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Rousseau C, Johnson-Lafleur J, Papazian-Zohrabian G, Measham T. Interdisciplinary case discussions as a training modality to teach cultural formulation in child mental health. Transcult Psychiatry 2020; 57:581-593. [PMID: 30131020 DOI: 10.1177/1363461518794033] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The DSM-5 Cultural Formulation Interview (CFI) may become an important tool to help operationalize culture in the clinical realm. However, challenges exist in teaching its use to avoid the risk of stereotyping and oversimplification, which could result in misunderstanding and stigma. The aim of this article is to document whether the CFI can be taught using regular Interdisciplinary Case Discussion Seminars (ICDSs), proposed as continuing education in child mental health and as part of clinical rotations for new trainees. During a two-year evaluative research project, ICDSs were held monthly in three different primary care settings servicing recent immigrants in Montreal, Canada. ICDSs were recorded and analyzed to examine their effect on the cultural formulation process and focus groups were conducted to explore the subjective experience of the participant trainees and professionals. Results suggest that ICDSs are a helpful way to teach the use of the CFI. The group discussions helped participants to better capture the complexity of the cultural and social experience of the child and family by moving away from simple identity assignations, supporting an inquiry into structural dimensions, and considering stigma and inequality in their formulation. The multiple levels of diversity (individual, disciplinary, and interinstitutional) represented in the discussion groups helped clinicians to understand the cultural formulation as situated in a specific relational context and a particular moment and, in so doing, helped trainees to avoid cultural formulations that essentialize culture.
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Yaseen F, Bertram M, Vickery M, Murphy M. A change in practice after the introduction of a state-wide service plan: standardisation of the provision of care to patients with an eating disorder in a regional hospital including support from a new Eating Disorders Outreach Service. Australas Psychiatry 2020; 28:213-219. [PMID: 32336136 DOI: 10.1177/1039856220908177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE A state-wide service plan was introduced to guide local practice of the inpatient management of patients with an eating disorder. There was significant change in our management of such patients in our regional hospital. Our aim is to describe the changes and characterise our current practice. METHOD We undertook a retrospective review of the characteristics of nine consecutive inpatients and a descriptive qualitative study to examine the care provided to the patients and to identify the resultant care provisions a year after the introduction of the service plan. RESULTS Patient demographics and clinical characteristics were within the expected range. By the end of the year, the following changes were identified: (i) a team of local champions emerged; (ii) a case conference and template became routine; (iii) high utilisation of the new Eating Disorder Outreach Service (EDOS); (iv) common treatment challenges and methods to address them. CONCLUSIONS Standardisation of care and a systematic team approach are helpful in allowing small regional non-specialist centres to successfully manage complex patients. Funding of a local coordinator and assistance from EDOS was paramount to facilitate change. Other regional services may wish to adopt some of the practices described.
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Dominicé Dao M, Inglin S, Vilpert S, Hudelson P. The relevance of clinical ethnography: reflections on 10 years of a cultural consultation service. BMC Health Serv Res 2018; 18:19. [PMID: 29325569 PMCID: PMC5765648 DOI: 10.1186/s12913-017-2823-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 12/28/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Training health professionals in culturally sensitive medical interviewing has been widely promoted as a strategy for improving intercultural communication and for helping clinicians to consider patients' social and cultural contexts and improve patient outcomes. Clinical ethnography encourages clinicians to explore the patient's explanatory model of illness, recourse to traditional and alternative healing practices, healthcare expectations and social context, and to use this information to negotiate a mutually acceptable treatment plan. However, while clinical ethnographic interviewing skills can be successfully taught and learned, the "real-world" context of medical practice may impose barriers to such patient-centered interviewing. Creating opportunities for role modeling and critical reflection may help overcome some of these barriers, and contribute to improved intercultural communication in healthcare. We report and reflect on a retrospective analysis of 10 years experience with a "cultural consultation service" (CCS) whose aim is to provide direct support to clinicians who encounter intercultural difficulties and to model the usefulness of clinical ethnographic interviewing for patient care. METHODS We analyzed 236 cultural consultation requests in order to identify key patient, provider and consultation characteristics, as well as the cross cultural communication challenges that motivate health care professionals to request a cultural consultation. In addition, we interviewed 51 clinicians about their experience and satisfaction with the CCS. RESULTS Requests for cultural consultations tended to involve patient care situations with complex social, cultural and medical issues. All patients had a migration background, two-thirds spoke French less than fluently. In over half the cases, patients had a high degree of social vulnerability, compromising illness management. Effective communication was hindered by language barriers and undetected or underestimated patient/provider differences in health-related knowledge and beliefs. Clinicians were highly satisfied with the CCS, and appreciated both the opportunity to observe how clinical ethnographic interviewing is done and the increased knowledge they gained of their patients' context and perspective. CONCLUSIONS A cultural consultation service such as ours can contribute to institutional cultural competence by drawing attention to the challenges of caring for diverse patient populations, identifying the training needs of clinicians and gaps in resource provision, and providing hands-on experience with clinical ethnographic interviewing.
