Professional Resource

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Critical Self-Reflection and Diversity-Informed Supervision/Consultation: Deepening the DC:0–5 Cultural Formulation

Dec 10, 2021

Carmen Rosa Noroña, Boston Medical Center Boston, Massachusetts; Patricia P. Lakatos, University of Southern California; Mary Wise-Kriplani, Center for Child & Family Health Durham, North Carolina, and Marian E. Williams, University of Southern California


Developing a cultural formulation during a diagnostic assessment with a young child is the foundation for work with diverse families. It requires critical reflection on the part of the clinician about the socio-cultural, historical, and political influences and consequently aspects of privilege and oppression in their own lives and professional practice, as well as on the impact of structural inequities in the lives of the families with whom they work. This article explores the origins and importance of the DC:0–5 Cultural Formulation for Use with Infants and Toddlers Table and its potential to be used as a tool to support the clinician’s ongoing commitment and accountability to engage in critical self-exploration and diversity-informed practice. The authors consider implications for practice and policy, and provide reflective questions to deepen one’s use of the Cultural Formulation in DC:0–5TM: Diagnostic Classification of Mental Health and Developmental Disorders in Infancy and Early Childhood.

Sofia is a recently licensed clinician who is worried about Joseph, a 10-month old baby who is having difficulties transitioning to eating solid foods. Struggles around feeding have created a great deal of tension in the family. Joseph had emergency surgery at birth because of an intestinal obstruction and required an extended hospital stay due to initial challenges with feeding. Joseph’s mother, a Mexican immigrant with strong beliefs about how a good mother should feed her baby, tried breastfeeding Joseph when he was in the hospital but had to switch to formula because she was not producing enough breast milk. Because of this difficult beginning she has always felt like a failure. This is a secret she has kept from her family who lives in her home country.

In this article, we will explore the role of the socio-cultural context in diagnostic assessment. We provide a vignette that offers the reader an ear to an intimate reflective supervisory discussion about how to consider the socio-cultural and intersectionality dynamics of the relationship between the child’s caregivers and the clinician, and how to integrate the Cultural Formulation for Use With Infants and Toddlers found in DC:0–5TM: Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC:0–5; ZERO TO THREE, 2016) into the understanding of the case. The clinician explores her own social identities, including their impact on her perceptions of the family and herself and consequently on her work.

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