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Lindberg LG, Carlsson J, Kristiansen M, Skammeritz S, Johansen KS. The Cultural Formulation Interview-Generating distance or alliance? A qualitative study of practice changes in Danish mental healthcare. Transcult Psychiatry 2022; 59:740-755. [PMID: 35331059 DOI: 10.1177/13634615211065617] [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: 01/20/2023]
Abstract
This article presents provider experiences with the Cultural Formulation Interview (CFI) in Danish mental healthcare for migrant patients. Semi-structured interviews with 17 providers and 20 recorded CFI sessions were analyzed with a constructivist grounded theory approach. Based on our empirical material, we endorse the CFI's ability to facilitate working alliance and a profound and contextually situated understanding of the patient. Further, the CFI supported less-experienced providers in investigating cultural issues. Conversely, we found that CFI questions about cultural identity and background evoked notions of distance and 'othering' in the encounter. Nine providers had felt discomfort and professional insecurity when the CFI compelled them to introduce explanatory frameworks of culture in the mental health assessment. Eleven providers had experienced that the abstract nature of the questions inhibited patient responses or led to short and stereotypical descriptions, which had limited analytical value. We describe the contradictory CFI experiences of alliance versus distance at three levels: 1) at the CFI instrument level; 2) at the organizational level; and 3) at the contextual and structural level. We demonstrate benefits and pitfalls of using the CFI with migrants in Denmark, which is an example of a European healthcare context where cultural consultation is not an integrated concept in health education programs and where the notion of culture is contentious due to negative political rhetoric on multiculturalism.We suggest that the CFI should be introduced with thorough training; focus on fidelity; and supervision in the clinical application and understanding of the concept of culture.
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Affiliation(s)
- Laura Glahder Lindberg
- Competence Centre for Transcultural Psychiatry, Mental Health Center Ballerup, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark.,Department of Public Health, University of Copenhagen, Denmark
| | - Jessica Carlsson
- Competence Centre for Transcultural Psychiatry, Mental Health Center Ballerup, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Maria Kristiansen
- Department of Public Health, University of Copenhagen, Denmark Center for Healthy Aging, University of Copenhagen, Denmark
| | - Signe Skammeritz
- Competence Centre for Transcultural Psychiatry, Mental Health Center Ballerup, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
| | - Katrine Schepelern Johansen
- Competence Centre for Dual Diagnosis, Mental Health Center Sct Hans, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
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Arshad SH, Chua J, Wayne SA, Bryant JL, Al-Mateen CS. Tools to Craft a Cultural Formulation. Child Adolesc Psychiatr Clin N Am 2022; 31:583-601. [PMID: 36182212 DOI: 10.1016/j.chc.2022.05.001] [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: 11/28/2022]
Abstract
Clinicians should strive to understand every patient from their own perspective. The authors present tools to help patients narrate their own experiences and elaborate on the context of their symptoms, allowing clinicians to appreciate the cultural influences on a patient and how that affects their symptomatology. This knowledge can then be crafted into a nuanced cultural formulation of the patient, with the goals of not only better understanding the patient's specific, intersectional context but also guiding treatment planning. As a result, the patient is evaluated in a holistic manner, and their specific needs are central in their care.
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Affiliation(s)
- Sarah H Arshad
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Perelman School of Medicine of the University of Pennsylvania School of Medicine, DCAPBS, Floor 12, 3500 Civic Center Boulevard, Philadelphia, PA 19104, USA.
