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Hoshmand S, Knegtering H, Spoelstra SK. Cultural competence of mental health practitioners in the Netherlands. Int J Soc Psychiatry 2024; 70:282-288. [PMID: 37874035 DOI: 10.1177/00207640231206062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
BACKGROUND The importance of providing mental health from a transcultural perspective in establishing a therapeutic alliance is recognized. However, it is currently unknown how many mental health practitioners in the Netherlands feel capable of providing mental healthcare from a transcultural perspective, or if they are familiar with the Cultural Formulation Interview (CFI). The CFI is a tool used in mental health care to gather culturally relevant patient information, enhancing cultural sensitivity in treatment. It is also unknown if there is a difference between psychiatrist and psychiatry residents in terms of their cultural competence. AIMS This study aimed to assess the self-appraised cultural competence of Dutch psychiatrist and psychiatry residents, including their knowledge of the CFI, and the need for further training. METHODS A cross-sectional study was conducted among psychiatrists and psychiatry residents by means of an online questionnaire. RESULTS Ninety-seven mental health practitioners completed the questionnaire. Of the psychiatrists 70% and of the residents 76% reported that treating patients from cultural backgrounds different from their own background is challenging. Only 44% of psychiatrists and 34% of residents considered themselves sufficiently culturally competent, and 56% and 47% respectively, were uninformed about the CFI. The majority of psychiatrists and residents (70 vs 84%) indicated a need for more training in cultural competence. CONCLUSION The majority of psychiatrists and residents in The Netherlands considered treating patients from different cultural backgrounds a challenge, reported feeling insufficiently culturally competent, lacked experience with the cultural formulation interview and reported a need for more training in cultural competence.
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Affiliation(s)
- S Hoshmand
- Lentis Psychiatric institute, Groningen, The Netherlands
| | - H Knegtering
- Lentis Psychiatric institute, Groningen, The Netherlands
- University Medical Center Groningen, University of Groningen, Rob Giel Research Center, Groningen, The Netherlands
| | - S K Spoelstra
- Addiction care North Netherlands, Groningen, The Netherlands
- NHL Stenden Hogeschool, Leeuwarden, The Netherlands
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Lam PC, Lewis-Fernández R, Aggarwal NK. The Cultural Formulation Interview: Building the Case for Cultural Competence in Clinical Care. Psychiatr Serv 2023; 74:216-217. [PMID: 36722093 DOI: 10.1176/appi.ps.202100650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Peter C Lam
- New York State Center of Excellence for Cultural Competence, New York State Psychiatric Institute, New York City (all authors); Columbia University Department of Psychiatry, New York City (Lewis-Fernández)
| | - Roberto Lewis-Fernández
- New York State Center of Excellence for Cultural Competence, New York State Psychiatric Institute, New York City (all authors); Columbia University Department of Psychiatry, New York City (Lewis-Fernández)
| | - Neil Krishan Aggarwal
- New York State Center of Excellence for Cultural Competence, New York State Psychiatric Institute, New York City (all authors); Columbia University Department of Psychiatry, New York City (Lewis-Fernández)
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Abstract
OBJECTIVE U.S. military service members, veterans, and their families increasingly seek care from providers with limited knowledge of military culture. The 16-item core DSM-5 Cultural Formulation Interview (CFI) was designed to integrate cultural factors into assessment and treatment of mental disorders. Although the CFI was designed for use with all patients, it is unknown whether the CFI adequately assesses military culture. The authors describe a methodology to determine the need for specific CFI versions and how to create a version for use with persons affiliated with the military. METHODS Published articles on cultural competence in the military were systematically reviewed. Cultural domains were abstracted from each article, inductively coded, and hierarchically organized for assessment against the core CFI. A military CFI was created with additional implementation instructions, questions, and probes when the core CFI was inadequate for eliciting relevant cultural domains. RESULTS Sixty-three articles were included. Coding revealed 22 military culture domains, of which only five would be elicited in the core CFI without additional guidance. Twelve of 16 questions in the core CFI required additional instructions, five benefited from question edits, and 10 needed additional probing questions. On the basis of these results, the authors crafted a military version of the CFI for service members, veterans, and their families. CONCLUSIONS The military CFI for clinicians assesses aspects of military culture that are not comprehensively evaluated through the core CFI. The development process described in this article may inform the creation of other versions when the core CFI does not comprehensively assess cultural needs for specific populations.
