ACCESS Lab Projects

Current Projects

Fairfax and Northern Virginia Consortium for Evidence-based Practice

In collaboration with Dr. Christy Esposito-Smythers, and Natasha Tonge our lab is working within the Fairfax Consortium for Evidence-based Practice to support equitable, quality mental health service delivery across Fairfax County and the Northern Virginia Region. Projects include:

1) The development and evaluation of training in Culturally Responsive Assessment practices. Our team has developed and is regularly implementing trainings in Cultural and Diagnostic Assessment. We collect quantitative effectiveness (e.g., knowledge change) and implementation data (e.g., acceptability, utility), and qualitative data via clinician interviews and focus groups. 

2) Supervision practices in community mental health with a focus on culturally humble supervision practices. We collaborate with Dr. Esposito-Smythers and her team to assess current supervision practices quantitatively and qualitatively. 

Youth and Clinician Perspectives of a Toolkit to Support Culturally Responsive Mental Health Practices.

This year we will be working to engage youth, especially those from minoritized backgrounds, and clinicians to provide feedback on culturally responsive strategies we developed in the RESPECT Toolkit (see previous projects for more information on the RESPECT Toolkit). Data will be collected via focus groups. This project is being developed with feedback from Fairfax Youth MOVE. This project is in the development phase.

Multilevel Examination of Youth Access to Community Mental Health Services

This year our team will be recruiting youth with lived experiences receiving or attempting to receive community-based mental health services, clinicians, and policy makers to examine barriers and facilitators of access to mental health care. This project will inform future work aimed at developing strategies to support youth mental health service engagement. This project is being developed with feedback from Fairfax Youth MOVE. This project is in the development phase.

Integration of a Culturally Responsive Family Peer Delivered Engagement Strategy in Coordinated Specialty Care. 

Funded by: NIMH; PI: Oladunni Oluwoye; Co-Investigator: Amanda Sanchez; Community Partners: Coordinated Specialty Care Clinics: 2025-2029

The specific aims of this study are, 1) Evaluate the effectiveness of family motivational engagement strategy (FAMES) on engagement during the implementation phase, using a stepped-wedge randomized controlled trial with 10 clinical teams (CSC) programs and  2) Evaluate the implementation of FAMES across the pre-implementation, implementation, and sustainability phase using mixed methods. Our team will be supporting on the implementation phase of this study including training peers in FAMES, which includes cultural assessment, and tracking fidelity to FAMES across implementation. This project is ongoing.

Upcoming Projects

We are interested in partnering with community organizations and clinics in Northern Virginia and the surrounding area that support the mental health of marginalized and underserved populations.

Clinicians as Shock Absorbers and Change Agents: Co-Creating Sustainable, Equity-Driven Solutions in Public Mental Health

Grant under review; PI: Amanda Sanchez, Co-PI: Rachel Goodman, Co-I: Natasha Tonge

Structural challenges within public mental health clinics negatively impact clinician wellbeing, retention, and ability to serve clients with complex needs and limited resources. Using Community-Based Participatory Action Research approaches and Community-Based System Dynamics, we will examine multiple constituent perspectives on structural barriers/solutions and together with a clinician advisory board, co-analysis qualitative data and develop a group model to visualize structural factors and actionable strategies for systems change. By centering clinician expertise, this project will generate innovative, equity-driven solutions to dismantle structural racism and build a just public mental health system.

Family-Led Systems Change: Co-creating an Artificial Intelligence-based Navigator Tool to Advance Equity in Early Care and Education 

Grant under review; PI: Colleen Vesley; Co-I: Amanda Sanchez

In the U.S., with no guaranteed access to high-quality early care and education (ECE), disparities in educational outcomes at the intersections of race, class, gender, and immigration status begin in early childhood and persist into adulthood. While ECE promises to disrupt disparate educational outcomes, the modern ECE system has evolved into a complex, public and privately-financed “system of systems” that requires specialized knowledge and resources to navigate. Despite long-standing efforts, the ECE system has been unable to mitigate such complexity, leaving many marginalized and minoritized families without timely information and on their own to access care, resulting in missed opportunities or worse, substandard or unsafe care. Families want a better ECE system. Using a Family-Centered Participatory Action Research (FCPAR) approach, we (lead investigators) partnered with marginalized families for over two years to co-develop this innovative, multidisciplinary, family-led project to advance ECE systems change. Together, we seek to build and implement an artificial intelligence (AI)-based ECE navigator tool, accessible via a mobile app, to democratize ECE knowledge, increase information sharing among diverse, multilingual families, and improve their access to high-quality ECE. Leveraging FCPAR, families who are the most motivated to disrupt inequitable and unjust systems will drive systems change.

