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Weiss MG, Deshmukh A, Sarmukaddam SB, Paralikar VP. Sociocultural Framework for Psychiatric Case Formulation. J Nerv Ment Dis 2024; 212:16-27. [PMID: 37874984 DOI: 10.1097/nmd.0000000000001721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
ABSTRACT A Cultural Formulation Interview (CFI) field trial in India, widely reported racist violence in the United States, and casteist and religious communal conflicts in India highlighted inattention to structural issues affecting mental health problems in the Outline for Cultural Formulation (OCF) and the CFI in the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition). Consequently, we revised the OCF as a sociocultural formulation (SCF) to better consider structures of society and culture. We studied and compared clinicians' ratings of SCF case formulations from a constructed assessment instrument (SCF Interview [SCFI]) and the CFI. Socio-cultural formulations from SCFI interviews were rated higher for details of societal structural impact, and overall interrater agreement was better. CFI interviews were rated higher for clinical rapport. Revision of the CFI should enhance consideration of structural issues and incorporate them in SCFs that better integrate assessment process and case formulation content. The need to acknowledge structural sources of mental health problems is clear, and our study indicates how a sociocultural framework may be used for that.
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Claus L, Schouler-Ocak M, Braakman MH, Sabbe B, Van Beuren G, van den Ameele S. Unlocking asylum seekers' voices: protocol of a mixed-method clinical study on the use of the cultural formulation interview with asylum seekers in Belgium. Front Psychiatry 2023; 14:1156803. [PMID: 37215655 PMCID: PMC10192900 DOI: 10.3389/fpsyt.2023.1156803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 04/06/2023] [Indexed: 05/24/2023] Open
Abstract
Background Despite a high prevalence of mental disorders among asylum seekers, many barriers to mental healthcare exist. Cultural and contextual factors strongly influence the experience and expression of psychological distress, putting asylum seekers at greater risk of misdiagnosis and inappropriate treatment. The Cultural Formulation Interview (CFI) is a useful tool to map out cultural and contextual factors of mental disorders; however, to the best of our knowledge, it has not yet been investigated in asylum seekers specifically. The primary aim of this study is to evaluate the value of the CFI in the psychiatric assessment of asylum seekers. Second, we will describe the themes relevant to psychiatric distress in asylum seekers that are identified by the CFI. In addition, asylum seekers' experience of the CFI will be evaluated. Methods and analysis This cross-sectional, mixed-method clinical study aims to recruit a group of 60-80 asylum seekers (age 15-29) with mental health symptoms. Data will be collected using structured (MINI, PCL-5, HDRS-17, WHOQoL-BREF & BSI) and semi-structured (CFI & CFI-debriefing) questionnaires to assess cultural background, contextual factors, and illness severity. Multidisciplinary case discussions will be held after the completion of interviews, following a methodological stepped approach. Combining qualitative and quantitative research techniques, this study aims to generate reliable knowledge on working with the CFI in asylum seekers. Based on the findings, recommendations for clinicians will be developed. Discussion This study addresses the knowledge gap on using the CFI in asylum seekers. Compared to prior studies, it will provide new insights into the use of the CFI in the specific context of working with asylum seekers. Ethics and dissemination Prior research on the CFI in asylum seekers is limited, partly because of their high vulnerability and low access to care. The study protocol has been tailored in close collaboration with several stakeholders and validated after piloting. Ethical approval has already been obtained. Together with the stakeholders, the results will be translated into guidelines and training materials. Recommendations to policymakers will also be provided.
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Affiliation(s)
- Lukas Claus
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Universiteit Antwerpen (UA), Antwerp, Belgium
- Department of Psychiatry, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Meryam Schouler-Ocak
- Department of Psychiatry and Psychotherapy, Psychiatric University Clinic of Charité at St. Hedwig Hospital, Berlin, Germany
| | - Mario H. Braakman
- Department of Psychiatric Residency Training, Pro Persona Mental Health, Wolfheze, Netherlands
- Department of Criminal Law, Tilburg Law School, Tilburg University, Tilburg, Netherlands
| | - Bernard Sabbe
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Universiteit Antwerpen (UA), Antwerp, Belgium
| | - Godfried Van Beuren
- Management Culturally Sensitive Care, St. Alexius Psychiatric Hospital, Grimbergen, Belgium
| | - Seline van den Ameele
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Universiteit Antwerpen (UA), Antwerp, Belgium
- Department of Psychiatry, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
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Johnson-Lafleur J, Zoldan Y, Frounfelker RL, Rousseau C. Collective case formulation in situations of violent radicalization: A critical perspective in training. Transcult Psychiatry 2023; 60:302-312. [PMID: 36632689 PMCID: PMC10149881 DOI: 10.1177/13634615221134932] [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: 01/13/2023]
Abstract
Case formulation is used in clinical training to weave together theoretical perspectives and support a shared plan of action. Although a cornerstone of clinical practice, critical social theorists have highlighted the risks of depoliticizing political struggles and of reifying and fixing subjects when using psychopathology and case formulation to address situations of injustice. In the field of violent radicalization, this risk is increased by the extreme affects evoked by terror in practitioners and in societies. This article explores the challenges of training clinicians in the field of violent radicalization. It does so by analyzing a Community of Practice (CoP) that was developed to support practitioners involved in this domain of practice in Quebec, Canada. Four focus groups with CoP participants and participant observation of nine CoP meetings were conducted. Thematic and narrative analyses were used to explore the training potential of the CoP and to identify the discursive processes and group dynamics associated with this modality. Results indicate that the diversity of professional perspectives and social positionalities in the group plays a central role in helping participants become aware of their biases and in developing more complex understandings of cases and of their social embedding. Results also suggest that the collective holding of risk is key to preserve practitioners' investment in patients involved with violent radicalization. The sensitive issue of partnership between health and social services and security agencies is also addressed. Results suggest that CoPs with strong leadership allow for experiential training to enhance clinical and critical thinking.