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Affiliation(s)
- Eric G Meyer
- Department of Psychiatry (Meyer, Hann) and Center for Deployment Psychology (Brim), Uniformed Services University of the Health Sciences, Bethesda, Maryland; Directorate for Mental Health, Naval Medical Center San Diego, San Diego (DeSilva); Department of Psychiatry, Columbia University, New York City (DeSilva, Aggarwal, Lewis-Fernández); Directorate for Mental Health, U.S. Naval Hospital Yokosuka, Japan (Hann); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Engel); Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento (Lu)
| | - Ravi B DeSilva
- Department of Psychiatry (Meyer, Hann) and Center for Deployment Psychology (Brim), Uniformed Services University of the Health Sciences, Bethesda, Maryland; Directorate for Mental Health, Naval Medical Center San Diego, San Diego (DeSilva); Department of Psychiatry, Columbia University, New York City (DeSilva, Aggarwal, Lewis-Fernández); Directorate for Mental Health, U.S. Naval Hospital Yokosuka, Japan (Hann); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Engel); Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento (Lu)
| | - Michael C Hann
- Department of Psychiatry (Meyer, Hann) and Center for Deployment Psychology (Brim), Uniformed Services University of the Health Sciences, Bethesda, Maryland; Directorate for Mental Health, Naval Medical Center San Diego, San Diego (DeSilva); Department of Psychiatry, Columbia University, New York City (DeSilva, Aggarwal, Lewis-Fernández); Directorate for Mental Health, U.S. Naval Hospital Yokosuka, Japan (Hann); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Engel); Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento (Lu)
| | - Neil K Aggarwal
- Department of Psychiatry (Meyer, Hann) and Center for Deployment Psychology (Brim), Uniformed Services University of the Health Sciences, Bethesda, Maryland; Directorate for Mental Health, Naval Medical Center San Diego, San Diego (DeSilva); Department of Psychiatry, Columbia University, New York City (DeSilva, Aggarwal, Lewis-Fernández); Directorate for Mental Health, U.S. Naval Hospital Yokosuka, Japan (Hann); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Engel); Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento (Lu)
| | - William L Brim
- Department of Psychiatry (Meyer, Hann) and Center for Deployment Psychology (Brim), Uniformed Services University of the Health Sciences, Bethesda, Maryland; Directorate for Mental Health, Naval Medical Center San Diego, San Diego (DeSilva); Department of Psychiatry, Columbia University, New York City (DeSilva, Aggarwal, Lewis-Fernández); Directorate for Mental Health, U.S. Naval Hospital Yokosuka, Japan (Hann); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Engel); Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento (Lu)
| | - Charles C Engel
- Department of Psychiatry (Meyer, Hann) and Center for Deployment Psychology (Brim), Uniformed Services University of the Health Sciences, Bethesda, Maryland; Directorate for Mental Health, Naval Medical Center San Diego, San Diego (DeSilva); Department of Psychiatry, Columbia University, New York City (DeSilva, Aggarwal, Lewis-Fernández); Directorate for Mental Health, U.S. Naval Hospital Yokosuka, Japan (Hann); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Engel); Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento (Lu)
| | - Francis G Lu
- Department of Psychiatry (Meyer, Hann) and Center for Deployment Psychology (Brim), Uniformed Services University of the Health Sciences, Bethesda, Maryland; Directorate for Mental Health, Naval Medical Center San Diego, San Diego (DeSilva); Department of Psychiatry, Columbia University, New York City (DeSilva, Aggarwal, Lewis-Fernández); Directorate for Mental Health, U.S. Naval Hospital Yokosuka, Japan (Hann); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Engel); Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento (Lu)
| | - Roberto Lewis-Fernández
- Department of Psychiatry (Meyer, Hann) and Center for Deployment Psychology (Brim), Uniformed Services University of the Health Sciences, Bethesda, Maryland; Directorate for Mental Health, Naval Medical Center San Diego, San Diego (DeSilva); Department of Psychiatry, Columbia University, New York City (DeSilva, Aggarwal, Lewis-Fernández); Directorate for Mental Health, U.S. Naval Hospital Yokosuka, Japan (Hann); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Engel); Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento (Lu)
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Lindberg LG, Johansen KS, Kristiansen M, Skammeritz S, Carlsson J. Negotiating Engagement, Worthiness of Care and Cultural Identities Through Intersubjective Recognition: Migrant Patient Perspectives on the Cultural Formulation Interview in Danish Mental Healthcare. Cult Med Psychiatry 2021; 45:629-654. [PMID: 33170411 DOI: 10.1007/s11013-020-09694-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/25/2020] [Indexed: 11/28/2022]
Abstract