| | - Jaclyn Chua
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Perelman School of Medicine of the University of Pennsylvania School of Medicine, DCAPBS, Floor 12, 3500 Civic Center Boulevard, Philadelphia, PA 19104, USA
| | | | | | - Cheryl S Al-Mateen
- Department of Psychiatry, Virginia Commonwealth University School of Medicine, Richmond, VA, USA; Department of Pediatrics, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
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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] [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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Fayed AA, Aung NM, Manger KM, Jimenez XF. Improving Psychiatric and Complex Case Formulation: an Assessment of the Accuracy and Time to Complete the Biopsychosocial/Three Ps (BPS/PPP) Approach. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2020; 44:64-67. [PMID: 31673956 DOI: 10.1007/s40596-019-01122-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 08/30/2019] [Accepted: 09/18/2019] [Indexed: 06/10/2023]
Affiliation(s)
| | - Ngu M Aung
- MetroHealth Medical Center, Cleveland, OH, USA
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Aggarwal NK, Cedeno K, Lewis-Fernandez R. Patient and clinician communication practices during the DSM-5 cultural formulation interview field trial. Anthropol Med 2019; 27:192-211. [PMID: 31550913 DOI: 10.1080/13648470.2019.1641014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Cultural psychiatrists and medical anthropologists have collaborated to help clinicians screen for culture-related issues in patient explanatory models of illness and to enhance the clinical processes of engagement, diagnosis, and treatment planning. This effort prioritises patient perspectives on suffering and healing to counter the trend of symptom-based interviews which assume biologically determined models of mental disorders. The 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) includes the Cultural Formulation Interview (CFI), a semi-structured questionnaire for eliciting patient explanatory models. This paper analyses specific linguistic meanings and practices that could account for patient perceptions of improved rapport with clinicians, clinician perceptions of improving information gathering, and cultural models of health and illness during the DSM-5 field trial piloting the CFI. Twenty-seven audiotapes were analysed through the Roter Interaction Analysis System (RIAS), a standardised method for examining medical interviews based on ethnographic studies of small-group communication. After an introduction with procedural and reassurance statements to orient communication, the CFI's open-ended questions elicited patients' opinions on interpersonal, environmental, and biomedical information. Clinicians made facilitation and activation statements for patients to speak more and informed patients about what to expect. Patients constructed cultural models of illness that weaved interpersonal, environmental, and biomedical information. Clinicians and patients made rapport-building statements to each other. A RIAS-derived patient-centred score indicates that CFI sessions addressed patient concerns. Our work offers a way to analyse the discursive construction of culture in health settings and patient-centredness through detailed examinations of linguistic meanings and practices.
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Affiliation(s)
- Neil Krishan Aggarwal
- New York State Psychiatric Institute, New York, NY, USA.,Columbia University Medical Center, New York, NY, USA
| | - Kryst Cedeno
- New York State Psychiatric Institute, New York, NY, USA
| | - Roberto Lewis-Fernandez
- New York State Psychiatric Institute, New York, NY, USA.,Columbia University Medical Center, New York, NY, USA
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Cultural Sensitive Care Provision in a Public Child and Adolescent Mental Health Centre: A Case Study from the Toulouse University Hospital Intercultural Consultation. Cult Med Psychiatry 2017; 41:630-655. [PMID: 28466116 DOI: 10.1007/s11013-017-9538-7] [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: 01/09/2023]
Abstract
Child and adolescent mental health services in Europe are confronted with children with increasingly diverse socio-cultural backgrounds. Clinicians encounter cultural environments of hyperdiversity in terms of languages and countries of origin, growing diversity within groups, and accelerated change with regards to social and administrational situations (Hannah, in: DelVecchio Good et al. (eds) Shattering culture: American medicine responds to cultural diversity, Russel Sage Foundation, New York, 2011). Children and families who live in these complex constellations face multiple vulnerabilizing factors related to overlapping or intersecting social identities (Crenshaw in Univ Chic Leg Forum 140:139-167, 1989). Mobilizing existing resources in terms of social and family support, and encouraging creative strategies of interculturation in therapeutic work (Denoux, in: Blomart and Krewer (eds) Perspectives de l'interculturel, L'Harmattan, Paris, 1994) may be helpful in order to enhance resilience. Drawing from experiences in the context of French transcultural and intercultural psychiatry, and inspired by the Mc Gill Cultural Consultation in Child Psychiatry, we developed an innovative model, the Intercultural Consultation Service (ICS). This consultation proposes short term interventions to children and families with complex migration experiences. It has been implemented into a local public health care structure in Toulouse, the Medical and Psychological Centre la Grave. The innovation includes the creation of a specific setting for short term therapeutic interventions and team training via shared case discussions. Our objectives are (a) to improve outcomes of mental health care for the children through a better understanding of the child's family context (exploration of family dynamics and their relatedness to complex migration histories), (b) to enhance intercultural competencies in professionals via shared case discussions, and, (c) to improve the therapeutic relationship between children and professionals on the basis of the work with the family and the dialogue with the team. In our paper, we present the rationale and functioning of the ICS and illustrate our work with a case study. The presentation of the case uses the Mc Gill B-version of the Cultural Formulation, combined with a relational and process oriented reflection on the intercultural dynamics that unfold during the encounter with a family.