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Affiliation(s)
- Melissa Dominicé Dao
- Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, 4 rue Gabrielle-Perret-Gentil, 1211 Geneva, Switzerland
- Institute of Primary Care Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | | | - Sarah Vilpert
- Institute of social and preventive medicine, University of Lausanne, Lausanne, Switzerland
| | - Patricia Hudelson
- Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, 4 rue Gabrielle-Perret-Gentil, 1211 Geneva, Switzerland
- Institute of Primary Care Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Kanagaratnam P, Pain C, McKenzie K, Ratnalingam N, Toner B. Recommendations for Canadian Mental Health Practitioners Working With War-Exposed Immigrants and Refugees. ACTA ACUST UNITED AC 2017. [DOI: 10.7870/cjcmh-2017-010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
With the inception of the mental health strategy for Canada, Changing Directions, Changing Lives, the ever increasing ethnic diversity in this country demands re-examination of our approaches to mental wellbeing and illness in the immigrant and refugee population arriving from war-torn countries. Contemporary clinical practice among mental health practitioners is not reflective of the emerging literature in this field, which points towards meaningful and culturally competent care. This article seeks to bridge the gap between existing knowledge and current practice, and provides recommendations for mental health practitioners who work with this population.
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Affiliation(s)
| | - Clare Pain
- University of Toronto
- University of Toronto
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Santhanam-Martin R, Fraser N, Jenkins A, Tuncer C. Evaluation of cultural responsiveness using a transcultural secondary consultation model. Transcult Psychiatry 2017; 54:488-501. [PMID: 28776452 DOI: 10.1177/1363461517724984] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article describes the expansion of a transcultural secondary consultation model run by a state-wide transcultural unit. The model aims to enhance cultural responsiveness in partnership with mental health services. We discuss a series of 12 consultations that occurred between 2011 and 2012. We outline the processes of setting up the structure of secondary consultation, the actual consultation-facilitation format, and methods of evaluation. Evaluations were done in two phases: the first immediately after the consult and the second after a period of 3-6 months. The discussion highlights the usefulness of a transcultural model of consultation and, based on the evaluations, identifies the benefits the model brings to understanding and intervening with clients, culture, and systems. The results emphasise the need for multidisciplinary collaboration and a facilitated space for clinical teams to explore culturally responsive therapeutic practices.
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Affiliation(s)
| | - Natalie Fraser
- The Melbourne Clinic.,St Vincent's Mental Health, Australia
| | - Anna Jenkins
- Metro North Mental Health Service, Australia.,University of Queensland Brisbane
| | - Can Tuncer
- St Vincent's Hospital, Australia.,University of Melbourne Victoria.,Istanbul Medeniyet University
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Adeponle AB, Groleau D, Kirmayer LJ. Clinician reasoning in the use of cultural formulation to resolve uncertainty in the diagnosis of psychosis. Cult Med Psychiatry 2015; 39:16-42. [PMID: 25310907 DOI: 10.1007/s11013-014-9408-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We examined how the process of cultural formulation contributes to diagnostic assessment of patients with psychotic disorders at a specialized Cultural Consultation Service (CCS). Specifically, we investigated the reasoning process used to resolve uncertainty of psychotic disorder diagnosis in African immigrant patients referred to the CCS for assessment of possible psychotic disorder. Qualitative thematic analysis of 23 clinical case conference transcripts was used to identify clinicians' reasoning styles. Use of the CF appears to facilitate the emergence of a rule-governed reasoning process that involved three steps: (i) problematize the diagnosis of the intake 'psychosis' symptoms or behavior; (ii) elaborate explanations as to why the symptoms or behavior may or may not be psychosis; and (iii) confirm the diagnosis of psychosis or re-interpret as non-psychosis. Prototypes and exemplars drawn from previous experience in intercultural work featured prominently in clinicians' reasoning. Prototypes were crucial in diagnostic decision-making and appear to be important sources of both clinician expertise and bias, and may need to be targeted specifically in cultural competence training.