This qualitative study presents migrant patient perspectives on using the Cultural Formulation Interview (CFI) in mental health assessments in Denmark. Empirical data consisted of 20 recorded CFI sessions and 16 patient interviews, coded with a constructivist grounded theory approach. Empirical findings prompted us to draw on the theoretical framework of intersubjective recognition in the analytical process. Our analysis showed how patients had multiple previous experiences of misrecognition in life and healthcare. This seemed to restrain their self-esteem and available positions for expressing preferences and reservations during the CFI and led to negotiations of worthiness of care. Despite occasional lack of flow and information in the recorded CFI sessions, patients subsequently recounted how they felt the CFI recognised the complexity and context of their cultural identities and illness narratives. Patients described how the CFI-guided provider approach of curiosity and empowerment carried significant meaning and left them feeling dignified, hopeful and engaged in future care. Intersubjective recognition is fundamental in all human interaction, but we argue that the recognising CFI approach is particularly important in vulnerable and asymmetrical mental health assessment encounters where access to care is determined and when working with migrants or other marginalised groups.
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Affiliation(s)
- Laura Glahder Lindberg
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services of the Capital Region of Denmark, Maglevænget 21, 2750, Ballerup, Denmark. .,Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Katrine Schepelern Johansen
- Competence Centre for Dual Diagnosis, Mental Health Centre Sct. Hans, Mental Health Services of the Capital Region of Denmark, Roskilde, Denmark
| | - Maria Kristiansen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Signe Skammeritz
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services of the Capital Region of Denmark, Maglevænget 21, 2750, Ballerup, Denmark
| | - Jessica Carlsson
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services of the Capital Region of Denmark, Maglevænget 21, 2750, Ballerup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Pearton T, van Staden W. The Core Cultural Formulation Interview in Yielding Religious Content Among Patients Suffering from a Current Major Depressive Episode. J Relig Health 2021; 60:2465-2483. [PMID: 33128219 DOI: 10.1007/s10943-020-01114-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/13/2020] [Indexed: 06/11/2023]
Abstract
Taken up in the DSM-5, the Cultural Formulation Interview (CFI) is a guide for assessing cultural context of an individual's mental health problem. Unreported before, the extent to which the cultural focus of the CFI yields religious content was explored qualitatively among patients with a current major depressive episode. Qualitative data were generated by applying the standard version of the CFI first and then reapplied it by phrasing its items in religious terms. Audio-recorded narratives so derived were typologically extracted for religious content and analysed thematically. Although only one of its questions on cultural identity explicitly refers to religion, the core CFI nonetheless yielded religious themes. These were similar to the themes emerging from the adapted CFI. They expressed inter alia, anger, shame and gains through personal (rather than organised) religion. The adapted CFI resulted in embellishment of religious content and clinically important revelations that inform on beliefs about suicide and feelings of guilt.
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Affiliation(s)
- Tania Pearton
- Department of Psychiatry, University of Pretoria, Pretoria, South Africa
| | - Werdie van Staden
- Department of Psychiatry, University of Pretoria, Pretoria, South Africa.
- Centre for Ethics and Philosophy of Health Sciences, Faculty of Health Sciences, University of Pretoria, Private Bag X323, Arcadia, Pretoria, 0007, South Africa.
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Abstract
Immediately before the release of DSM-5, a group of psychiatric thought leaders published the results of field tests of DSM-5 diagnostic criteria. They characterized the interrater reliability for diagnosing major depressive disorder by two trained mental health practitioners as of "questionable agreement." These field tests confirmed an open secret among psychiatrists that our current diagnostic criteria for diagnosing major depressive disorder are unreliable and neglect essential experiences of persons in depressive episodes. Alternative diagnostic criteria exist, but psychiatrists rarely encounter them, forestalling the discipline's epistemological crisis. In Alsadair MacIntyre's classic essay, such crises occur in science when a person encounters a rival schemata that is incompatible with their current schemata and subsequently constructs a narrative that allows them to reconstruct their own tradition. In search of rival schemata that are in conversation with their own tradition, psychiatric practitioners can utilize alternative diagnostic criteria like the Cultural Formulation Interview, embrace an epistemologically humble psychiatry, and attend to the narrative experience of a person experiencing a depressive episode.