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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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Tools for Practical Psychotherapy: A Transtheoretical Collection (or Interventions Which Have, At Least, Worked for Us). J Psychiatr Pract 2017; 23:60-77. [PMID: 28072647 DOI: 10.1097/pra.0000000000000208] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND AND OBJECTIVES Regardless of their historical and theoretical roots, strategies, tactics, and techniques used in everyday psychotherapy across diverse theoretical schools contain common factors and methods from other specific psychotherapeutic modalities that contribute substantially to psychotherapy outcomes. Common factors include alliance, empathy, goal consensus/collaboration, positive regard/affirmation, and congruence/genuineness, among others. All therapies also recognize that factors specific to therapists impact treatment. Starting with these common factors, we add psychotherapeutic methods from many theoretical orientations to create a collection of clinical tools. We then provide concrete suggestions for enacting psychotherapy interventions, which constitute a transtheoretical collection. METHODS We begin with observations made by earlier scholars, our combined clinical and teaching experiences, and oral traditions and clinical pearls passed down from our own supervisors and mentors. We have compiled a list of tools for students with foundational knowledge in the basic forms of psychotherapy, which may expand their use of additional interventions for practicing effective psychotherapy. RESULTS Our toolbox is organized into 4 categories: Relating; Exploring; Explaining; and Intervening. We note how these tools correspond to items previously published in a list of core psychotherapy competencies. CONCLUSIONS In our view, the toolbox can be used most judiciously by students and practitioners schooled and grounded in frameworks for conducting established psychotherapies. Although they are still a work in progress, these tools can authorize and guide trainees and practitioners to enact specific approaches to psychotherapy utilizing other frameworks. We believe that psychotherapy education and training might benefit from explicitly focusing on the application of such interventions.
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Aggarwal NK, Lam P, Castillo EG, Weiss MG, Diaz E, Alarcón RD, van Dijk R, Rohlof H, Ndetei DM, Scalco M, Aguilar-Gaxiola S, Bassiri K, Deshpande S, Groen S, Jadhav S, Kirmayer LJ, Paralikar V, Westermeyer J, Santos F, Vega-Dienstmaier J, Anez L, Boiler M, Nicasio AV, Lewis-Fernández R. How Do Clinicians Prefer Cultural Competence Training? Findings from the DSM-5 Cultural Formulation Interview Field Trial. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2016; 40:584-91. [PMID: 26449983 PMCID: PMC4826320 DOI: 10.1007/s40596-015-0429-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 09/11/2015] [Indexed: 05/20/2023]
Abstract
OBJECTIVE This study's objective is to analyze training methods clinicians reported as most and least helpful during the DSM-5 Cultural Formulation Interview field trial, reasons why, and associations between demographic characteristics and method preferences. METHOD The authors used mixed methods to analyze interviews from 75 clinicians in five continents on their training preferences after a standardized training session and clinicians' first administration of the Cultural Formulation Interview. Content analysis identified most and least helpful educational methods by reason. Bivariate and logistic regression analysis compared clinician characteristics to method preferences. RESULTS Most frequently, clinicians named case-based behavioral simulations as "most helpful" and video as "least helpful" training methods. Bivariate and logistic regression models, first unadjusted and then clustered by country, found that each additional year of a clinician's age was associated with a preference for behavioral simulations: OR = 1.05 (95 % CI: 1.01-1.10; p = 0.025). CONCLUSIONS Most clinicians preferred active behavioral simulations in cultural competence training, and this effect was most pronounced among older clinicians. Effective training may be best accomplished through a combination of reviewing written guidelines, video demonstration, and behavioral simulations. Future work can examine the impact of clinician training satisfaction on patient symptoms and quality of life.
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Affiliation(s)
| | - Peter Lam
- New York State Psychiatric Institute, New York, NY, USA
| | | | - Mitchell G Weiss
- Swiss Tropical and Public Health Institute and University of Basel, Basel, Switzerland
| | - Esperanza Diaz
- Yale University and the Connecticut Mental Health Center, New Haven, CT, USA
| | | | | | - Hans Rohlof
- Stichting Centrum '45, Oegstgeest, The Netherlands
| | | | | | | | | | | | - Simon Groen
- De Evenaar, Center for Transcultural Psychiatry North Netherlands, Beilen, The Netherlands
| | - Sushrut Jadhav
- UCL Mental Health Sciences Unit, University College London, London, UK
| | | | | | | | | | | | - Luis Anez
- Yale University and the Connecticut Mental Health Center, New Haven, CT, USA
| | - Marit Boiler
- New York State Psychiatric Institute, New York, NY, USA
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Aggarwal NK, Cedeño K, Guarnaccia P, Kleinman A, Lewis-Fernández R. The meanings of cultural competence in mental health: an exploratory focus group study with patients, clinicians, and administrators. SPRINGERPLUS 2016; 5:384. [PMID: 27065092 PMCID: PMC4814393 DOI: 10.1186/s40064-016-2037-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 03/20/2016] [Indexed: 11/18/2022]
Abstract
Cultural competence training is mandatory in the United States of America to alleviate minority health disparities though few studies have examined perceptions across stakeholders. We conducted separate focus groups with patients, clinicians, and administrators from the psychiatry department at one community hospital and compared responses to hospital policies. Stakeholders defined cultural competence through group-based or person-centered traits despite policies recommended person-centered approaches. Administrators and clinicians named clinician techniques for psycho-education whereas patients named these techniques for enlistment in treatment planning as equals. All groups named patient cultural views and institutional challenges as barriers to care, but only patients and administrators additionally named clinician biases as possible barriers. We discuss these discrepant perceptions and possible solutions to improve research, practice, and policy on cultural competence in mental health.
