and pass the
appropriate licensing
exams. (SE)
V Y Higher expectations for success
and perceptions of
confidence can positively
influence learning and
motivation (Eccles, 2006)

Feedback and modeling
increases self-efficacy
(Pajares, 2006).

Provide MLCs
concise and timely
feedback loop to
reflect on previous
practice
experiences, to
guide, and improve
future practice
through teaching
MLCs on their
current progress
toward clinical
licensure.
MLCs need to
maintain a high level
of interest in the
problem and
understand their role
in the solution
thereof. (GO)
V Y Focusing on mastery, individual
improvement, learning, and
progress
promotes positive motivation
(Yough & Anderman, 2006).

Goals motivate and direct
students (Pintrich, 2003).
Provide MLCs
individual
improvement,
progress
in obtaining clinical
licensure and
addressing the
problem of
practice.

Increase Value of Cultural Relatability (Utility Value)
Without enough value placed on the importance of a task or problem, an individual’s
performance level or efforts toward completing that task is likely to be adversely impacted
(Eccles, 2006). The recommended solution for this influence is based on models of interest and
expectancy value theory. Enthusiastically providing an experience that connects real-world tasks
to learner interests, that also builds upon their prior knowledge can enhance motivation to
perform toward those real-world tasks (Eccles, 2006; Pintrich, 2003; Schraw & Lehman, 2009).
The results of this study indicate that all participants indicated interest in the role of culture in
how urbanized and minoritized children and families experience treatment. Themes that
emerged from interviews included the perception of trust and understanding that cultural
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 91
relatability can afford some urbanized and minoritized families. Another theme was participants
who identified as more culturally relatable felt the onus assist families in challenging their
worldviews and learning about new cultures and how to interact with people from other cultures.
When the problem space is real to the individual in terms of personal interest and the learner is
also afforded the opportunity act toward the problem, performance can be enhanced. The
recommendation is to recruit, select, train, and support MLC’s who are intrinsically motivated to
serve urbanized and minoritized populations and continue to clearly, constantly, and
enthusiastically communicate the importance of cultural relatability.
Enhance Confidence in Ability to Achieve Clinical Licensure (Self-Efficacy)
While many participants reported knowledge of the clinical licensure pursuit process,
more reported nervousness about the actual process. When considering a solution for this
motivational need, this researcher found a solution rooted in self-efficacy theory to be a suitable
recommendation. Pajares (2006) stated self-efficacy can be enhanced when individuals are made
to feel capable of learning and performing. Setting smart, clear, and challenging goals with
strong scaffolding, and a combination of short and long feedback loops depending on the
complexity of the goal being pursued can boost sense of self-efficacy (Borgogni et al., 2011;
Pajares, 2006). In the context of social work and counseling practice, the recommendation is
that, through the process of clinical supervision, individuals can receive support from their
clinical supervisor that allows them to persist through challenges with the numerous licensing
requirements, improving their clinical practice, and assuring them that clinical licensure is an
attainable goal.
Castex et al. (2018) described the loss of many would-be social workers through the
process of licensing exams. The authors continue to present research to support the concept that
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 92
aspiring social workers from educationally and economically disadvantaged areas experience
significant challenges in obtaining clinical licenses. Castex et al. (2018) purported and later
supported by evidence that a disproportionate amount of African American and Latinx
individuals fail licensing examines in New York and New Jersey, whose boards were both sued
for this disparity in 2007 and 2010, respectively. Research suggests economic and educational
background challenges can work against sense of self-efficacy for those who have experienced
trauma associated with membership to a certain ethnicity or social group (Castex et al., 2018;
Champine et al. (2019). Given the focus on the promising practice is increasing representation in
the in-home mental health workforce of individuals from minoritized ethnic groups and from
urbanized areas to better match service recipients who are minoritized and urbanized, it is
important to know note some educational challenges that may decrease self-efficacy when it
comes to achieving clinical licensure and pedagogy and support that considers these factors must
be offered to assist MLCs, especially those who themselves have been or are themselves
members of urbanized and minoritized groups.
Improve Interest in Addressing the Performance Gap (Utility Value)
To close the gap identified in the problem of practice and answer the research question as
to how MLCs can be utilized in the CSOC to increase cultural relatability for urbanized and
minoritized families, it is critical that the MLCs share the organizational goal, understand the
performance goal, and have an orientation toward the required contributions of them to achieve
the goal with the organization. The recommendation for this motivational area is steeped in goal
orientation theory. Creating an environment that promotes learning and mastery where members
support each other’s learning and mastery feed goal orientation (Pintrich, 2003; Yough &
Anderman, 2006). In the face of field service-related challenges, it is important to consider
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 93
MLCs’ persistence as they pursue clinical licensure hours and trainings. This requires the
organization provide a supportive learning environment in which risks are met with reward and
failure is framed as learning opportunity. Research by Anderman and Anderman (2006)
suggested making it safe to take risks and instilling learning from one’s own mistakes as
opportunities to learn. The recommendation is that, through its clinical supervision function, E-
CFT should maintain a pedagogy of individual growth and development as they advance toward
clinical licensure and, thus, the organizational performance goal.
The research question is more than just a question regarding an interesting concept, as it
speaks to a large social justice matter. Understanding the cultural stigmas that serve as barriers
to effective mental health treatment as well as the experiences of discrimination for members of
certain ethnic groups and subgroups firsthand, has impact on how children and families served
by the wraparound model function at home and in society (Citation). In a literature review of 36
peer-reviewed articles, Maschi, Baer, and Turner (2011) found clinical social work practice has
strong direct and indirect effects on social justice on various levels and made a series of
recommendations for further research. Years later, Asakura and Maurer (2018) suggested
pedagogical practice that highlights the importance of social justice issues will increase clinician
goal orientation toward social justice related causes. They stated clinical supervision is
instrumental in the development of this goal orientation. Clinical supervision supported by
learning-in-action pedagogy transfers theory into practice that the learning clinician can feel
(Saltzburg, Greene, & Drew; 2010). Research shows goals motivate learners, so setting goals
that focus on improvement, mastery, and offer support in connecting the learner with the cause
can positively influence motivation (Asakura, 2018; Pintrich, 2003; Yough & Anderman, 2006).
The aforementioned recommendation for this area provides just that. It directly involves the
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 94
learner in the cause to which the goal pursues through in-action learning, then through the
process of pedagogy that instills the importance of understanding and persistence.
Organization: General theory. The organizational component of the Clark and Estes
(2008) KMO framework describes issues ranging from inadequate facilities to ineffective or
inefficient policies and procedures that can hinder performance toward the organization’s goals.
When workflows are out of alignment with organizational structure or strategy, the organization
will experience barriers to progress and success, even if the areas of knowledge and motivation
are strong (Clark & Estes, 2008). As such, it is essential to understand the elements of the
organizational structure that can serve as barriers to performance. Two elements for
consideration in the analysis of organizational challenges are cultural models and cultural
settings. Gallimore and Goldberg (2001) defined these two concepts as the shared understanding
of how the world works, or ought to, and whenever two or more people come together to
accomplish something, respectively. For the purposes of this section, the focus will be on the
promising practices of E-CFT that set out to challenge and overcome the organizational barriers
that previously contributed to the shortage in clinically licensed and culturally relatable in-home
mental health clinicians to serve the needs of urbanized and minoritized youths in areas like
Newark, New Jersey.

DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 95
Table 8
Summary of Organization Influences and Recommendations
Assumed
Organization
Influence

Validated
as a Gap
Yes, High
Probabilit
y, No
(V, HP, N)
Priorit
y
Yes, No
(Y, N)
Principle and Citation

Context-Specific
Recommendation
There is a firm
and shared
understanding of
the value of
family voice and
choice amongst E-
CFT
administration and
clinicians as it
pertains to
preferences in
provider ethnic
background. (CM)
V Y Effective leaders are
knowledgeable about the use of
effective communication skills to
facilitate change and enhance
organizational capacity (Clark &
Estes, 2008).

Provide clear
communication
regarding the
organizational
performance goal
of a shared
understanding of
the value of family
voice and choice
amongst E-CFT
administration and
clinicians.
MLCs trust and
believe that E-
CFT will provide
the clinical
support required
for their
development and
eventual
licensure. (CM)
V Y Accountability is increased
when individual roles and
expectations are aligned with
organizational goals and
mission. Incentives and rewards
systems need to reflect this
relationship (Clark & Estes, 2008)

Provide trainings
that Master Level
Clinicians find
effective that
reinforces their
belief in the
clinical support
capability and
impresses a high
level of alignment
with the goal of
achieving
licensure.

DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 96
Table 8, continued
Assumed
Organization
Influence

Validated
as a Gap
Yes, High
Probabilit
y, No
(V, HP, N)
Priorit
y
Yes, No
(Y, N)
Principle and Citation

Context-Specific
Recommendation
MLCs at E-CFT
have licensed
level clinicians
who are dually
licensed as
supervisors that
effectively serve
as role models for
them as they
guide them
through field
experiences in
preparation for
clinical licensure.
(CS)
V Y Organizational effectiveness
increases when leaders behave
with integrity. The most powerful
teaching tool a leader has is
leading by example, which is
occurring all the time, whether
intended or not, conscious or not
(Clark & Estes, 2008)
Provide pedagogy
through clinical
supervision that
effectively
provides role
models for them
as they guide them
through field
experiences in
preparation for
clinical licensure.

MLCs have
access to clinical
license test
preparation
resources. (CS)
N Y Organizational effectiveness
increases when leaders ensure that
employees have the resources
needed to achieve the
organization’s goals. (Clark &
Estes, 2008)

Provide trainings
that promote the
availability of test
preparation
resources and
instruction on how
to properly access
and utilize them.