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7
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Mabaso DJ, Kotze C. Cultural formulation interview: Awareness and attitudes of South African psychiatrists and psychiatry registrars. S Afr J Psychiatr 2020; 26:1467. [PMID: 33240549 PMCID: PMC7670022 DOI: 10.4102/sajpsychiatry.v26i0.1467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 08/05/2020] [Indexed: 11/30/2022] Open
Abstract
Background The Cultural Formulation Interview (CFI) includes a set of 16 questions formulated for clinicians to obtain information about cultural influences on an individual’s clinical presentation during a mental health assessment. The CFI is a newly formulated interview that has been evaluated in various localities, but not in South Africa. Aim We assessed the awareness and attitudes of South African psychiatrists and psychiatrists in training towards the CFI and its use in their patient care. Setting Participants were recruited via the South African Society of Psychiatrists (SASOP) database and were invited to complete an online questionnaire. Methods Certain demographic aspects of psychiatrists and psychiatrists in training were compared with regard to their awareness of and attitudes towards the CFI. Results Of the 75 participants who completed the questionnaire, only 46.7% (n = 35) were aware of the CFI, and of these, only 5.3% (n = 4) used the CFI. There was generally a positive attitude towards the CFI with the majority of the participants agreeing that the CFI is easy to understand and relevant in clinical practice; however, none of the results showed statistical significance. Most participants who were aware of the CFI (89%, n = 31) were of the opinion that the CFI would prolong their patient assessment time. Conclusion Most participants had a positive attitude towards the CFI. The negative response regarding the CFI prolonging patient assessment time could be a potential barrier in its clinical application. This study is an essential first step for further research into the CFI and its use in SA and contributed towards improving awareness of the CFI.
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Affiliation(s)
- Dijeng J Mabaso
- Department of Psychiatry, School of Medicine, Faculty of Health Science, Weskoppies Psychiatric Hospital, University of Pretoria, Pretoria, South Africa
| | - Carla Kotze
- Department of Psychiatry, School of Medicine, Faculty of Health Science, Weskoppies Psychiatric Hospital, University of Pretoria, Pretoria, South Africa
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8
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Skammeritz S, Lindberg LG, Mortensen EL, Norredam M, Carlsson J. Using the Cultural Formulation Interview in Denmark: Acceptability and clinical utility for medical doctors and migrant patients. Transcult Psychiatry 2020; 57:556-566. [PMID: 32838657 DOI: 10.1177/1363461520935673] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Previous studies have shown the importance of focusing on the cultural background of migrant patients in the psychiatric assessment. The Cultural Formulation Interview (CFI) offers a patient-focused approach to foreground the cultural context of the patient in the clinical encounter. Our objective was to explore the acceptability and clinical utility of the CFI for physicians and its acceptability for migrant patients seen at a transcultural mental health clinic in Denmark. In this study, the CFI was used in a second session following the standard clinical assessment to explore what additional information was gained from the CFI. Data on the use of the CFI data were collected immediately after the interview with questionnaires for medical doctors (MDs) (N = 12) and patients (N = 71). The findings showed that the CFI, in addition to standard assessment, was useful to the MDs for planning the treatment (60.0%) and for exploring the patients' view on their cultural and social context (74.7%), but less so for the diagnostic process (9.9%). Patients reported high overall satisfaction with the CFI (93.0%) and viewed it as a welcome opportunity to tell their story. The findings add to existing knowledge on the CFI in terms of acceptability for patients of a primarily Middle Eastern origin and patients using an interpreter during the CFI session. Based on the findings of this study, the CFI is recommended to clinicians for treatment planning purposes and for exploring the cultural and social context of the patient.