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Affiliation(s)
- Neil Krishan Aggarwal
- Columbia University, 1051 Riverside Drive, Unit 11, New York, NY 10032 USA ; New York State Psychiatric Institute, New York, NY USA
| | - Kryst Cedeño
- New York State Psychiatric Institute, New York, NY USA
| | - Peter Guarnaccia
- Department of Human Ecology, Rutgers, The State University of New Jersey, Newark, NJ USA
| | - Arthur Kleinman
- Department of Social Medicine, Harvard University, Cambridge, MA USA
| | - Roberto Lewis-Fernández
- Columbia University Medical Center, New York, NY USA ; NYS Center of Excellence for Cultural Competence, and Hispanic Treatment Program, New York State Psychiatric Institute, New York, NY USA
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Aggarwal NK, DeSilva R, Nicasio AV, Boiler M, Lewis-Fernández R. Does the Cultural Formulation Interview for the fifth revision of the diagnostic and statistical manual of mental disorders (DSM-5) affect medical communication? A qualitative exploratory study from the New York site. ETHNICITY & HEALTH 2013; 20:1-28. [PMID: 25372242 PMCID: PMC4221811 DOI: 10.1080/13557858.2013.857762] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVES Cross-cultural mental health researchers often analyze patient explanatory models of illness to optimize service provision. The Cultural Formulation Interview (CFI) is a cross-cultural assessment tool released in May 2013 with DSM-5 to revise shortcomings from the DSM-IV Outline for Cultural Formulation (OCF). The CFI field trial took place in 6 countries, 14 sites, and with 321 patients to explore its feasibility, acceptability, and clinical utility with patients and clinicians. We sought to analyze if and how CFI feasibility, acceptability, and clinical utility were related to patient-clinician communication. DESIGN We report data from the New York site which enrolled 7 clinicians and 32 patients in 32 patient-clinician dyads. We undertook a data analysis independent of the parent field trial by conducting content analyses of debriefing interviews with all participants (n = 64) based on codebooks derived from frameworks for medical communication and implementation outcomes. Three coders created codebooks, coded independently, established inter-rater coding reliability, and analyzed if the CFI affects medical communication with respect to feasibility, acceptability, and clinical utility. RESULTS Despite racial, ethnical, cultural, and professional differences within our group of patients and clinicians, we found that promoting satisfaction through the interview, eliciting data, eliciting the patient's perspective, and perceiving data at multiple levels were common codes that explained how the CFI affected medical communication. We also found that all but two codes fell under the implementation outcome of clinical utility, two fell under acceptability, and none fell under feasibility. CONCLUSION Our study offers new directions for research on how a cultural interview affects patient-clinician communication. Future research can analyze how the CFI and other cultural interviews impact medical communication in clinical settings with subsequent effects on outcomes such as medication adherence, appointment retention, and health condition.
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Affiliation(s)
- Neil K. Aggarwal
- Department of Psychiatry, Columbia University, 1051 Riverside Drive, New York, NY 10032
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032
| | - Ravi DeSilva
- Department of Psychiatry, Columbia University, 1051 Riverside Drive, New York, NY 10032
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032
| | - Andel V. Nicasio
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032
| | - Marit Boiler
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032
| | - Roberto Lewis-Fernández
- Department of Psychiatry, Columbia University, 1051 Riverside Drive, New York, NY 10032
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032
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Aggarwal NK, Nicasio AV, DeSilva R, Boiler M, Lewis-Fernández R. Barriers to implementing the DSM-5 cultural formulation interview: a qualitative study. Cult Med Psychiatry 2013; 37:505-33. [PMID: 23836098 PMCID: PMC4299818 DOI: 10.1007/s11013-013-9325-z] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
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 were lack of conceptual relevance between intervention and problem, drift from the format, repetition, severity of patient illness, and lack of clinician buy-in. The Subgroup has revised the CFI based on these barriers for final publication in DSM-5. Our findings expand knowledge on the cultural formulation by reporting the CFI's reception among patients and clinicians.
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Warren BJ. How Culture Is Assessed in the
DSM-5. J Psychosoc Nurs Ment Health Serv 2013; 51:40-5. [DOI: 10.3928/02793695-20130226-04] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 02/15/2013] [Indexed: 11/20/2022]
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Current world literature. Curr Opin Psychiatry 2012; 25:565-73. [PMID: 23037966 DOI: 10.1097/yco.0b013e328359edae] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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