Shared Vision of Family Voice and Choice (Cultural Model)
During the qualitative phase of this research study, all interviewees communicated clear
understanding of the value of family voice and choice in a manner consistent with both E-CFT
and NJ-SSC. Knowles (1980) stated individuals are more motivated to participate and learn
when they can see the relevance in the “why” of a given task. A recommendation rooted in
leadership theory was selected to close this organizational gap. Research by Clark and Estes
(2008) shows effective leaders are knowledgeable about the use of communication skills to
facilitate change and enhance organizational capacity. This would speak to the foundation
behind the findings that participants felt that the principle of family voice and choice is clearly
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 97
communicated in multiple ways. The recommendation for replication of this promising practice
would be for the organizations to develop multiple points of communication of the mission,
vision, and values of the organization. Examples could include posting the mission and vision of
the organization on the website, in training materials including videos, and to ensure leadership
through communication keeps MLCs engaged with the goals of the organization to better assure
alignment between individual MLCs and the organization.
Rath and Conchie (2009) stated vision provides hope and that followers consider the best
leaders to provide this along with stability, compassion and trust. This is particularly important
that MLC leaders from administrators to clinical supervisors demonstrate alignment with the
stated goals of the organization to influence MLCs to espouse organizational values and
approaches. Conversely, research also points to the fact that incongruence between the values of
a leader and that of the organization create barriers to leadership for that leader (Shein, 2004).
Minzanov et al. (2016) pointed to the critical role that leadership through critical supervision
plays in developing a base for understanding and quality of clinical practice for social workers.
As such, it appears that the literature would support the necessity for communication for the
benefits of MLCs, the organization and the families they serve.
MLCs Have Access to Clinical Licensing Preparation Resources (Cultural Setting)
Approximately 60% of participants indicated they have access to and understand how to
access clinical license preparation resources such as practice exams. It is important to
understand licensing challenges that MLCs may face when seeking licensure. Research indicates
barriers are experienced, especially among Black and Latinx candidates seeking licensure
(Castex et al., 2018). The recommendation for promising practice replication rooted in
leadership theory has been selected to close this organizational gap. Clark and Estes (2008)
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 98
stated performance increases when leaders ensure that employees have what they need to work
toward the goals of the organization. MLCs’ feeling they have what they need to be successful
allows them to stay focused on developing instead of resourcing. The recommendation is to
provide training that promotes the availability of test preparation resources and instruction on
how to properly access and utilize them, post them prominently, and utilize clinical supervision
to instill this knowledge. An example of how to accomplish this would be to add a special
section on the organization’s onboarding video that highlights the availability of these resources,
lists methods to accessing them, and visually demonstrates different methods of accessing them.
Ensuring staff resource needs are met is correlated with increased student learning
outcomes (Waters, Marzano, & McNulty, 2003). For MLCs, this includes resources that
increase clinical knowledge in preparation for their clinical licensure exams. This includes
practice exams. In an outside study by Morrison and Hostetter (2006), 52 MLCs were
interviewed regarding challenges to obtaining clinical licensure. A major theme was the lack of
information on what resources they could rely on and access to those resources. Forty percent of
MLCs who participated in surveys either did not agree or disagree (20%), somewhat disagreed
(6.7%) or disagreed (13.3%). This area of organizational influence remains important, but E-
CFT, according to MLCs feedback, can be stronger in this area. Through the process of
supervision, MLCs can discuss their progress, share their practice scores, and receive advice to
help them better perform on practice exams as they prepare for their clinical exams. As such, it
appears that the literature would support the benefit that clinical test preparatory tools have for
MLCs.
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 99
Integrated Implementation and Evaluation Plan
Results, whether favorable or not, are indicators of performance. Unlike the original
Kirkpatrick model in which reaction, learning, behavior, and the results were assessed in that
order, the New World Kirkpatrick Model reverses that order and focuses on the results first
(Kirkpatrick & Kirkpatrick, 2016). With the overall goal of addressing performance goals in a
very scientific and methodical way, the Kirkpatrick model evaluated the aforementioned areas as
a means of fine-tuning how future practice improvement is implemented from actual results,
down to the learner experience in the process. Starting at Level 4, results, allows the emergence
of leading indicators that assess progress along the way toward achieving the organization’s
highest goals (Kirkpatrick & Kirkpatrick, 2016). For this research study, the model and the
Clark & Estes KMO framework will be used to diagnose need on each level of learning
development.
Starting in reverse order, Level 4 allows us to look at larger organizational goals, identify
leading indicators of performance associated with that goal and then make associations between
those indicators and behaviors at Level 3. Level 3 assesses how training participants apply the
knowledge that they should have obtained between Level 2 and Level 1 identify required drivers
and reinforcements to for critical behaviors that generate results (Kirkpatrick & Kirkpatrick,
2016). In Level 2, learning, the experience occurs during and after actual training (Kirkpatrick &
Kirkpatrick, 2016). In the expanded New World Kirkpatrick Model, this level is no longer
looking at learning transfer, but also the acquisition of attitude, confidence, and knowledge
required for success. Attitude by itself is very important to understand. In Level 1, reactions,
participants’ attitudes toward the training itself is teased out more. The learning process, or
preparation for Level 2 to transfer into Level 3 and subsequently Level 4 sets the foundation of
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 100
training that participants find the training engaging and relevant to their jobs (Kirkpatrick &
Kirkpatrick, 2016).
Organizational Purpose, Need and Expectations
Essex Children and Families Together (E-CFT) is a learning organization that strives to
develop sustainable therapeutic programming for children and families across the State of New
Jersey. The problem of practice is the lack of ability to provide in-home therapeutic services that
are both culturally matched and/or relatable for urbanized and minoritized families in Newark.
In what this study purports to be a promising practice, E-CFT is developing training
systems behind key stakeholders, MLCs, who are from the area of need and culturally relatable
to the stakeholder affected by the problem of practice and providing the resources necessary to
close this performance gap in a manner in which the clinical licensing quality is similar to that
enjoyed by their non-urbanized, non-minoritized counterparts. The goal is to advance 50 MLCs
from the Newark area into clinical licensure by December 2021.
Level 4: Results and Leading Indicators
Table 9 represents the New World Kirkpatrick Model Level 4 and outlines both desired
internal and external results and their leading indicators. Working from the inside outward,
achievement of the desired internal results from recruitment, selection, education, and support
will drive E-CFT and this stakeholder group toward the proposed external outcomes.

DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 101
Table 9
Outcomes, Metrics, and Methods for External and Internal Outcomes
Outcome Metric(s) Method(s)
External Outcomes
Increased workforce
ability family voice and
choice as it pertains to
provider cultural matching
and relatability.
Self-Reports by way of family
quality assurance calls.
Year end NJ-SSOC review
statistics and comparison with
that over the past 3 years.
Increased workforce
scaffolding capacity for
new MLCs to be applied
to other populations of
interest.
Number of licensed clinicians
and supervisors within the
system workforce.
Quarterly review of HR reports
on hiring and retention.
Increased organizational
capacity to provide
Licensed Level Clinical
Services statewide.
Number of licensed clinicians
within the organization.
Month over month comparison.
Monthly review of HR reports
on availability and missed
opportunities.
Internal Outcomes
Increased interest in
clinical licensure amongst
MLCs
Supervision and training
attendance
Weekly supervision compliance
reporting.
Increased clinical
licensure passing rates.
Notification of License Issuance Monthly licensing reports from
the Department of Licensing
with the State of New Jersey

Level 3: Behavior
Critical behaviors. MLCs own their licensing path and process. The process only
advances as they do. That said, the following behaviors are critical in their success toward the
performance goal: meeting supervision attendance requirements, completing their field hour
requirement, keeping track of their licensing path, investing time and effort into converting field
experiences into learning opportunities. Table 10 below provides an outline for the critical
behavior, metrics and methods of measurement, and the timing or frequency of measurement.

DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 102
Table 10
Critical Behaviors, Metrics, Methods, and Timing for Evaluation
Critical Behavior Metric(s)
Method(s)
Timing
MLCs Meet
supervision
attendance
requirements.
Supervisor attendance
log
Clinical supervisors will
mark attendance.
Weekly
MLCs Meet field hour
requirements.
Direct service
encounter form
submissions rates
Compliance team will
monitor assignments
and submissions.
Weekly
MLCs Track their
licensing path.
Monthly
individualized
supervision session
Clinical supervisor will
conduct a monthly
individualized review in
which the participant
will reflect on his/her
path and receive support
in identifying and
completing the next
steps.
Monthly
MLCs convert their
field experience into
knowledge for their
licensing exam.
Monthly
individualized
supervision session
Clinical supervisor will
conduct Monthly
individualized review
session in which field
service reflections and
impressions will be used
as teaching moments for
license preparation.
Monthly

Required drivers. Clear communication of a SMART goal can go a long way toward
achieving that goal, but, in the case of the MLCs, their support structure is not just high-level
leadership, but their core support staff, compliance and reporting staff, and clinical supervisors,
who all share a hand in supporting critical behaviors necessary to achieve desired results through
paying attention to this stakeholder group’s required drivers. Table 11 shows an outline for the
required drivers to support critical behaviors.

DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 103
Table 11
Required Drivers to Support Critical Behaviors
Method(s) Timing
Critical Behaviors Supported
1, 2, 3 Etc.
Reinforcing
Compliance unit participation
can provide an electronic
tracking aid and training video
to assist MLCs in remaining
organized.
Ongoing 2
Core Support can provide an
electronic folder of document
templates and completion job
aides to assist with
compliance.
Ongoing 2
Encouraging
Clinical supervisor should be
structured as both a
pedagogical and encouraging
experience that allows for
growth.
Weekly 1, 3,4
Rewarding
Bonuses offered for key
licensing milestones such as
passing the clinical licensing
exam.
One-Time and as necessary
per milestone
1,2,3,4
Monitoring
Supervision, documentation,
and field completion
requirements can be
monitored on behalf of the
MLC to help identify
individuals in need of
increased assistance for their
development.
Ongoing 1,2,3,4