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Affiliation(s)
- Signe Skammeritz
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services of the Capital Region, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Laura Glahder Lindberg
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services of the Capital Region, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Erik Lykke Mortensen
- Department of Public Health and Center for Healthy Aging, University of Copenhagen, Denmark
| | - Marie Norredam
- Danish Research Centre for Migration, Ethnicity and Health, Section for Health Services Research, Department of Public Health, University of Copenhagen, Denmark.,Section of Immigrant Medicine, Department of Infectious Diseases, University Hospital Hvidovre, Denmark
| | - Jessica Carlsson
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services of the Capital Region, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Aggarwal NK, Jarvis GE, Gómez-Carrillo A, Kirmayer LJ, Lewis-Fernández R. The Cultural Formulation Interview since DSM-5: Prospects for training, research, and clinical practice. Transcult Psychiatry 2020; 57:496-514. [PMID: 32838655 DOI: 10.1177/1363461520940481] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
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 ranging from 1 to 460 participants. In all pilot CFI studies 960 unique subjects were enrolled, and in final CFI studies 739 were enrolled. Studies focused on how the CFI affects clinical practice; explored the CFI through research paradigms in medical communication, implementation science, and family psychiatry; and examined clinician training. In most studies, patients and clinicians reported that using the CFI improved clinical rapport. This evidence base offers an opportunity to consider implications for training, research, and clinical practice and to identify crucial areas for further research.
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Abstract
After years of extensive research, the Cultural Formulation Interview (CFI) was released in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Similar to its predecessor, the Outline of the Cultural Formulation (OCF), the CFI aims to refine the psychiatric assessment process by systematically examining cultural factors. However, in contrast to the OCF which employs open-ended questions, the CFI uses a semi-structured interview format. Unfortunately, children and adolescents have only been included in a handful of OCF and CFI studies, which raises questions about their applicability with youth, particularly young children (11 years or younger). In this article, we start examining the usefulness of the CFI with young children and propose recommendations to enhance its benefits by suggesting the development of a supplementary module specifically designed for young children. These ideas are illustrated with the assessment of a 6-year-old boy of Somali descent.
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Aggarwal NK, Lam P, Jiménez-Solomon O, Desilva R, Margolies PJ, Cleary K, Cain B, Dixon L, Lewis-Fernández R. An Online Training Module on the Cultural Formulation Interview: The Case of New York State. Psychiatr Serv 2018; 69:1135-1137. [PMID: 30041589 PMCID: PMC6347550 DOI: 10.1176/appi.ps.201800119] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Professional organizations and government guidelines recommend cultural competence training for providers, but the lack of a standardized cultural assessment has hindered research. Studies with the DSM-5 Cultural Formulation Interview (CFI) suggest that active learning during training improves perceptions of the CFI's usefulness as a cultural competence tool. This column reports demographic characteristics and evaluation scores among 423 providers who completed an online CFI training module developed through the New York State Office of Mental Health. Both the module, which uses the principle of active learning, and the CFI were associated with strong favorability ratings.
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Affiliation(s)
- Neil Krishan Aggarwal
- Dr. Aggarwal, Mr. Lam, Mr. Jiménez-Solomon, Dr. Desilva, Dr. Margolies, Ms. Cleary, and Ms. Cain are with the New York State Psychiatric Institute, New York. Dr. Aggarwal, Dr. Desilva, and Dr. Margolies are also with Columbia University College of Physicians and Surgeons, New York. Dr. Dixon and Dr. Lewis-Fernández are with the Department of Psychiatry, Columbia University Medical Center, New York. Dr. Lewis-Fernández is editor of this column
| | - Peter Lam
- Dr. Aggarwal, Mr. Lam, Mr. Jiménez-Solomon, Dr. Desilva, Dr. Margolies, Ms. Cleary, and Ms. Cain are with the New York State Psychiatric Institute, New York. Dr. Aggarwal, Dr. Desilva, and Dr. Margolies are also with Columbia University College of Physicians and Surgeons, New York. Dr. Dixon and Dr. Lewis-Fernández are with the Department of Psychiatry, Columbia University Medical Center, New York. Dr. Lewis-Fernández is editor of this column
| | - Oscar Jiménez-Solomon