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Affiliation(s)
| | - Yann Zoldan
- Department of Health Sciences, 14661Université du Québec à Chicoutimi (UQAC), Chicoutimi, Quebec, Canada
| | - Rochelle L Frounfelker
- Department of Community and Population Health, College of Health, Lehigh University, Bethlehem, Pennsylvania, USA
| | - Cécile Rousseau
- Division of Social and Transcultural Psychiatry, 5620McGill University, Montreal, Quebec, Canada
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Jones-Lavallée A, Bernard G, Taing J, Leanza Y. The State of Current Knowledge on the Cultural Formulation Interview: A Scoping Review. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2022. [DOI: 10.1007/s10862-022-10009-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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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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Johnson-Lafleur J, Nadeau L, Rousseau C. Intercultural Training in Tense Times: Cultural Identities and Lived Experiences Within a Community of Practice of Youth Mental Health Care in Montréal. Cult Med Psychiatry 2022; 46:391-413. [PMID: 33988790 DOI: 10.1007/s11013-021-09720-x] [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] [Accepted: 04/22/2021] [Indexed: 10/21/2022]
Abstract
This article presents an analysis of the lived experiences of youth mental health practitioners taking part in Transcultural Interinstitutional and Interdisciplinary Case Discussion Seminars (TIICDS), an intercultural training initiative developed in Montréal (Québec, Canada), while considering the current context of increasing social polarizations. Using insights from the community of practice (CoP) framework and drawing on the analysis of 21 seminar sessions and 26 semi-structured individual interviews, this article examines the relation between the local sociopolitical context, the participants' verbalization about their identities, and the affect and cognition evoked by the training. Results indicate that TIICDSs present several features of a CoP and that intercultural training needs to build on both theoretical and experiential knowledge, while considering local contextual elements. These include historical and contemporary social representations and power differentials between groups, the cultural identities of trainees, and the institutions and sociopolitical structures in which clinical practices take place. These elements, we argue, are sensitive and potentially conflictual but can be addressed through supportive and reflexive group-based initiatives such as CoPs that bring together practitioners on a regular basis and provide them with a 'culturally safe enough' space in which they can learn to complexify their understanding of clinical situations.
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Affiliation(s)
- Janique Johnson-Lafleur
- Division of Social and Transcultural Psychiatry, McGill University, Montreal, Canada. .,SHERPA Research Center, 7085, rue Hutchison, Montreal, QC, H3N 1Y9, Canada.
| | - Lucie Nadeau
- Division of Social and Transcultural Psychiatry, McGill University, Montreal, Canada.,SHERPA Research Center, 7085, rue Hutchison, Montreal, QC, H3N 1Y9, Canada
| | - Cécile Rousseau
- Division of Social and Transcultural Psychiatry, McGill University, Montreal, Canada.,SHERPA Research Center, 7085, rue Hutchison, Montreal, QC, H3N 1Y9, Canada
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Johnson-Lafleur J, Nadeau L, Rousseau C. Families’ and Practitioners’ Use of Culture in Youth Mental Health Services: A Double-Edged Sword. CHILD & YOUTH CARE FORUM 2022. [DOI: 10.1007/s10566-022-09688-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Salam Z, Odenigbo O, Newbold B, Wahoush O, Schwartz L. Systemic and Individual Factors That Shape Mental Health Service Usage Among Visible Minority Immigrants and Refugees in Canada: A Scoping Review. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2022; 49:552-574. [PMID: 35066740 DOI: 10.1007/s10488-021-01183-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2021] [Indexed: 11/30/2022]
Abstract
There exists considerable research which reports that mental health disparities persist among visible minority immigrants and refugees within Canada. Accessing mental health care services becomes a concern which contributes to this, as visible minority migrants are regarded as an at-risk group that are clinically underserved. Thus, the purpose of this review is to explore the following research question: "what are the barriers and facilitators for accessing mental health care services among visible immigrants and refugees in Canada?". A scoping review following guidelines proposed by Arksey and O'Malley (International Journal of Social Research Methodology 8(1): 19-32, 2005) was conducted. A total of 45 articles published from 2000 to 2020 were selected through the review process, and data from the retrieved articles was thematically analyzed. Wide range of barriers and facilitators were identified at both the systemic and individual levels. Unique differences rooted within landing and legal statuses were also highlighted within the findings to provide nuance amongst immigrants and refugees. With the main layered identity of being a considered a visible minority, this yielded unique challenges patterned by other identities and statuses. The interplay of structural issues rooted in Canadian health policies and immigration laws coupled with individual factors produce complex barriers and facilitators when seeking mental health services. Through employing a combined and multifaceted approach which address the identified factors, the findings also provide suggestions for mental health care providers, resettlement agencies, policy recommendations, and future directions for research are discussed as actionable points of departure.