Organizational support. In terms of accountability, E-CFT holds weekly health checks,
called “huddles” in which key areas of operation provide status reports. Information shared
during these sessions allows the organization to be held accountable by all its moving parts and
to identify growth opportunities. For this specific development program, there is a
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 104
recommendation to implement a specific tracking model that uniquely supports the drivers and
critical behaviors as there currently is not one in place. Such a recommendation will include
specific roles for clinical supervisors, organization leaders, compliance, and field service support
staff involved in the success of the MLC stakeholder group by clearly defining and
communicating goals, roles, expectations, accountability, and timing.
Level 2: Learning
Learning goals. Learning occurs during and after the training program looks at learning
transfer, the acquisition of attitude, confidence, and commitment required for success
(Kirkpatrick & Kirkpatrick). Planning for this level and Level 1 requires that the organization
create the conditions conducive to initiating and sustaining organizational change through
measurement of on-the-job behavior (Kirkpatrick & Kirkpatrick, 2016). To support the critical
behaviors outlined in Table 11, the learning objectives of the MLC training program will assist
MLCs in learning:
1. What their supervision attendance requirements with E-CFT are. (F)
2. What their field hour requirements for their chosen discipline are. (F)
3. What their clinical licensure path is. (F)
4. How to track their progress in pursuit of clinical licensure. (P)
5. How to engage in metacognitive practice that transfers field experiences to situational
knowledge required by their licensing exam. (P)
6. How their personal development not only helps others, but also the mental health field.
(A)
7. What cultural relatability is, how it impacts urbanized and minoritized children and
families, and how their role in the overall picture. (UV)
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 105
8. How to establish and maintain confidence in the clinical licensing process. (C)
Program. The training program will be synchronous in nature and offered both in-
person and electronically for groups of six to ten participants. The program is designed to
address the knowledge and motivation needs of the participants in a manner that is directly in
alignment with the critical behaviors associated with the achievement of desired results. The
training will be a 3-hour to half-day training inclusive of an hour allotted for questions and
answers.
The program consists of an on-site or electronic structured trainings in which the learning
objectives will be outlined, then each objective addressed section by section with time at the
conclusion of each section for discussions regarding learning objectives 1 and 2. There will be
extra time for illustration, role play, and further discussion for learning objectives 3 and 4. The
program will communicate the learning objectives clearly, set expectations for course design and
participation.
Job aids defining key terms and concepts will be provided at the beginning of the
program. Additional job aids outlining clinical licensing paths for each clinical discipline will be
provided during that portion of the training and used to facilitate activities that demonstrate
understanding of the licensing paths and how they apply to each participant. The instructor will
pulse check between major concepts to allow participants to engage with the training material in
whichever way that they need to prior to moving onto the next concept or learning objective. An
independent observer will be assigned to each room regardless of format with the purpose of
evaluating participant engagement behavior.
Evaluation of the components of learning. There will be a series of assessments during
the training, then two retrospective assessments of the training by way of quizzing for knowledge
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 106
and providing a survey to detect motivational factors. Both assessments will be online using
Google Forms’ quiz and survey functions.
Table 12
Evaluation of the Components of Learning for the Program
Method(s) or Activity(ies) Timing
Declarative Knowledge “I know it.”
Summarizing - Review and discussion of E-CFT
supervision attendance requirements (1)
Intra - Immediately following presentation
outlining E-CFT’s supervision attendance policy.
Classifying - Participant verbal statement of chosen
discipline and associated field hour requirement (1,
2)
Intra -Immediately following the presentation
outlining the field hour requirements for each
discipline.
Evaluating - Retrospective assessment of
declarative knowledge (1, 2)
Post - Online quiz by Google Form
Procedural Skills “I can do it right now.”
Listing - Illustration of participant understanding of
their own clinical licensure path.
Intra - Immediately following the presentation
outlining clinical licensing paths for each MLC
discipline.
Interrogating - Motivational Interview with a past
participant who has achieved licensure through the
program (1, 2, 3, 4)
Intra - During the final discussion hour
Summarizing - Group discussion on how they
transfer field experience into their own learning (4)
Intra - Immediately following the illustration on
how to identify and process opportunities in field
experience.
Evaluating - Retrospective assessment of
procedural knowledge (3)
Post - Online quiz by Google Form
Attitude “I believe this is worthwhile.”
Remembering - Participant verbal statements on
key takeaways from the training program (1, 2, 3,
4)
Intra - During final discussion hour
Retrospective assessment of motivation (UV) Post - Online survey by Google Form
Confidence “I think I can do it on the job.”
Applying - Role play to assist with understanding
how to measure current progress and set course to
continue toward the goal of clinical licensure (3)
Intra - Immediately following the
Analyzing - Illustration of how to identify and
process learning opportunities in the field. (4)
Intra - Immediately following the presentation on
the relationship between metacognition and exam
preparation
Evaluating- Retrospective assessment of motivation
(SE) (3)
Post - Online survey by Google Form
Commitment “I will do it on the job.”
Producing - Participants will produce a contract to
themselves in which they commit to the relevant
learning objectives associated with their chosen
discipline. (1, 2, 3, 4)
Intra - Final Activity of the Program

DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 107
Level 1: Reaction
At the beginning and end of the Kirkpatrick model is Level 1: Reactions. This level
focuses on learner’s attitude toward the training itself, namely whether it is relevant to the
participant’s jobs, whether MLCs are engaged throughout the program, and participant
satisfaction with the training program (Kirkpatrick & Kirkpatrick, 2016).
Table 13
Components to Measure Reactions to the Program.
Method(s) or Tool(s) Timing
Engagement
Instructor observation and survey rating on
questions regarding participant reactions,
participation, and other behaviors
Post - Within a 2-week period
Attendance Rating - Comparison of number of
registrants versus attendees
Post - Immediately
Course Evaluation Participation - Comparison
of the number of attendees versus post-training
survey responses.
Post - Within a 2-week period
Course Evaluation Scores Post - Within a 2-week period
Relevance
Registration Rate - Comparison of how many
MLCs register for the program versus how
many MLCs are eligible to register
Pre/Intra/Post - Period between initial offering
and conclusion of training program.
Pulse check with participants during training
after key points, sections, discussions, and/or
other activities
Intra - various times during the training
Course Evaluation Scores Post - Within a 2-week period
Customer Satisfaction
Pulse check with participants during training
after key points, sections, discussions, and/or
other activities
Intra - various times during the training
Participant verbal statements on key takeaways
from the training program (1, 2, 3, 4)
Intra - final discussion hour
Course Evaluation Scores Post - Within a 2-week period

DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 108
Evaluation Tools
Immediately following the program implementation. Evaluation of the MLC training
will focus on Levels 1 and 2. In other words, the evaluation will focus on participants’
perception of relevance, their engagement, and/or overall satisfaction with the training format
and delivery as well as knowledge and skill transfer, attitude, confidence, and commitment. The
evaluation will take place in two phases: during the training program and again within two weeks
of the conclusion of the training. In this process elements such as engagement may report earlier
than items such as the actual participant feedback regarding their training experience. During the
first phase of evaluation, observations of learner participation in discussion and group activities
will be made and rated between instructor and dedicated observer onsite. Immediately following
the training program and shifting into phase two of evaluation, a Google Form quiz, which is
outlined in Appendix E, will be presented to learns to measure knowledge transfer in the areas of
declarative and procedural knowledge. Test scores below 90% may indicate the need for
additional training for certain individuals or be indicative of a flaw in the training. The post-
program evaluation survey, which is outlined in Appendix F, will be conducted in the second
phase of evaluation and specifically measures participant satisfaction, relevance, and engagement
(Level 1). The survey will also cover learning perceptions of changes, if any, in knowledge, both
declarative and procedural, as well as attitude and commitment (Level 2).
Delayed for a period after the program implementation. Delayed evaluation tools
require that participants have time to demonstrate critical behaviors and produce results. This
level of blended evaluation will link Levels 1 and 2 with Levels 3 and 4. Changes in behavior
and results take at least 90 days to be adequately observed and assessed (Kirkpatrick &
Kirkpatrick, 2016). The assessment of critical behaviors will focus on how MLCs have taken the
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 109
training on clinical licensure pursuit and conducted by clinical supervisors as confirmed by the
combination of attending and observations. Appendix F illustrates the items under consideration
for this level of evaluation.
Data Analysis and Reporting
Level 4 MLC results will be measured quantitatively through the Quickbase HR
platform. The platform will capture data regarding MLCs who transition into becoming licensed
level clinicians available to serve Newark. These results are subject to change daily as human
resources management updates MLC records, which are available on demand through
Quickbase. Quarterly reporting on the progression toward the organizational performance goal
will be provided by human resources and quality assurance calls with care managers and families
will help measure whether the clinicians who graduate this special course of programming are
excelling and closing gaps in culturally relatable provider availability for children and families in
Newark and similar areas.
Level 3 MLC critical behaviors will be monitored through the E-CFT compliance
process, also using the Quickbase platform, which will primarily focus on supervision attendance
and the frequency thereof, field hour acquisition, and pace toward licensing exam preparation.
Level 2 learning will be measured by the Google Forms platform, which offers quizzes that
provide date and time stamping and scores for all attempts on a Google Sheet backend for quick
quantitative analysis. Level 1 reporting, as mentioned in the evaluation section, will be captured
through Google Forms, both survey and quiz functions, which are powered by a Google Sheet
spreadsheet on the backend for instant quantitative data analysis.

DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 110
Summary
Implementing Kirkpatrick and Kirkpatrick’s (2016) New World Kirkpatrick Model to
design, implement and monitor practice recommendations provides an organized approach to
performance improvement in a way that allows intensely focused effort on each level within the
framework to drive success. The process through this framework is a reverse engineering of
sorts in that the New World model examines the results first at Level 4 in measuring an
organization or stakeholder’s progress toward a pre-defined desired outcome. Level 3 examines
behaviors, namely the behaviors that are critical to the achievement of the desired results defined
in Level 4. This level looks at reinforcement of learning and the transfer of learning into action.
Level 2 looks at the actual learning material, whereas Level 1 measures the participants’
perception of the actual learning experience.
In the context of E-CFT, which this study identifies as demonstrating a promising
practice in their organizational efforts into the development of MLCs, the performance goal is to
develop 50 culturally relatable licensed level clinicians through training and advocacy for
workforce opportunities by December 2021. The goal is to do this in Newark and like areas,
where research has indicated experiences a shortage in culturally relatable clinicians at the
clinically licensed level. To achieve this goal, E-CFT has implemented a recruitment, selection,
and training strategy that has created an environment that fosters the growth and development of
MLCs. E-CFT has also advocated for their MLCs, who often are restricted from opportunities
within NJ-SSC. The desired outcome is not only the quantity, but a certain quality of clinicians
in the E-CFT workforce. This effort requires that MLCs are indoctrinated into the E-CFT culture
in a manner that influences their continued interest and efforts into the critical behaviors that
assist E-CFT in achieving this performance goal. The indoctrination process is driven by
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 111
learning, which will occur through the proposed training program. If properly designed between
recruitment and selection as well as program design, the training program should be a positive
experience for MLCs in a way that influences learning and encourages engagement in critical
behaviors. Understanding the New World Kirkpatrick Model not just for this stakeholder group,
but the other provider types through E-CFT’s numerous service lines has strong and positive
implications on the capacity for E-CFT to realize its global goals.
Recommendations for Further Research
In this study, a few influences emerged that were not originally assumed and may call for
further research. Inductive findings from this study would suggest that the connections between
MLC interest, intrinsic motivation, and growth needs as a recruitment and selection strategy and
performance in the realm of mental health could be a study of interest. Also recommended
would be further research into the connection between clinical supervision as more of an
educational experience and both the knowledge and motivation needs of MLC’s who are
providing in-home services specifically via the wraparound model. Finally, research into how
cultural relatability, as it is defined in this study, can create bridges to conversations that can
enhance socialization skills and expand worldviews for urbanized and minoritized recipients of
mental health services and whether this phenomenon can be incorporated into mental health
professional and paraprofessional training.

DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 112
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DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 121
APPENDIX A
Quantitative Survey Questions and Likert Scale Values

Q1 My gender is
o Male (1)
o Female (2)
o Other (3)

Q2 Ethnically, I identify as
o Asian/Pacific Islander (1)
o Black/African American (2)
o Caucasian (3)
o Biracial (4)
o Hispanic/Latino (5)
o Other (6)

Q3 In terms of Faith, I consider myself to be
o Catholic (1)
o Christian (2)
o Jewish (3)
o Muslim (4)
o Agnostic (5)
o Other (6)

Q4 I fall within the following age range
o 18-24 (1)
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 122
o 25-34 (2)
o 35-44 (3)
o 45-54 (4)
o 55-65 (5)
o 65 and older (6)

Q5 I would describe the area that I grew up in as:
o Urban/City (1)
o Suburban (2)
o Rural (3)

Q6 I would describe the quality of education where I grew up as:
o Below Average (1)
o Average (2)
o Above Average (3)

Q7 My educational/clinical discipline is:
o Social Work (1)
o Counseling (2)
o Psychology (3)

Q8 My primary reason for choosing this discipline is that:
o I am interested in matters of mental health. (1)
o I am interested in matters of social justice. (2)
o I am interested in career stability. (3)
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 123
o I am interested in helping others in general. (4)

Q9 I have been providing services as an in home clinician for
o 0-2 years (1)
o 2-5 years (2)
o 6 -10 years (3)
o Over 10 years (4)

Q10 I believe that the families that I work with generally trust and believe in me.
o Strongly agree (4)
o Agree (5)
o Somewhat agree (6)
o Neither agree nor disagree (7)
o Somewhat disagree (8)
o Disagree (9)
o Strongly disagree (10)

Q11 Achieving clinical licensure is important to me.
o Strongly agree (1)
o Agree (2)
o Somewhat agree (3)
o Neither agree nor disagree (4)
o Somewhat disagree (5)
o Disagree (6)
o Strongly disagree (7)

DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 124

Q12 I believe that E-CFT generally trusts and believes in me.
o Strongly agree (4)
o Agree (5)
o Somewhat agree (6)
o Neither agree nor disagree (7)
o Somewhat disagree (8)
o Disagree (9)
o Strongly disagree (10)

Q13 E-CFT supports my career and licensing goals.
o Strongly agree (1)
o Agree (2)
o Somewhat agree (3)
o Neither agree nor disagree (4)
o Somewhat disagree (5)
o Disagree (6)
o Strongly disagree (7)

Q14 I feel confident in my ability to pass the clinical licensing exam for my chosen discipline.

o Strongly agree (1)
o Agree (2)
o Somewhat agree (3)
o Neither agree nor disagree (4)
o Somewhat disagree (5)
o Disagree (6)
o Strongly disagree (7)

DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 125
Q15 I am confident in my level of knowledge as to the supervision an practice requirements to
achieving clinical licensure.
o Strongly agree (1)
o Agree (2)
o Somewhat agree (3)
o Neither agree nor disagree (4)
o Somewhat disagree (5)
o Disagree (6)
o Strongly disagree (7)

Q16 I feel confident in my ability to achieve the supervision and practice requirements necessary
to achieve clinical licensure within the next 2 years.
o Strongly agree (1)
o Agree (2)
o Somewhat agree (3)
o Neither agree nor disagree (4)
o Somewhat disagree (5)
o Disagree (6)
o Strongly disagree (7)

Q17 My clinical supervisor at E-CFT provides additional information and support to enhance my
understanding of the licensing process.
o Strongly agree (1)
o Agree (2)
o Somewhat agree (3)
o Neither agree nor disagree (4)
o Somewhat disagree (5)
o Disagree (6)
o Strongly disagree (7)

DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 126

Q18 I view my clinical supervisor at E-CFT as a teacher and mentor.
o Strongly agree (4)
o Agree (5)
o Somewhat agree (6)
o Neither agree nor disagree (7)
o Somewhat disagree (8)
o Disagree (9)
o Strongly disagree (10)
Q19 My clinical supervision experience at E-CFT includes reflection of my field service,
discovery of my talents/skills, and instruction on how to improve as I move forward in achieving
my required field hours.
o Strongly agree (1)
o Agree (2)
o Somewhat agree (3)
o Neither agree or disagree (4)
o Somewhat disagree (5)
o Disagree (6)
o Strongly disagree (7)

Q20 I am motivated to and capable of achieving clinical licensure for my chosen discipline
within the next 2 years.
o Strongly agree (1)
o Agree (2)
o Somewhat agree (3)
o Neither agree nor disagree (4)
o Somewhat disagree (5)
o Disagree (6)
o Strongly disagree (7)

Q21 I fully comply with clinical supervision requirements.
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 127
o Strongly agree (1)
o Agree (2)
o Somewhat agree (3)
o Neither agree nor disagree (4)
o Somewhat disagree (5)
o Disagree (6)
o Strongly disagree (7)
Q22 I attend _____ supervision sessions per month.
▼ 1 (1) ... 8 (8)

Q23 E-CFT provides me with the job aids, including templates and explainer videos, necessary
for me to complete my field hours.
o Strongly agree (1)
o Agree (2)
o Somewhat agree (3)
o Neither agree nor disagree (4)
o Somewhat disagree (5)
o Disagree (6)
o Strongly disagree (7)

Q24 I feel that E-CFT core support staff provides me with additional assistance in matters of
field service, progress reporting, and treatment planning.
o Strongly agree (11)
o Agree (12)
o Somewhat agree (13)
o Neither agree nor disagree (14)
o Somewhat disagree (15)
o Disagree (16)
o Strongly disagree (17)

DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 128

Q25 Clinical psychology, social work, and counseling all have social injustice implications.
o Strongly agree (1)
o Agree (2)
o Somewhat agree (3)
o Neither agree nor disagree (4)
o Somewhat disagree (5)
o Disagree (6)
o Strongly disagree (7)

Q26 I believe that the role of culture plays a critical role in how children and families experience
treatment.
o Strongly agree (1)
o Agree (2)
o Somewhat agree (3)
o Neither agree nor disagree (4)
o Somewhat disagree (5)
o Disagree (6)
o Strongly disagree (7)

Q27 I feel that my role as a clinician, to satisfy family voice and choice can include being
culturally matched and or similar to the child and family that I am serving.
o Strongly agree (1)
o Agree (2)
o Somewhat agree (3)
o Neither agree nor disagree (4)
o Somewhat disagree (5)
o Disagree (6)
o Strongly disagree (7)
Q28 I feel a desire to work with children and families who are ethnically and culturally
similar to me more often than not.
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 129
o Strongly agree (1)
o Agree (2)
o Somewhat agree (3)
o Neither agree nor disagree (4)
o Somewhat disagree (5)
o Disagree (6)
o Strongly disagree (7)

Q29 Cultural relationships - connections and differences with children and families has been
discussed during my clinical supervision time at one point or another.
o Strongly agree (1)
o Agree (2)
o Somewhat agree (3)
o Neither agree nor disagree (4)
o Somewhat disagree (5)
o Disagree (6)
o Strongly disagree (7)

Q30 I believe that traumatic experiences like violence in community, school, or domestic
settings, abuse or neglect, and racial discrimination are experienced at a higher than average rate
by urban minorities.
o Strongly agree (1)
o Agree (2)
o Somewhat agree (3)
o Neither agree nor disagree (4)
o Somewhat disagree (5)
o Disagree (6)
o Strongly disagree (7)

DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 130
Q31 I believe that urban and minority children and families tend to trust in-home providers that
they perceive as having personally experienced the same or similar experiences as they have.
o Strongly agree (4)
o Agree (5)
o Somewhat agree (6)
o Neither agree nor disagree (7)
o Somewhat disagree (8)
o Disagree (9)
o Strongly disagree (10)

Q32 I believe that I have personally experienced trauma associated with my culture, ethnicity, or
area in which I live or grew up in at one point or another in my life.
o Strongly agree (4)
o Agree (5)
o Somewhat agree (6)
o Neither agree nor disagree (7)
o Somewhat disagree (8)
o Disagree (9)
o Strongly disagree (10)

Q33 I am motivated to mainly work with children and families who have experienced trauma
that I myself have personally experienced.
o Strongly agree (4)
o Agree (5)
o Somewhat agree (6)
o Neither agree nor disagree (7)
o Somewhat disagree (8)
o Disagree (9)
o Strongly disagree (10)

DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 131

Q34 I would rate my desire to work with urban and minority youth as:
o Low (1)
o Average (2)
o High (3)

Q35 I would be less likely to provide in-home services in Newark, NJ and like areas because
o Personal safety concerns (1)
o Conditions of some of the homes or neighborhoods. (2)
o Inability to connect with families. (3)
o I am not unlikely to reject in-home work in Newark. (4)

Q36 My interest in providing in-home services in areas like Newark, NJ over other less urban
locations can be described as
o Much stronger (1)
o Moderately stronger (2)
o Slightly stronger (3)
o No change (4)
o Slightly weaker (5)
o Moderately weaker (6)
o Much weaker (7)

DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 132
APPENDIX B
Quantitative Survey Results

Table 1. Participant demographic characteristics
Characteristic N (%)
N=31
Gender
Female (%) 24 (77.4)
Male (%) 7 (22.6)
Other (%) 0 (0.0)
Race/ethnicity
Black/African American 11 (35.5)
Caucasian 11 (35.5)
Hispanic/Latino 7 (22.6)
Biracial 1 (3.2)
Asian/Pacific Islander 0 (0.0)
Other 1 (3.2)
Religious affiliation
Christian 11 (35.5)
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 133
Catholic 10 (32.3)
Agnostic 4 (12.9)
Jewish 2 (6.5)
Muslim 0 (0.0)
Other 4 (12.9)
Age
18-24 0 (0.0)
25-34 22 (71.0)
35-44 7 (22.6)
45-54 2 (6.5)
55-64 0 (0.0)
65 and older 0 (0.0)
Childhood living area
Urban 19 (61.3)
Suburban 9 (29.0)
Rural 3 (9.7)
Education quality in childhood living area
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 134
Below average 5 (16.1)
Average 19 (61.3)
Above average 7 (22.6)

Table 2. Participant work characteristics
Characteristic N (%)
N=31
Educational/clinical discipline
Counseling 16 (51.6)
Social work 15 (48.4)
Psychology 0 (0.0)
Primary reason for choosing discipline
I am interested in helping others in general 18 (58.1)
I am interested in matters of mental health 9 (29.0)
I am interested in matters of social justice 4 (12.9)
I am interested in career stability 0 (0.0)
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 135
Length of time providing services as an in-home clinician
0-2 years 18 (58.1)
2-5 years 10 (32.3)
6-10 years 2 (6.5)
10+ years 1 (3.2)
Number of clinical sessions attended per month
1 14 (45.2)
2 3 (9.7)
4 13 (41.9)
5 1 (3.2)

DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 136
Table 3. Participants’ feelings about their current work environment
Statement Strongl
y agree
Agre
e
Somewh
at agree
Neithe
r agree
nor
disagre
e
Somewh
at
disagree
Disagre
e
Strongl
y
disagre
e
I believe that
the families I
work with
generally
trust and
believe in me
17
(54.8)
12
(38.7
)
2 (6.5) -- -- -- --
Achieving
clinical
licensure is
important to
me
25
(80.7)
5
(16.1
)
-- 1 (3.2) -- -- --
I believe that
E-CFT
generally
trusts and
believes in
me
19
(61.3)
10
(32.3
)
1 (3.2) 1 (3.2) -- -- --
E-CFT
supports my
career and
licensing
goals
19
(61.3)
6
(19.4
)
4 (12.9) 2 (6.5) -- -- --
I feel
confident in
my ability to
pass the
clinical
licensing
exam for my
chosen
discipline
20
(64.5)
7
(22.6
)
4 (12.9) -- -- -- --
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 137
I am
confident in
my level of
knowledge
as to the
supervision
and practice
requirement
s to
achieving
clinical
licensure*
16
(53.3)
12
(40.0
)
1 (3.3) 1 (3.3) -- -- --
I feel
confident in
my ability to
achieve the
supervision
and practice
requirement
s necessary
to achieve
clinical
licensure
within the
next 2
years*
17
(56.7)
8
(26.7
)
2 (6.7) 2 (6.7) -- 1 (3.3) --
My clinical
supervisor at
E-CFT
provides
additional
information
and support
to enhance
my
understandi
ng of the
licensing
process
14
(45.2)
11
(35.5
)
3 (9.7) 3 (9.7) -- -- --
I view my
clinical
supervisor at
E-CFT as a
17
(54.8)
8
(25.8
)
1 (3.2) 5 (16.1) -- -- --
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 138
teacher and
mentor
My clinical
supervision
experience
at E-CFT
includes
reflection of
my field
service,
discovery of
my
talents/skills,
and
instruction
on how to
improve as I
move
forward in
achieving
my required
field hours
13
(41.9)
10
(32.3
)
2 (6.5) 6 (19.4) -- -- --
I am
motivated to
and capable
of achieving
clinical
licensure for
my chosen
discipline
within the
next 2
years*
21
(70.0)
7
(23.3
)
1 (3.3) -- 1 (3.3) -- --
I fully
comply with
clinical
supervision
requirement
s
22
(71.0)
9
(29.0
)
-- -- -- -- --
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 139
E-CFT
provides me
with the job
aids,
including
templates
and
explainer
videos,
necessary
for me to
complete my
field hours*
9 (30.0) 6
(20.0
)
3 (10.0) 6 (20.0) 2 (6.7) 4 (13.3) --
I feel that E-
CFT core
support staff
provides me
with
additional
assistance in
matters of
field service,
progress
reporting,
and
treatment
planning
15
(48.4)
11
(35.5
)
3 (9.7) 1 (3.2) 1 (3.2) -- --
** one participant did not respond (n=30)

Table 3b. Participants’ feelings about their current work environment*
Statement Mean
± SD
Median
(IQR)
Mode
I believe that the families I work with generally trust and
believe in me
1.52 ±
0.63
1.0 (1.0–
2.0)
1.0
Achieving clinical licensure is important to me 1.26 ±
0.63
1.0 (1.0–
1.0)
1.0
I believe that E-CFT generally trusts and believes in me 1.48 ±
0.72
1.0 (1.0–
2.0)
1.0
E-CFT supports my career and licensing goals 1.65 ±
0.95
1.0 (1.0–
2.0)
1.0
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 140
I feel confident in my ability to pass the clinical licensing
exam for my chosen discipline
1.48 ±
0.72
1.0 (1.0–
2.0)
1.0
I am confident in my level of knowledge as to the
supervision and practice requirements to achieving
clinical licensure**
1.57 ±
0.73
1.0 (1.0–
2.0)
1.0
I feel confident in my ability to achieve the supervision
and practice requirements necessary to achieve clinical
licensure within the next 2 years**
1.77 ±
1.19
1.0 (1.0–
2.0)
1.0
My clinical supervisor at E-CFT provides additional
information and support to enhance my understanding of
the licensing process
1.84 ±
0.97
2.0 (1.0–
2.0)
1.0
I view my clinical supervisor at E-CFT as a teacher and
mentor
1.81 ±
1.11
1.0 (1.0–
2.0)
1.0
My clinical supervision experience at E-CFT includes
reflection of my field service, discovery of my
talents/skills, and instruction on how to improve as I move
forward in achieving my required field hours
1.56 ±
0.65
1.0 (1.0–
2.0)
1.0
I am motivated to and capable of achieving clinical
licensure for my chosen discipline within the next 2
years**
1.43 ±
0.86
1.0 (1.0–
2.0)
1.0
I fully comply with clinical supervision requirements 1.29 ±
0.46
1.0 (1.0–
2.0)
1.0
E-CFT provides me with the job aids, including templates
and explainer videos, necessary for me to complete my
field hours**
2.93 ±
1.78
2.5 (1.0–
4.0)
1.0
I feel that E-CFT core support staff provides me with
additional assistance in matters of field service, progress
reporting, and treatment planning
1.77 ±
0.99
2.0 (1.0–
2.0)
1.0

*Responses are scored on a scale of 1 (strongly agree) to 7 (strongly disagree)
**One participant did not respond (n=30)
SD, standard deviation; IQR, interquartile range

DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 141
Table 4. Participants’ feelings about their current discipline
Statement Strongl
y agree
Agre
e
Somewh
at agree
Neithe
r agree
nor
disagre
e
Somewh
at
disagree
Disagre
e
Strongl
y
disagre
e
Clinical
psychology,
social work,
and
counseling
all have
social
injustice
implications
19
(61.3)
6
(19.4
)
6 (19.4) -- -- -- --
I believe that
the role of
culture plays
a critical
role in how
children and
families
experience
treatment
27
(87.1)
2
(6.5)
2 (6.5) -- -- -- --
I feel that
my role as a
clinician, to
satisfy
family voice
and choice
can include
being
culturally
matched and
or similar to
the child and
family that I
am serving
12
(38.7)
11
(35.5
)
2 (6.5) 3 (9.7) 2 (6.5) 1 (3.2) --
I feel a
desire to
work with
children and
4 (12.9) 8
(25.8
)
5 (16.1) 5 (16.1) 2 (6.5) 7 (22.6) --
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 142
families who
are
ethnically
and
culturally
similar to
me more
often than
not
Cultural
relationships
- connections
and
differences
with
children and
families has
been
discussed
during my
clinical
supervision
time at one
point or
another
9 (29.0) 14
(45.2
)
4 (12.9) 2 (6.5) -- 2 (6.5) --
I believe that
traumatic
experiences
like violence
in
community,
school, or
domestic
settings,
abuse or
neglect, and
racial
discriminati
on are
experienced
at a higher
than average
rate by
18
(58.1)
7
(22.6
)
3 (9.7) 2 (6.5) -- 1 (3.2) --
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 143
urban
minorities
I believe that
urban and
minority
children and
families tend
to trust in-
home
providers
that they
perceive as
having
personally
experienced
the same or
similar
experiences
as they have
10
(32.3)
10
(32.3
)
7 (22.6) 3 (9.7) -- 1 (3.2) --
I believe that
I have
personally
experienced
trauma
associated
with my
culture,
ethnicity, or
area in
which I live
or grew up
in at one
point or
another in
my life
11
(35.5)
12
(38.7
)
2 (6.5) 1 (3.2) -- 3 (9.7) 2 (6.5)
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 144
I am
motivated to
mainly work
with
children and
families who
have
experienced
trauma that
I myself
have
personally
experienced
2 (6.5) 4
(12.9
)
5 (16.1) 8 (25.8) 2 (6.5) 8 (25.8) 2 (6.5)

Table 4b. Participants’ feelings about their current discipline*
Statement Mean
± SD
Median
(IQR)
Mode
Clinical psychology, social work, and counseling all have
social injustice implications
1.58 ±
0.81
1.0 (1.0–
2.0)
1.0
I believe that the role of culture plays a critical role in
how children and families experience treatment
1.19 ±
0.54
1.0 (1.0–
1.0)
1.0
I feel that my role as a clinician, to satisfy family voice
and choice can include being culturally matched and or
similar to the child and family that I am serving
2.30 ±
1.29
2.0 (1.0–
3.0)
2.0
I feel a desire to work with children and families who are
ethnically and culturally similar to me more often than
not
3.45 ±
1.77
3.0 (2.0–
5.0)
2.0
Cultural relationships - connections and differences with
children and families has been discussed during my
clinical supervision time at one point or another
2.23 ±
1.31
2.0 (1.0–
3.0)
2.0
I believe that traumatic experiences like violence in
community, school, or domestic settings, abuse or neglect,
and racial discrimination are experienced at a higher than
average rate by urban minorities
1.77 ±
1.20
1.0 (1.0–
2.0)
1.0
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I believe that urban and minority children and families
tend to trust in-home providers that they perceive as
having personally experienced the same or similar
experiences as they have
2.23 ±
1.20
2.0 (1.0–
3.0)
1.0
I believe that I have personally experienced trauma
associated with my culture, ethnicity, or area in which I
live or grew up in at one point or another in my life
2.48 ±
1.90
2.0 (1.0–
3.0)
2.0
I am motivated to mainly work with children and families
who have experienced trauma that I myself have
personally experienced
4.16 ±
1.73
4.0 (3.0–
6.0)
4.0

*Responses are scored on a scale of 1 (strongly agree) to 7 (strongly disagree)
SD, standard deviation; IQR, interquartile range

Table 5. Participants’ feelings about providing services in urban environments
Statement N (%)
N=31
I would rate my desire to work with urban and minority youth as…
Low 1 (3.2)
Average 17
(54.8)
High 13
(41.9)
I would be less likely to provide in-home services in Newark, NJ and like
areas because…

Personal safety concerns 11
(36.7)
Conditions of some of the homes or neighborhoods 2 (6.7)
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I am not likely to reject in-home work in Newark 17
(56.7)
My interest in providing in-home services in areas like Newark, NJ over other
less urban locations can be described as…

Much stronger 1 (3.2)
Moderately stronger 6 (19.4)
Slightly stronger 3 (9.7)
No change 14
(45.2)
Slightly weaker 3 (9.7)
Moderately weaker 3 (9.7)
Much weaker 1 (3.2)

DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 147
APPENDIX C
Qualitative Interview Questions

1. What is your chosen clinical discipline?
a. What was your motivation to choose this particular discipline over another
one?

2. Please describe your overall experience as an in-home therapy provider in and
outside of E-CFT.
a. Are there specific differences or similarities that you could elaborate on?

3. Has E-CFT itself influenced your experience as an in-home provider either in a
positive or negative way?

a. Can you elaborate further on these experiences with some examples?

4. Do you feel that E-CFT has supports your field service efforts?
a. Can you elaborate further on how you felt supported (or did not feel
supported)?
b. Can you compare this experience to that with any other organization?