- Dr. Aggarwal, Mr. Lam, Mr. Jiménez-Solomon, Dr. Desilva, Dr. Margolies, Ms. Cleary, and Ms. Cain are with the New York State Psychiatric Institute, New York. Dr. Aggarwal, Dr. Desilva, and Dr. Margolies are also with Columbia University College of Physicians and Surgeons, New York. Dr. Dixon and Dr. Lewis-Fernández are with the Department of Psychiatry, Columbia University Medical Center, New York. Dr. Lewis-Fernández is editor of this column
| | - Ravi Desilva
- Dr. Aggarwal, Mr. Lam, Mr. Jiménez-Solomon, Dr. Desilva, Dr. Margolies, Ms. Cleary, and Ms. Cain are with the New York State Psychiatric Institute, New York. Dr. Aggarwal, Dr. Desilva, and Dr. Margolies are also with Columbia University College of Physicians and Surgeons, New York. Dr. Dixon and Dr. Lewis-Fernández are with the Department of Psychiatry, Columbia University Medical Center, New York. Dr. Lewis-Fernández is editor of this column
| | - Paul J Margolies
- Dr. Aggarwal, Mr. Lam, Mr. Jiménez-Solomon, Dr. Desilva, Dr. Margolies, Ms. Cleary, and Ms. Cain are with the New York State Psychiatric Institute, New York. Dr. Aggarwal, Dr. Desilva, and Dr. Margolies are also with Columbia University College of Physicians and Surgeons, New York. Dr. Dixon and Dr. Lewis-Fernández are with the Department of Psychiatry, Columbia University Medical Center, New York. Dr. Lewis-Fernández is editor of this column
| | - Katherine Cleary
- Dr. Aggarwal, Mr. Lam, Mr. Jiménez-Solomon, Dr. Desilva, Dr. Margolies, Ms. Cleary, and Ms. Cain are with the New York State Psychiatric Institute, New York. Dr. Aggarwal, Dr. Desilva, and Dr. Margolies are also with Columbia University College of Physicians and Surgeons, New York. Dr. Dixon and Dr. Lewis-Fernández are with the Department of Psychiatry, Columbia University Medical Center, New York. Dr. Lewis-Fernández is editor of this column
| | - Bernadette Cain
- Dr. Aggarwal, Mr. Lam, Mr. Jiménez-Solomon, Dr. Desilva, Dr. Margolies, Ms. Cleary, and Ms. Cain are with the New York State Psychiatric Institute, New York. Dr. Aggarwal, Dr. Desilva, and Dr. Margolies are also with Columbia University College of Physicians and Surgeons, New York. Dr. Dixon and Dr. Lewis-Fernández are with the Department of Psychiatry, Columbia University Medical Center, New York. Dr. Lewis-Fernández is editor of this column
| | - Lisa Dixon
- Dr. Aggarwal, Mr. Lam, Mr. Jiménez-Solomon, Dr. Desilva, Dr. Margolies, Ms. Cleary, and Ms. Cain are with the New York State Psychiatric Institute, New York. Dr. Aggarwal, Dr. Desilva, and Dr. Margolies are also with Columbia University College of Physicians and Surgeons, New York. Dr. Dixon and Dr. Lewis-Fernández are with the Department of Psychiatry, Columbia University Medical Center, New York. Dr. Lewis-Fernández is editor of this column
| | - Roberto Lewis-Fernández
- Dr. Aggarwal, Mr. Lam, Mr. Jiménez-Solomon, Dr. Desilva, Dr. Margolies, Ms. Cleary, and Ms. Cain are with the New York State Psychiatric Institute, New York. Dr. Aggarwal, Dr. Desilva, and Dr. Margolies are also with Columbia University College of Physicians and Surgeons, New York. Dr. Dixon and Dr. Lewis-Fernández are with the Department of Psychiatry, Columbia University Medical Center, New York. Dr. Lewis-Fernández is editor of this column
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Mills S, Xiao AQ, Wolitzky-Taylor K, Lim R, Lu FG. Training on the DSM-5 Cultural Formulation Interview improves cultural competence in general psychiatry residents: A pilot study. Transcult Psychiatry 2017; 54:179-191. [PMID: 28358239 DOI: 10.1177/1363461517700812] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The objective of this study was to assess whether a 1-hour didactic session on the DSM-5 Cultural Formulation Interview (CFI) improves the cultural competence of general psychiatry residents. The main hypothesis was that teaching adult psychiatry residents a 1-hour session on the CFI would improve cultural competence. The exploratory hypothesis was that trainees with more experience in cultural diversity would have a greater increase in cultural competency scores. Psychiatry residents at a metropolitan, county hospital completed demographics and preintervention questionnaires, were exposed to a 1-hour session on the CFI, and were given a postintervention questionnaire. The questionnaire was an adapted version of the validated Cultural Competence Assessment Tool . Paired samples t tests compared pre- to posttest change. Hierarchical linear regression assessed whether pretraining characteristics predicted posttest scores. The mean change of total pre- and posttest scores was significant ( p = .002), as was the mean change in subscales Nonverbal Communications ( p < .001) and Cultural Knowledge ( p = .002). Demographic characteristics did not predict higher posttest scores (when covarying for pretest scores). Psychiatry residents' cultural competence scores improved irrespective of previous experience in cultural diversity. More research is needed to further explore the implications of the improved scores in clinical practice.
