Person-Centered Cultural Assessment
Culturally Responsive Screening for Anxiety and OCD
This section provides guidance for conducting culturally responsive screening for anxiety and OCD symptoms that could benefit from Ex-CBT. The goal is to understand the full extent of a client’s symptoms and the context in which the client’s symptoms are occurring. This holistic approach guides the development of your culturally responsive treatment approach, by supporting accurate identification of impairing anxiety and OCD, while minimizing risk of over pathologizing behaviors normative to the client’s context.  
What to look for:
Our primary objective with this screening is to learn if the client is experiencing impairing fear or anxiety, that is out of proportion given the child’s environment, or if the child is exhibiting maladaptive avoidance behaviors or significant distress that gets in the way of their lives. Anxiety and OCD become problematic when maladaptive avoidance is occurring alongside functional impairment that persists across multiple settings.  
Process Tips for Anxiety and OCD Assessment
Measures
Along with culturally responsive assessment, use measures tested in diverse populations to assess for maladaptive avoidance associated with elevated OCD and anxiety symptoms. In addition to aligning with gold-standard recommendations for diagnosing anxiety or OCD, using standard, structured assessment tools can also normalize the fact that many youths experience distressing, anxious emotions and demonstrates that the youth is not alone in their experience and that you will not judge or shame them for their thoughts and worries.  
Anxiety or OCD Symptoms:  
Children’s Yale-Brown Obsessive Compulsive Scale (CYBOCS)
​Screen for Child Anxiety and Related Disorders (SCARED)
Important Considerations and Follow-up Questions for Culturally Responsive Screening for Anxiety and OCD
Screening for Anxiety
Below are common anxiety disorders, sample screening questions, and follow-up questions that relate back to the culturally responsive assessment. The goal is to identify targets that may benefit from exposure, not to get hung up on the diagnostic label.
Note: In many cultures, anxiety can present in different ways, including with externalizing behaviors. Aim to assess the antecedent to behaviors, not just the behaviors themselves.  
Screening for OCD
Note: OCD is notoriously hard to accurately diagnose. It often “hides” in family routines or aspects of the client's life that is important to them (e.g., scrupulosity with a religious client) and can present in a variety of ways. However, for all youth, no matter their background, OCD likes to attach itself to clients’ values or aspects of their identity that are important to them and twist it. We can think of OCD as the “best friend you never wanted” because by driving compulsions, it is trying to support youth to remind themselves over and over that their core fears are not true; it just does so in a way that cause a lot of long-term distress! For example, a teenager with pedophilia obsessions about her niece, that lead to compulsive prayers asking for forgiveness and avoidance of being around young children, is likely best conceptualized as someone who loves and cares for her niece yet is terrified of being an immoral or terrible person. Compulsions provide repeated, short-term relief that her fears are not true; however, long-term, they lead to long-term distress.   
Below are some of the common OCD symptoms, sample screening questions, and follow-up questions, that relate back to the culturally responsive assessment that expand on questions included in standard assessment measures.  
Differential Diagnoses and Common Comorbidities
Anxiety and OCD often present alongside other mental health conditions. Accurate detection of co-occurring presentations is critical to effectively sequencing treatment strategies to address the needs of each individual youth.  
Wrap-Up and Disposition
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Check in about the client and family’s experiences and give a clear description of next steps in the treatment process. 
Sample Language: “This can be a new experience for many families. What was this experience like for you?”
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Give a clear and accurate description of the treatment you offer either during the intake or during a scheduled disposition. Differentiate it from negative past experiences or preconceptions, if necessary. Discussing how treatment can help the youth’s specific challenges, can help give feelings of hope and improve treatment engagement. 
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Ask the client and their family if they have any questions and remind them that they can continue to ask questions throughout treatment. 
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Give a summary of what you feel confident about, what you still need to learn and why you think therapy will be helpful for them.  
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Provide them with information and or a skill they can take home with them right away. 
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We find teaching strategies, such as a grounding practice (5-4-3-2-1 grounding-see augmented strategies), monitoring their anxiety/OCD experiences or naming their anxiety to externalize it, to be useful first practice.