5. Please describe the role E-CFT is playing in assisting in preparing you for clinical
licensure.

6. What, if any, value do you see in having increased clinical supervision?

7. Please consider the overall experience of receiving in-home therapy on families.

a. What do you think that experience is like for the children and families that
we serve?

8. How, if at all, does this experience differ for urbanized and minoritized families in
areas like Newark, NJ as compared to non-urbanized, non-minoritized families?

9. Now, let’s talk about family voice and choice. In your own words, what does
“family voice and choice” mean?

10. Do you think that family voice and choice can apply to families who have
preferences in either their provider’s cultural background or skill set? Please explain.
a. What do you believe drives these preferences?

DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 148
11. Please describe what if any value being culturally matched may have for urban and
minority families receiving in-home services?
a. What are some of the positives and/or negatives of cultural matching.
I.From a client experience perspective?
II.From your perspective as a clinician?

12. In thinking about yourself and your work with youth and families, and providing
services in the homes of the youth and families, can you describe a little bit about your
comfort level working with families that are culturally different from you versus families
that are culturally similar, if any?

13. Please describe any motivation or lack of motivation that you or another clinician
might have working in Newark, NJ or a similar urban area? (Again remind them that
their answers are confidential.)

14. Using the lens of a social justice perspective, providing services to children and
families involved in the children’s system of care (CSOC) providers, such as IIC and IIH
professionals, must also be concerned and involved in social change efforts with and on
behalf of vulnerable and oppressed individuals and groups. How do you work to ensure
access to needed information, services, and resources; equality of opportunity; and
meaningful participation in decision making for the youth and families that you are
working with?

DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 149
APPENDIX D
Qualitative Interview Code Book

Topic Area Emergent
Theme
Illustrative Quote

Supervision Confidence
as a clinician

“(E-CFT), specifically through my clinical supervision, just allows
me to just gain more insight into like myself.” – Participant 1

“Um, I've never had that type of support before, and that it allows me
to get that support, makes me an even more comfortable in-home
clinician.” – Participant 1

“It can help confidence because a lot of times I'd question whether
I'm doing something correctly and she's like, "Yeah," or things that I
didn't even think were really cool or good or helpful and she'd point
them out like, "That was really wise." And so that helped me to just
kind of grow that confidence in my clinical skills.” – Participant 3
“Well in school you get the basics. You get a lot of foundation stuff,
you intern, you get a good idea, but you never know who’s going to
walk into your door or whose door you’re going to walk into. So
sometimes you have to talk to someone and say, “I didn’t know what
I was doing.” And a lot of times they’re like, “You did know what
you were doing, it was just different” And those are the kind of words
that stick with you. Sometimes it doesn’t feel like you know, but a lot
of times the supervisor points out like, “No, you knew what you were
doing” or, ”You handled this situation correctly” And there’s a lot of
validation that goes with that. And then also just saying, “Oh, check
this out. Try this next time”; So I find it extremely helpful for my
confidence.” - Participant 5

DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 150

Support “I feel like I have a really good relationship with my
supervisor, who's also one of the managers or regional
manager. I can call him anytime. To call him or text him
anytime. He's always gotten right back to me, if we don't
connect. So, I just feel like, and I've never felt like I've
been a bother to him.” – Participant 2

“I didn't have any cultural issues. I don't feel like I had
any cultural issues. There were other clinicians that did
when we would have supervision since it's peer
supervised as well that I would listen to it and hear it and
they would also get help from her, from my supervisor.
Personally I just didn't have any, but yeah, definitely I feel
like to her capacity that she knows and understands the
culture differences that she was able to help and get
feedback on that.”-Participant 3

“Well having the group supervision, I think, is beneficial
because we all bring different things to the table. So by
discussing it in a group you hear other people’s
experiences and feedback. And of course the clinical
supervisor is great and gives a lot of great feedback, but
we all have different experiences so sometimes the
greatest things have come from my peers.” - Participant 5

Rationale behind
chosen
disciplines
Intrinsic
motivation

DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 151

“Um, but just knowing that there are other possibilities out
there is something that always motivates me so that I can
motivate other people. Like that's something that, I mean,
as a social worker, you're motivated and rewarded by, um,
seeing change in other people, and seeing when their
light's bright, and you know, their lights bright up, you
know, when they have that you know light on top of their
head like, "Oh," when they have their realization that
things don't have to stay the same um, that's what
motivates me with just my clients in general, is that the-
they don't have to stay. If they feel like they're in a sucky
place, they don't have to stay in that sucky place.” –
Participant 1

“Well, my motivation is I'm from Newark, New Jersey, so
I want to help the people from my city, show them that,
okay, there's someone on your side here. There's someone
who came from an urban area and is trying to help you
guys to deal with whatever situation is going on right
now. So I think that it motivates me to help the people in
these urban areas that might feel like no one cares about
them, that might feel like, "No one wants to come and
visit me in this home because I live in the projects or the
ghetto," or whatever the case is. It pushes me to want to
see these people more, because I think it's important for
them to get services, and I know that a lot of times people
don't want to go to these areas. So it motivates me.” -
Participant 6

“I felt counseling, it just fit me personally. Just with my
skillset, just really being able to connect with people and
just being able to work with people in their struggles and
just the classic things like empathy, and just being able to
understand, a knack for understanding what's going on in
people's interior life.” – Participant 2

“I always wanted to help people and I always thought ...
At the time I didn’t know what it was called, but that
human rights and social justice issues are so important and
how they factor into helping people. So when I found
social work it was kind of like the best of the
combination.” - Participant 5

“I think it could come from a lot of different areas. I think
it could come from a passion of wanting to help children
and families, a passion of wanting to help on a systematic
level of human rights and social justice issues, of possibly
being privileged and wanting to go into areas where
resources might not be available and go there or maybe
they’ve come from an area like there and want to return it.

DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 152
I think motivation can come from a lot of different places,
but I think those would be some of the big ones.” -
Participant 5

“Yeah. I feel like this organization is one that kind of...
Um, even from my interview with, um, Marlon, it was just
kind of immediately supportive, honestly, because with
the other organizations that I've worked with, um, it's been
very all about the money.” - Participant 1

“And, um, that's what's made me not stay with them, um,
because our families, um, become our checks. Right? And
obviously, we don't just serve our families because we're
just bored, but our intention is like to serve our families to
make a difference, and I feel like that's what (E-CFT) is
about.” - Participant 1

Organizational
Support
Supervision

“The supervision is always a big thing. I think with (E-
CFT), I liked the flexibility of supervision that you were
able to put it. If we want it weekly, we could put it
weekly, if we want it every biweekly, you know, I like
that, that is flexible. And I love that they provided the
supervision within the agency, because there are some,
like my outpatient work, I have to pay for the supervision,
compared to (E-CFT) where it was provided. So that,
that's a plus. I think that's a good thing.” – Participant 3

DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 153
Support from
mentor
“And I feel like they- like you guys have really just
incorporated my utilization of that approach to serve our
families. Um, so that's something that I'm really
passionate about and that, um, (E-CFT) is able to support
me with. It's something that makes me even more
motivated to stay with an agency that supports what my
goals and missions are too.” –Participant 1

“So, I've had a very positive experience. They've just been
very supportive. I feel really supported. You're out on
your own a little bit, which is something that's attractive to
me, but also having the, knowing that you're supported on
the backend. Supervisor, I know there's clinical, any
clinical questions I have, there's definitely people I can
call. Any administrative questions, there's definitely,
there's a whole office. I feel really supported there.” –
Participant 2

“Sure. Well one of the main things that really caught my
attention with (E-CFT). is they work with you. If there's a
family that for some reason the parent's just being difficult
or you don't feel comfortable because maybe, I don't
know, the environment or whatever the case is, (E-CFT).
does work with you and they say, "Okay, well how can we
help you to fix the situation? Or I'll give you another case
instead and I'll find someone to take over that case." Well,
if any problems arise, I know that I can talk to my
supervisor and they can help me to rectify the situation,
and they definitely make me feel like the provider is as
important as the family.” - Participant 6

DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 154
Support from
peers

“So, if I don't know something, I will ask my peer. Um, I
think that, you know, anybody that you talk to, they kind
of- you can work with them to kind of, um, help you get
some knowledge that you don't know, or they can help
you get some more information where, um, they might
have like a connection somewhere or whatever, but even
working with like CMO um, it's kind of just like, "Hey, I
am seeing that this family needs this, and how can we
advocate for this?" Um, just that's just like collaboration
with my own system partners or like even my peers, um,
through peer supervision too. Like, "Hey, I have a
question. Like this is where this family's at and how can I
assist them moving forward?" Um, that advocacy piece on
behalf of the family is super important” – Participant 1

“Constant contact, the availability and just bouncing
things off of them. That's been really positive. And then
also even just, I know there's other supervisors, like Dr.
Mazza is available if I ever wanted to talk to her. If I ever
wanted the group supervision, that's always there for me. I
know there's other clinicians like Nick who works in the
office, he's a clinician, he's always, I feel like I could call
him if there's any clinical questions.” – Participant 2

DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 155
Perceptions of
In-home
experience
Child and family
perspective
“But in the home, they're very much more, I think it feels
like they're very much more comfortable, there's kids
there, they have toys that they're used to playing with. Or,
adolescents that they don't want to leave their room. It's
like, so you see, and it's just like you see the family
interact I think more in a natural, relaxed way. You can
see some more of the dynamics that are going on, whereas
in an office, I think it's harder to see those dynamics.” –
Participant 2

“They're kind of at a place where they're just really
reaching out for help. So, it can be a little like a humbling
experience of not a lot of people like to ask for help, so
you get to that point where you're like, "Okay, we really
need help." A little bit of a humbling experience, and then
inviting a stranger into your home I think can be
vulnerable. Depending on the situation, if it's whatever, so
they're really showing themselves as a family. You're
allowing a stranger in, and really letting them see you as a
family, in your environment.” – Participant 2

“Okay. I mean, I can only tell you from my experience.
Because I'm a white male, middle class, I come from that
background, working into an urbanized environment,
whether it be an African American neighborhood or
Hispanic neighborhood, whatever it may be, it definitely
has a different dynamic because I'm like, I'm not quite an
insider there. I think it has a power dynamic in a sense
that I'm coming from more of a privileged place. I'm the
one coming into their home and trying to fix them and
help them, and so there may be some of that dynamic.” –
Participant 2
“There're some families that are of course in the more
urban areas that they may not feel comfortable having
someone coming to their homes, just the stigma that
comes with social workers and things like that. And so I
feel like that just we as clinicians just need to know how
to approach that, you know, not to make them feel
uncomfortable, not to make them feel like they're in
trouble or anything, but just to show that we're here as an
asset to help, you know, in any way and we're here to help
whatever they feel like needs to be helped, you know. “ -
Participant 3
“I can see how it can be intimidating for families or
frightening, maybe not frightening but I think a lot of
times initially intimidating because you do open a door to
a stranger that comes in and tries to help you with the
problem. Unfortunately a lot of times a lot of families still

DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 156
feel their problems are only their problems and they have
to deal with them [00:22:00] so being a stranger come in I
think might be intimidating but overall I think it is a
positive experience.” - Participant 4
“So I keep that in mind when I meet with these families,
but from my experience and the longer that you get to
know them, the more you build rapport, they start to feel
more comfortable with you, and they definitely appreciate
the service. The parents that I've seen through (E-CFT).,
they're definitely appreciative, because they're usually in a
position where they don't know what to do with their kid
anymore. Well, you come in and, yeah, at first it's like,
"Oh my god, this stranger's here." But then it's like,
"Okay, I see that this stranger who is now getting to know
us is really trying to help my kid." - Participant 6
“Um, just because it's awkward. You know, a lot of the
families that I service are- um, it's their first time with
Perform Care, or it's their... Sometimes it might be their
millionth time with Perform Care, and their attitudes are
kind of the same, kind of, "You're walking into my home.
You're telling me how to raise my child," - Participant 1
“But if you take the time, I really find that the family is
still appreciative of the service because ultimately if
they're not mandated, like if it's not through DCPP, which
none of my cases are right now, the help, they're asking
for the help. It's not like going in there, like let me in, I'm
going to tell you what to do now.” Participant 6

DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 157
Provider
perspective
“so I love doing in-home work just because it allows me
to kind of, um, integrate the family more easily because
I'm in their home.” – Participant 1

“It's been very interesting, just going into the home, just
having that extra I would say dataset of the home
environment. I think it's very unique in terms of the
counseling fields. Usually it's in an office or a neutral
place, so going into someone's home, you can really see a
lot more. I think in their natural environments, whatever,
you can see a lot more and I've been very, I'm very
comfortable going into people's homes. It's not
uncomfortable for me, so if it's not clean or whatever, I
can deal with that. I'm not rattled by that.” – Participant 2

“I mean, I think it's probably less comfortable for me as a
clinician, as a counselor. I think it's a lot easier to be in an
office in your environment, where they don't have the TV
distract them, or games, or their siblings, or those types of
things. It's a little bit more easy to contain an office
setting, whereas in the house, there's a lot more variables
that you don't have any control over.” – Participant 2

“Because you're kind of, like I said before, you're stepping
into their household, their environment, their space and so
therefore you have to be able to conform a bit to make
them feel comfortable. It's just like if they're coming, like
if I have a client coming to me, I had to build that rapport
with them. I had to meet them where they are and make
them feel comfortable because they're coming into an
unknown place. But within their home, they're already
comfortable, they're already where they are, and so
therefore I had to adapt myself so that they can feel
comfortable. “ – Participant 3

DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 158
Perceptions of
wraparound
service
Meeting the
family where they
are

“We talk to them about, um, male or female, um, stuff like
that, um, language preferences, um, so it's meeting them
where they're at and figuring out where they wanna go.” –
Participant 1

“Or is it because it makes us more comfortable? Um,
because that's different. Right? Like if we're stuck where
we're at, then okay, let's see how we can get more
comfortable with just our society in general, because we
can't live in this bubble. Um, but yeah, I definitely think
that if- you know, that always needs to be explored, but
meeting them where they're at is where they're
comfortable, so if you bring someone who's totally
opposite to what they want I don't think that will be- that
would have much of an impact, especially in the
beginning” – Participant 1

“Just trying to meet people where they're at, try to help
motivate them towards change. Taking it one step at a ...
You have to meet them where they're at, and guide them,
they can only take the next step, so you can't force them
into something that's 10 steps ahead. You can just walk
with them, wherever they're willing to walk.” –
Participant 2

Rapport building

“ Because regardless of whether you share the same
cultural background with the person or not, I think it's
important to get to know if that's a significant thing for
them and learn a little bit more, because that also helps to
establish rapport.” - Participant 6

DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 159
“Voice and
choice”

“I mean, the family lets us know where they're at and
where they wanna go, um, and they choose whatever
providers they are more comfortable with. Right?” –
Participant 1

“Family voice and choice would be the family is
determining the course of treatment or services. They're
deciding, their voice is the determining factor and their
choice is the determining factor of how services are going
to unfold. We meet them where they're at, and so they
have their voice and their choice, and it's up to the team or
the clinician to work with what they want to work on.” –
Participant 2

“You can provide the guidance but it’s up to them to have
that voice and to be empowered to stand on their own or
stand up for themselves” - Participant 4

“Family voice and choice, I would say kind of just
allowing them to have a chance to express themselves,
their needs, their concerns, as well as choosing whether or
not they want to continue with whatever services that are
given outside of being pushed and mandated to do what
others feel like the recommended in [inaudible 00:29:35]
system having the, the voice pretty much to choose
whether or not they agree with it or not. I guess something
along those lines.” - Participant 3

“I would say that family voice and choice means that
every family has
their own history, their own story, their own goals, and
it's very important as
clinicians that we hear that and that they, to a certain
extent have the right to
autonomy and how they want to raise their children.” -
Participant 5

DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 160
Perceptions of
In-home
experience
Child and family
perspective

“Um, just because it's awkward. You know, a lot of the
families that I service are- um, it's their first time with
Perform Care, or it's their... Sometimes it might be their
millionth time with Perform Care, and their attitudes are
kind of the same, kind of, "You're walking into my home.
You're telling me how to raise my child," and so I feel like
even with the incorporation of the Nurture Hard approach
that I utilize so much, the battle validation of the families,
and how tough it's been, and how tough it is, even, you
know, being new to this experience, and how awkward it
is and it's awkward for me too. This is weird. It's awkward
for you? Imagine me.” –Participant 1

“Well, the more urbanized areas will probably be more
resistant to it because more than likely, unfortunately a lot
of the families would be under more mandated, like, you
know, they have to go through it or this is required for
whatever. And so I feel like they're a bit more resistant to
it just because it's just seen like, again, the negative stigma
so they don't want anyone coming to their home or trying
to find something and so they're a bit more resistant, I feel
like, compared to the non urbanized areas.” - Participant 3

Provider
perspective

“Um, but as you go through the process, um, and I mean, I
think the, the biggest thing that's helped me is not thinking
I know the family already.” – Participant 1

DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 161
Cultural
Matching
psychoeducation

Pros of cultural
matching

“I mean, their own personal experiences. Right? Like their
trauma. Right? Um, I, I think about trauma all the time,
um, and also like, if a family does request like a specific
cultural background, um, I always like to dig into that.” -
Participant 1

“Um, because they are gonna encounter, and especially
their youth are going to encounter people of all different
backgrounds. So I'm always interested to know, like, is
this because like we're stuck with it where we're at?”-
Participant 1

“You know, we talk about boundaries so much in social
work. Right? And, um, that's something that, when you go
inhome, those boundaries are not as strict. Um, it's
definitely more fluid. Um, I feel with, um, families and
youth, you know, that don't live in Newark or, you know,
urban areas, don't feel like, like they keep that boundary.
It's kind of, "You're this person, I'm this person, that's it."
Um, but families in more urban communities, minorities,
whatever, they, they feel the need to have a connection
because of their lack of connection. Um, so that
connection piece is always something that makes me
more, um, comfortable.” – Participant 1

“So, um, I think the positives are just being able to have
open communication, say, "Hey, I know you chose this
and, you know, uh, you know, this is who I am, and you
know it's... Does this make you more comfortable?" –
Participant 1

“Um, part of like the field is that we wanna create change.
Right? And with, um... Like with the youth, for example,
if they see someone who looks just like them. Right?
Also, a positive is that, basically, they're like, "Whoa, I
could do this role too? Like that's crazy." – Participant 1

“The value would be the ability to connect. There's an
understanding or a trust or this experience of like you
know what it's like. You understand. So, I can open up to

DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 162
you, so you know what I'm talking about. It's an ability to
just have that, an easier path of connection and trust, and
relationship.” – Participant 2
“Again, so culturally matching positively, they just might
feel more comfortable initially and throughout the whole
process. That level of trust and openness would be a
positive throughout.” – Participant 2
“They can feel relatable so that, you know, maybe there
are certain things with the families that I had that I
probably didn't necessarily understand, but someone who
is within the same culture can right away pick that up and
can understand what the family is going through. If they're
struggling with maybe the child, why is it an issue that the
child refuses to take assistance from the family. And for
them, culturally, that's something that parents have grown
up to that the child was always depending on them.” –
Participant 3

“Positive is that ... okay. I think a positive is that I feel
confident because I can understand. I don't know what I'm
walking into but I know I have a level of relatability to
them and so I feel confident just walking into the home. I
feel ready, and I think I can help them with whatever
resources I have.” - Participant 3

“I think so. I think its important for the family to be
comfortable with the provider that they have.” -
Participant 4

“For example, I’ve heard numerous, numerous, numerous
times from DCP&P workers that when
they walk on the street to go to a client’s house,
sometimes all the kids run Away. And in these areas,
these children are minorities and they are white. So just
the presence of what they look like sends a signal that
something’s not right. This isn’t someone we can talk to.
So depending on the family and the situation, it could be
really beneficial for families to be able to culturally or
racially or religiously identify with their clinician.” -
Participant 5

“But everyone lives their own experience and within
cultures there are similar experiences so having that
understanding or maybe speaking the same language or
understanding the family dynamics, I think that could be
really beneficial. And also knowing ... For the clinician
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 163
having insight on their own lives, how that has possibly
affected other people. Things might be similar in that
sense.” - Participant 5

“Well, number one, it already makes them put their guard
down a little bit, because they see them, they can identify
with the provider. They can say, "Okay, so she might
understand me a little bit better because she knows what
it's like. She can
identify, like we're the same, from the same country or we
speak the same language." So that already can lower that
defense a little bit.” - Participant 6

“I think also what that does is it helps them to see that (E-
CFT). is diverse and that we're not just going to send them
a cookie cutter provider who is just going to all the
different homes and doesn't really see the importance that
culture does play in certain families, and is understanding
and is open to hearing what the family's experience is and
things like that. I think it definitely helps to build that
rapport, to lower the defenses, and to help the family be
more engaged... of treatment” - Participant 6

“And maybe in American culture that's something that's
different because they're pushed to be independent. And
so for a culture that really relies itself on dependency of
the child on a parent, it can be hard to really understand
that, but someone who's within the culture can see, "Oh
yeah, it's normal for you to rely on your parents even if
you're 18. It's something that's culturally, that's what we
do." And so it's difficult, you know? And so that's just
like, you know, you have a level of understanding that
someone out of the culture may not necessarily have.” -
Participant 3