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Affiliation(s)
- Stacia Mills
- Los Angeles County + University of Southern California
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Mills S, Wolitzky-Taylor K, Xiao AQ, Bourque MC, Rojas SMP, Bhattacharya D, Simpson AK, Maye A, Lo P, Clark A, Lim R, Lu FG. Training on the DSM-5 Cultural Formulation Interview Improves Cultural Competence in General Psychiatry Residents: A Multi-site Study. Acad Psychiatry 2016; 40:829-834. [PMID: 27093964 DOI: 10.1007/s40596-016-0551-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 03/28/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE The authors assessed whether a 1-h didactic session on the DSM-5 Cultural Formulation Interview (CFI) improves cultural competence of general psychiatry residents. METHODS Psychiatry residents at six residency programs completed demographics and pre-intervention questionnaires, were exposed to a 1-h session on the CFI, and completed a post-intervention questionnaire. Repeated measures ANCOVA compared pre- to post-intervention change. Linear regression assessed whether previous cultural experience predicted post-intervention scores. RESULTS Mean scores on the questionnaire significantly changed from pre- to post-intervention (p < 0.001). Previous cultural experience did not predict post-intervention scores. CONCLUSIONS Psychiatry residents' cultural competence scores improved with a 1-h session on the CFI but with notable limitations.
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Affiliation(s)
- Stacia Mills
- Los Angeles County University of Southern California Medical Center, Los Angeles, CA, USA.
| | - Kate Wolitzky-Taylor
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Anna Q Xiao
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | | | | | | | - Aleea Maye
- University of California, Davis, Sacramento, CA, USA
| | - Pachida Lo
- University of California, Davis, Sacramento, CA, USA
| | | | - Russell Lim
- University of California, Davis, Sacramento, CA, USA
| | - Francis G Lu
- University of California, Davis, Sacramento, CA, USA
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Drožđek B. Challenges in treatment of posttraumatic stress disorder in refugees: towards integration of evidence-based treatments with contextual and culture-sensitive perspectives. Eur J Psychotraumatol 2015; 6:24750. [PMID: 25573504 PMCID: PMC4287632 DOI: 10.3402/ejpt.v6.24750] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 10/20/2014] [Accepted: 12/08/2014] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Research shows that trauma-focused therapy and multimodal interventions are the two most often used strategies in treatment of refugees suffering from posttraumatic stress disorder (PTSD). While preliminary evidence suggests that trauma-focused approaches may have some efficacy, this could not be established for multimodal interventions. However, it may be that multimodal interventions have been studied in more treatment-resistant refugees with very high levels of psychopathology, disability, and chronicity. In the past decades, various models for understanding of the complex relationship between mental health problems and well-being have emerged. They aim at framing mental health problems in individualized, contextual, epigenetic, and culturally sensitive ways, and may be useful in tailoring content and timing of multimodal interventions. OBJECTIVE To draw clinicians' attention to the possibility of using the Integrative Contextual Model for understanding and assessment of posttrauma mental health sequelae while tailoring multimodal interventions; to present a possible way of combining multimodal with evidence-based trauma-focused approaches; and to improve the understanding and treatment of PTSD and other mental health problems in refugee survivors of prolonged and repeated trauma. METHOD Based on literature, clinical experience, and presentation of a fictional case, the use of the Integrative Contextual Model in tailoring the treatment of severe PTSD in a refugee patient is presented and discussed. RESULTS The Integrative Contextual Model for understanding and assessing factors, which may play a role in causing and maintaining of PTSD and comorbidity in refugees, may help tailoring of multimodal interventions. These interventions can be combined with evidence-based trauma-focused treatments. CONCLUSION The field of refugee mental health intervention and clinical practice with traumatized refugees may be enriched with the use of contextual and developmental models for assessment and conceptualization of posttrauma sequelae. Multimodal and trauma-focused interventions may be applied sequentially in a course of the treatment trajectory.
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Affiliation(s)
- Boris Drožđek
- Psychotrauma Centrum Zuid Nederland, Reinier van Arkel groep, Den Bosch, The Netherlands;
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