Culture and psychiatric evaluation: operationalizing cultural formulation for DSM-5 (original) (raw)
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Psychiatric Annals, 2018
The Diagnostic and Statistical Manual of Mental Disorders , fifth edition, (DSM-5) Cultural Formulation Interview (CFI) is a systematic, semi-structured interview developed to guide clinicians on conducting a cultural assessment in routine mental health settings. An international field trial with 318 patients, 75 clinicians, and 86 family members in 6 countries found the core version of the CFI to be feasible, acceptable, and clinically useful, and a growing evidence base has led to its inclusion in worldwide mental health services. We review the definition of culture that underlies the CFI, its development and components, and how to apply it in care. We also focus on barriers to its implementation and how these are being addressed by investigators and clinicians. The cultural formulation approach stemming from DSM-IV , of which the DSM-5 CFI is the latest iteration, constitutes the cultural competence paradigm with the largest evidence base in mental health service delivery. [ Psyc...
Transcultural Psychiatry, 2020
While social science research has demonstrated the importance of culture in shaping psychiatric illness, clinical methods for assessing the cultural dimensions of illness have not been adopted as part of routine care. Reasons for limited integration include the impression that attention to culture requires specialized skills, is only relevant to a subset of patients from unfamiliar backgrounds, and takes too much time to be useful. The DSM-5 Cultural Formulation Interview (CFI), published in 2013, was developed to provide a simplified approach to collecting information needed for cultural assessment. It offers a 16-question interview protocol that has been field tested at sites around the world. However, little is known about how CFI implementation has affected training, health services, and clinical outcomes. This article offers a comprehensive narrative review that synthesizes peer-reviewed, published studies on CFI use. A total of 25 studies were identified, with sample sizes ran...
The British journal of psychiatry : the journal of mental science, 2017
There is a need for clinical tools to identify cultural issues in diagnostic assessment. To assess the feasibility, acceptability and clinical utility of the DSM-5 Cultural Formulation Interview (CFI) in routine clinical practice. Mixed-methods evaluation of field trial data from six countries. The CFI was administered to diagnostically diverse psychiatric out-patients during a diagnostic interview. In post-evaluation sessions, patients and clinicians completed debriefing qualitative interviews and Likert-scale questionnaires. The duration of CFI administration and the full diagnostic session were monitored. Mixed-methods data from 318 patients and 75 clinicians found the CFI feasible, acceptable and useful. Clinician feasibility ratings were significantly lower than patient ratings and other clinician-assessed outcomes. After administering one CFI, however, clinician feasibility ratings improved significantly and subsequent interviews required less time. The CFI was included in DSM...
Culture, Medicine, and Psychiatry, 2021
The Cultural Formulation Interview (CFI), included in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, is a person-centered instrument for systematically appraising the impact of cultural factors in psychiatric assessment. A number of key areas in the future development of the CFI have been identified in order to ensure further clinical uptake. In this paper, we suggest that applying a Therapeutic Assessment (TA) approach in using the CFI—i.e., framing the interview in a way that gives primacy to its self-transformative potential by explicitly focusing on those issues that are seen as the most urgent, relevant, and meaningful by the patient—could prove helpful in alleviating patients’ suffering beyond what is achieved by merely collecting relevant cultural information that may inform diagnosis and subsequent treatment interventions. The TA methodology has been designed as a collaborative approach to psychological assessment in which the assessment proc...
The Core and Informant Cultural Formulation Interviews in DSM-5
DSM-5® Handbook on the Cultural Formulation Interview, 2015
In this chapter, we introduce the DSM-5 (American Psychiatric Association 2013) core Cultural Formulation Interview (CFI) and the CFI-Informant Version. We begin with a theoretical description of the core CFI. The CFI comprises three tools for clinicians to complete a cultural assessment: 1) the core CFI of 16 questions with associated prompts for direct patient interviewing; 2) the CFI-Informant Version that can be administered to close associates of the patient, such as family, friends, caregivers, and other social supports; and 3) the 12 CFI supplementary modules that expand the number of questions by cultural domain or include topics of additional interest for certain populations. All of these tools share a common theoretical foundation, and our aim in this chapter is to describe this foundation through detailed descriptions of the core CFI and the CFI-Informant Version; Chapter 3 ("Supplementary Modules") covers the supplementary modules in greater depth. In addition, in this chapter we review key findings from the DSM-5 field trial that tested an earlier version of the core CFI consisting of 14 items. The field trial results were taken into account in the final revised core CFI that is included in DSM-5. More
Journal of Health Care for the Poor and Underserved, 2014
This paper reports on the development of the Cultural Formulation Interview-Fidelity Instrument (CFI-FI) which assesses clinician fidelity to the DSM-5 Cultural Formulation Interview (CFI). The CFI consists of a manualized set of standard questions that can precede every psychiatric evaluation. It is based on the DSM-IV Outline for Cultural Formulation, the cross-cultural assessment with the most evidence in psychiatric training. Using the New York sample of the DSM-5 CFI field trial, two independent raters created and finalized items for the CFI-FI based on six audio-taped and transcribed interviews. The raters then used the final CFI-FI to rate the remaining 23 interviews. Inter-rater reliability ranged from .73 to 1 for adherence items and .52 to 1 for competence items. The development of the CFI-FI can help researchers and administrators determine whether the CFI has been implemented with fidelity, permitting future intervention research.
Barriers to Implementing the DSM-5 Cultural Formulation Interview: A Qualitative Study
Culture Medicine and Psychiatry
The Outline for Cultural Formulation (OCF) in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) marked an attempt to apply anthropological concepts within psychiatry. The OCF has been criticized for not providing guidelines to clinicians. The DSM-5 Cultural Issues Subgroup has since converted the OCF into the Cultural Formulation Interview (CFI) for use by any clinician with any patient in any clinical setting. This paper presents perceived barriers to CFI implementation in clinical practice reported by patients (n = 32) and clinicians (n = 7) at the New York site within the DSM-5 international field trial. We used an implementation fidelity paradigm to code debriefing interviews after each CFI session through deductive content analysis. The most frequent patient threats were lack of differentiation from other treatments, lack of buy-in, ambiguity of design, over-standardization of the CFI, and severity of illness. The most frequent clinician threats...