Previous Projects

Revamping Evidence-based Supports to Promote Effective Culturally-responsive Treatment (RESPECT)

Funded by: International OCD Foundation; PI: Sanchez; Collaborators: Emily Becker-Haimes; Community Partners: Pediatric Anxiety Treatment Center at Hall Mercer; Advisory board comprised of clinicians and experts in culturally responsive care and 

The goal of this study is to improve access to and effectiveness of treatment for youth from minoritized backgrounds. There is strong evidence that current evidence-based interventions need systematic adaptation to improve the cultural responsiveness and fit for historically underserved youth and families, but there is little guidance on what and how to systematically adapt, especially within treatment for anxiety and OCD. By employing a practice-based mixed methods design, we are collaboratively developing a clinician toolkit. It is being developed through a systematic, user-centered process that centers stakeholders’ voices and emphasizes collaborative decision making for use with youth with OCD and related disorders. There are three main aims of the study: Aim 1: Understand current practices in community mental health through retrospective chart review and qualitative interviews with clinicians, clients and caregivers, Aim 2: collaboratively develop the toolkit with inputs from aim 1 and current literature, and Aim 3: evaluate initial acceptability and feasibility of the toolkit. This study is completed, but data is still being analyzed and manuscripts prepared.

Saving Young Lives and Decreasing Health Disparities Through the Dissemination of Culturally Sensitive Evidence-Based Assessments to State-Funded Behavioral Health Organizations

Funded by: Substance Abuse & Mental Health Svcs Admin (SAMHSA); PI Christy Esposito-Smythers; Co-Is Amanda Sanchez and Natasha Tonge.

The goal of this study was to train clinicians who serve diverse, low-income youth and families, and their clinical supervisors, in the use of MBC to allow for regular administration of culturally sensitive evidence-based assessments to clients; and help administrators effectively implement use of MBC across five Northern Virginia Region 2 Community Services Boards (CSB) so that all clients may benefit from their use.This study is complete. 

Person-Centered Cultural Assessment Can Improve Child Mental Health Service Engagement and Outcomes

Funded by NIMH: R36MH116677-02; PI: Amanda Sanchez

Disparities in child mental health service engagement suggest traditional evidence-based practices do not properly consider cultural and contextual factors relevant for marginalized families. We propose a person-centered approach to improve the cultural responsiveness of services. Preliminary research supports broadening standard assessments to include a person-centered evaluation of patient cultural factors, however, controlled studies have not been conducted in the context of children’s mental health care. Participants included families (N = 89; 89% racial/ethnic minority) receiving services for child externalizing problems. Prior to intake, caregivers were randomized to receive either Assessment as Usual (AAU) or AAU augmented with the Cultural Formulation Interview (CFI+AAU), a brief caregiver assessment of cultural factors affecting their child’s problems and family help-seeking. Implementation data showed strong provider fidelity and clinical utility. Following assessments, CFI+AAU caregivers (relative to AAU caregivers) reported feeling better understood by their provider, and providers reported better understanding CFI+AAU families’ values. Caregiver satisfaction was rated highly overall, yet providers reported being more satisfied with the assessment when the CFI was incorporated. Engagement outcomes found CFI+AAU families were significantly more likely than AAU families to subsequently complete the first phase of treatment. Further, among families receiving services in Spanish, CFI+AAU, relative to AAU, was associated with significantly higher treatment attendance, homework completion, and treatment response. The results underscore the utility of incorporating a brief cultural assessment in pretreatment assessments. To improve the cultural responsiveness of services, efforts may do well to promote the uptake of person-centered approaches such as cultural assessment into usual care. This study is complete but data from the study are still available for analysis.