“Yeah. I think it's more difficult when... So when I first
started in the field, right, I think we're, we're taught, um,
boundaries. Right? You're supposed to be this like, no, no,
rigid, rigid, rigid person and maintain your boundaries,
and I think that it's okay. Like when you're dealing with
different cultures, I think it's totally fine to just be like,
"Yeah, I will eat your meal." - Participant 1

DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 164
Cons of cultural
matching

“Or they can see that, um, not everyone is the same, or go
outside of the box that they're in, um, because, you know,
with society changing so much now, like their children
aren't just gonna see one type of person.” – Participant 1

“But again, that negative is just being stuck in your
bubble.” – Participant 1

“You're limiting your pool of clinicians available, so the
quality of clinicians is limited. I think there's also
therapeutic advantages of having someone who's not in
the same culture, that I kind of described before. You're
missing out on a possible therapeutic avenue that might be
there, as well. “-Participant 2
“A negative from a clinician's experience would be like
there could be a fear of not being able to connect because
you're an outsider. You're different, so there can be a little
bit of anxiety going into a different culture from a clinical
perspective.” – Participant 2
“I think the negative is that they expect the person to be
on their side. They expect the person to just see where
they're coming from, see what's going on and just
advocate for what they want, but not necessarily are
willing to hear another side of what's going on, another
side of the presenting problem, the crisis, whatever.” –
Participant 3
“With negative sometimes you feel you’re afraid you
might be biased a little bit. Being of the same culture, so I
think that would be one negative.” - Participant 4
“Negative, sometimes the clients feel that you might be
able to do more than you are...I think sometimes they feel
because you’re of the same culture or you speak the same
language that you might be able to make miracle happen”
- Participant 4.
“Yeah, so there's an ability to flesh out culture differences
and to have a curiosity. It's also up to the clinician to be
culturally competent, so if you have someone who is
different culturally than you, then you have to do some
research and find out what are some cultural dynamics
that are typical to that culture, but also to ... Like I
mentioned before, the ability to have someone who is
outside of the culture come in and say, "Oh yeah, I can see
how that works and oh yeah, that's different. I can see
where that's valuable or that's a challenge culturally," or
whatever, and to be able to connect that way. It can open

DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 165
up their experience of different cultures as well.” -
Participant 2

DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 166
APPENDIX E
Immediate Evaluation Of Kirkpatrick Levels 1 & 2: Quiz and Answer Key

1. In addition to being an in-home clinical service agency, E-CFT is also a:
a. Psychiatric hospital training center
b. Respite training center
c. A learning organization (Correct Answer)
d. A clinical innovation teaching hospital
e. A medical staff development organization

2. A goal of E-CFT is developing increased capacity for cultural relatability in providing in-
home clinical services. Cultural relatability means:
a. A relationship founded on the shared tendency to understand, directly relate to, and
sympathize with experiences of a member of specific ethnic group based on one’s own
membership to the same or similar group. (Correct Answer)
b. A relationship founded on being of the same race from the same country of origin that
creates mutual understanding of perceptions of mental health.
c. A relationship founded on the basis of being from the same community beit church,
neighborhood, or city.

3. E-CFT’s supervision requirements are as follows:
a. Once a year
b. Once a month
c. Four times a year
d. Four times a month
e. Once a week (Correct answer)

4. Licensed Social Workers are supervised by:
a. Licensed Marriage and Family Therapists
b. Licensed Clinical Social Workers (Correct Answer)
c. Doctors of Psychology
d. Licensed Mental Health Social Workers
e. Licensed Professional Counselors

5. Licensed Associate Counselors are supervised by:
a. Licensed Marriage and Family Therapists
b. Licensed Clinical Social Workers
c. Doctors of Psychology
d. Licensed Mental Health Social Workers
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 167
e. Licensed Professional Counselors (Correct Answer)

6. Psy.D. with a 3 year permit are supervised by:
a. Licensed Marriage and Family Therapists
b. Licensed Clinical Social Workers
c. Doctors of Psychology (Correct Answer)
d. Licensed Mental Health Social Workers
e. Licensed Professional Counselors

7. Which of the following statements is true?
a. Only an E-CFT clinician can supervise you for clinical licensure.
b. Only a licensed and board certified supervisor from any clinical discipline and from any
organization can supervise you for clinical licensure
c. Clinical supervision for licensure must occur outside of E-CFT due to conflict of interest.
d. Any licensed clinician can provide you clinical supervision.
e. Only a licensed and board certified supervisor from my clinical discipline and from any
organization can supervise you for clinical licensure (Correct Answer)

8. Which of the following statements is false?
a. Clinical supervision is available to me in the field. (Correct Answer)
b. Clinical supervision is available to me in a face-to-face setting.
c. is available to me in through video conferencing platforms such as Google Meet or
Zoom.

9. Clinical supervision hours include the following (check all that apply):
a. Field Service Hours (Correct Answer)
b. Clinical Notation (Correct Answer)
c. Collateral Contacts (Correct Answer)
d. Contact with E-CFT staff regarding paperwork
e. Commuting between sites

10. Field experiences can transfer into knowledge through (check all that apply):
a. Reflection (Correct Answer)
b. Review of progress notes covering a span of time (Correct Answer)
c. Clinical Supervision (Correct Answer)
d. Child and Family Team meetings (Correct Answer)

DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 168
APPENDIX F
Immediate Evaluation of Kirkpatrick Levels 1 & 2: Instructor and Observer Survey

1. The MLC’s participated at a high level during the training program. (Engagement)
Strongly Disagree, Disagree, Agree, Strongly Agree

2. The MLC’s demonstrated understanding of the content during discussions and group
activities. (Engagement)
Strongly Disagree, Disagree, Agree, Strongly Agree

3. The MLC’s communicated genuine sentiment regarding the relevance of the training.
(Relevance)
Strongly Disagree, Disagree, Agree, Strongly Agree

4. The MLC’s demonstrated ability to recognize and account for their respective licensing
paths . (Procedural)
Strongly Disagree, Disagree, Agree, Strongly Agree

5. The MLC’s exhibited confidence in the management of their licensing journeys during
role play. (Confidence/Engagement)
Strongly Disagree, Disagree, Agree, Strongly Agree

6. The MLC’s responded positively to pulse checks after key with consistency.
(Engagement)
Strongly Disagree, Disagree, Agree, Strongly Agree

7. The MLC’s communicated having quality takeaways from the training.
(Attitude/Customer Satisfaction)
Strongly Disagree, Disagree, Agree, Strongly Agree

8. The MLC contracts to self were substantive and relevant to the training material.
(Commitment/Relevance)
Strongly Disagree, Disagree, Agree, Strongly Agree

DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 169
APPENDIX G
Blended Evaluation of Kirkpatrick Levels 1, 2, 3, & 4.

Level 1: Reactions

1. I found the training program relevant both to my job and career. (Relevance)
Strongly Disagree, Disagree, Agree, Strongly Agree

2. My instructor was engaging and answered all of my questions clearly. (Customer
Satisfaction)
Strongly Disagree, Disagree, Agree, Strongly Agree

3. I would recommend this course to other MLC’s. (Customer Satisfaction)
Strongly Disagree, Disagree, Agree, Strongly Agree

4. I found value in participating in discussions and group activities. (Engagement) Strongly
Disagree, Disagree, Agree, Strongly Agree

5. I was able to obtain the following key takeaways from this training program: (Customer
Satisfaction)

Level 2: Learning

6. The collaborative group exercises helped me increase my knowledge and confidence in
how I monitor my own clinical licensure progress (Confidence) Strongly Disagree, Disagree,
Agree, Strongly Agree

7. I clearly understand the supervision requirements both of E-CFT and my clinical
discipline. (Factual)
Strongly Disagree, Disagree, Agree, Strongly Agree

8. I am fully aware of the major developmental milestones associated with my own clinical
licensure process . (Factual)
Strongly Disagree, Disagree, Agree, Strongly Agree
DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 170

9. I know how to and feel confident in my ability to advance toward each developmental
milestone associated with my own clinical licensure process. (Procedural & Confidence)
Strongly Disagree, Disagree, Agree, Strongly Agree

10. My professional development contract to self includes the following elements from this
training: (Commitment)

Level 3: Behavior

11. I am applying metacognition to manage the process of transferring my field experiences
into learning toward my licensing exam (Critical Behavior 4)
Strongly Disagree, Disagree, Agree, Strongly Agree

12. I attend supervision weekly as required. (Critical Behavior 1)
Strongly Disagree, Disagree, Agree, Strongly Agree

13. I am actively maintaining a caseload conducive to me completing my field hours toward
licensure in a timely manner (Critical Behavior 2)
Strongly Disagree, Disagree, Agree, Strongly Agree

14. I am organizing and tracking my field hours toward clinical licensure regularly. (Critical
Behavior 3)
Strongly Disagree, Disagree, Agree, Strongly Agree

15. I am applying the following elements from my contract to self into everyday practice on
the job: (Critical Behaviors 1, 2, 3, & 4)

Level 4: Results

16. I am able and have been providing in-home services to children and families where
cultural relatability is a part of their voice and choice desire (External Outcome 1)
Strongly Disagree, Disagree, Agree, Strongly Agree

DEVELOPING CULTURAL RELATABILITY IN MENTAL HEALTH 171
17. I am attending as many training and supervision sessions as I can in order to move my
learning forward (Internal Outcome 1)
Strongly Disagree, Disagree, Agree, Strongly Agree

18. My current progress toward clinical licensure is: (Internal Outcomes 1 & 2)

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Asset Metadata

Creator Gray, Marlon Wellesley (author)

Core Title Enhancing capacity to provide cultural relatability in the in-home mental health service experience for urbanized and minoritized youths through workforce development strategy: a promising practi...

School Rossier School of Education

Degree Doctor of Education

Degree Program Organizational Change and Leadership (On Line)

Publication Date 11/18/2019

Defense Date 10/02/2019

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag children's system of care,clinician,Counseling,cultural competence,cultural relatability,Mental Health,New Jersey,Newark,OAI-PMH Harvest,Psychology,Social Work,Urban,workforce development,wraparound,youth mental health

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Tobey, Patricia (committee chair), Crawford, Jenifer (committee member), Mazza, Elena (committee member)

Creator Email marlonwg@usc.edu,mwellesleyg@me.com

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c89-236570

Unique identifier UC11675428

Identifier etd-GrayMarlon-7937.pdf (filename),usctheses-c89-236570 (legacy record id)

Legacy Identifier etd-GrayMarlon-7937.pdf

Dmrecord 236570

Document Type Dissertation

Rights Gray, Marlon Wellesley

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the a...

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus MC 2810, 3434 South Grand Avenue, 2nd Floor, Los Angeles, California 90089-2810, USA