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Affiliation(s)
- Ademola B Adeponle
- Division of Social & Transcultural Psychiatry, Department of Psychiatry, McGill University, Montreal, QC, Canada,
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Napier AD, Ancarno C, Butler B, Calabrese J, Chater A, Chatterjee H, Guesnet F, Horne R, Jacyna S, Jadhav S, Macdonald A, Neuendorf U, Parkhurst A, Reynolds R, Scambler G, Shamdasani S, Smith SZ, Stougaard-Nielsen J, Thomson L, Tyler N, Volkmann AM, Walker T, Watson J, Williams ACDC, Willott C, Wilson J, Woolf K. Culture and health. Lancet 2014; 384:1607-39. [PMID: 25443490 DOI: 10.1016/s0140-6736(14)61603-2] [Citation(s) in RCA: 340] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
| | - Clyde Ancarno
- Department of Education, King's College London, London, UK
| | | | | | - Angel Chater
- Department of Psychology, University of Bedfordshire, Bedfordshire, UK
| | | | - François Guesnet
- Hebrew and Jewish Studies, University College London, London, UK
| | - Robert Horne
- School of Pharmacy, University College London, London, UK
| | - Stephen Jacyna
- Centre for the History of Medicine, University College London, London, UK
| | - Sushrut Jadhav
- Division of Psychiatry, University College London, London, UK
| | | | | | | | - Rodney Reynolds
- Institute for Global Health, University College London, London, UK
| | | | - Sonu Shamdasani
- School of European Languages, Culture and Society, University College London, London, UK
| | | | | | - Linda Thomson
- Museums and Collections, University College London, London, UK
| | - Nick Tyler
- Civil Engineering, University College London, London, UK
| | - Anna-Maria Volkmann
- Clinical, Educational and Health Psychology, University College London, London, UK
| | | | | | | | - Chris Willott
- Institute for Global Health, University College London, London, UK
| | - James Wilson
- Philosophy and Health, University College London, London, UK
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Miklavcic A, LeBlanc MN. Culture Brokers, Clinically Applied Ethnography, and Cultural Mediation. CULTURAL CONSULTATION 2014. [DOI: 10.1007/978-1-4614-7615-3_6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Lewis-Fernández R, Aggarwal NK, Bäärnhielm S, Rohlof H, Kirmayer LJ, Weiss MG, Jadhav S, Hinton L, Alarcón RD, Bhugra D, Groen S, van Dijk R, Qureshi A, Collazos F, Rousseau C, Caballero L, Ramos M, Lu F. Culture and psychiatric evaluation: operationalizing cultural formulation for DSM-5. Psychiatry 2014; 77:130-54. [PMID: 24865197 PMCID: PMC4331051 DOI: 10.1521/psyc.2014.77.2.130] [Citation(s) in RCA: 106] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The Outline for Cultural Formulation (OCF) introduced with DSM-IV provided a framework for clinicians to organize cultural information relevant to diagnostic assessment and treatment planning. However, use of the OCF has been inconsistent, raising questions about the need for guidance on implementation, training, and application in diverse settings. To address this need, DSM-5 introduced a cultural formulation interview (CFI) that operationalizes the process of data collection for the OCF. The CFI includes patient and informant versions and 12 supplementary modules addressing specific domains of the OCF. This article summarizes the literature reviews and analyses of experience with the OCF conducted by the DSM-5 Cross-Cultural Issues Subgroup (DCCIS) that informed the development of the CFI. We review the history and contents of the DSM-IV OCF, its use in training programs, and previous attempts to render it operational through questionnaires, protocols, and semi-structured interview formats. Results of research based on the OCF are discussed. For each domain of the OCF, we summarize findings from the DCCIS that led to content revision and operationalization in the CFI. The conclusion discusses training and implementation issues essential to service delivery.
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Kirmayer LJ. Embracing uncertainty as a path to competence: cultural safety, empathy, and alterity in clinical training. Cult Med Psychiatry 2013; 37:365-72. [PMID: 23539307 DOI: 10.1007/s11013-013-9314-2] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Laurence J Kirmayer
- Division of Social and Transcultural Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada.
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