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Affiliation(s)
- Zoha Salam
- Department of Global Health, McMaster University, 1280 Main St. West MDCL 3500, Hamilton, ON, L8S 4L8, Canada.
| | - Odera Odenigbo
- School of Counselling, Psychotherapy, and Spirituality, Saint Paul University, Ottawa, Canada
| | - Bruce Newbold
- School of Earth, Environment and Society, McMaster University, Hamilton, Canada
| | - Olive Wahoush
- School of Nursing, McMaster University, Hamilton, Canada
| | - Lisa Schwartz
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
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10
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Strand M, Bäärnhielm S. Could the DSM-5 Cultural Formulation Interview Hold Therapeutic Potential? Suggestions for Further Exploration and Adaptation Within a Framework of Therapeutic Assessment. Cult Med Psychiatry 2022; 46:846-863. [PMID: 34881417 PMCID: PMC9596502 DOI: 10.1007/s11013-021-09761-2] [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] [Accepted: 11/18/2021] [Indexed: 10/19/2022]
Abstract
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 procedure itself is meant to induce therapeutic change. This is achieved by explicitly focusing on the particular questions and queries that patients have about themselves with respect to their mental health problems or psychosocial well-being; these questions are then allowed to guide the assessment process and the interpretation of the findings. We suggest a number of potential modifications to the related Outline for Cultural Formulation and to the CFI content that could strengthen a TA-inspired focus. With this paper, we do not claim to offer a definitive integration of the TA approach in using the CFI but hope to further the discussion of a therapeutic potential of the instrument.
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Affiliation(s)
- Mattias Strand
- Transcultural Centre, Stockholm Health Care Services, Region Stockholm, Solnavägen 4, 113 65, Stockholm, Sweden. .,Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, 171 77, Stockholm, Sweden.
| | - Sofie Bäärnhielm
- grid.467087.a0000 0004 0442 1056Transcultural Centre, Stockholm Health Care Services, Region Stockholm, Solnavägen 4, 113 65 Stockholm, Sweden ,grid.4714.60000 0004 1937 0626Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, 171 77 Stockholm, Sweden
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Kirmayer LJ, Fung K, Rousseau C, Lo HT, Menzies P, Guzder J, Ganesan S, Andermann L, McKenzie K. Guidelines for Training in Cultural Psychiatry. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2021; 66:195-246. [PMID: 32345034 PMCID: PMC7918872 DOI: 10.1177/0706743720907505] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This position paper has been substantially revised by the Canadian Psychiatric Association (CPA)'s Section on Transcultural Psychiatry and the Standing Committee on Education and approved for republication by the CPA's Board of Directors on February 8, 2019. The original position paper1 was first approved by the CPA Board on September 28, 2011.
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Affiliation(s)
- Laurence J Kirmayer
- James McGill Professor and Director, Division of Social and Transcultural Psychiatry, 5620McGill University, Montreal, Quebec; Director, Culture and Mental Health Research Unit, Jewish General Hospital, Montreal, Quebec
| | - Kenneth Fung
- Clinical Director, Asian Initiative in Mental Health, University Health Network, Toronto, Ontario; Associate Professor, Department of Psychiatry, University of Toronto, Toronto, Ontario; President, Society for the Study of Psychiatry and Culture, Toronto, Ontario
| | - Cécile Rousseau
- Professor, Division of Social and Cultural Psychiatry, 5620McGill University, Montreal, Quebec
| | - Hung Tat Lo
- Director, Asian Clinic, Hong Fook Mental Health Association, Toronto, Ontario
| | - Peter Menzies
- Psychiatrist, Four Directions Therapeutic and Consulting Services, working with First Nations communities in northern Ontario
| | - Jaswant Guzder
- Professor, Department of Psychiatry, 5620McGill University, Montreal, Quebec; Senior Clinician, Cultural Consultation Service, Institute of Community and Family Psychiatry, Sir Mortimer B Davis Jewish General Hospital, Montreal, Quebec; Senior Clinician, Child Psychiatry, Jewish General Hospital, Montreal, Quebec
| | - Soma Ganesan
- Clinical Professor of Psychiatry, University of British Columbia, Vancouver, British Columbia; Director, Cross Cultural Psychiatry Program, University of British Columbia, Vancouver, British Columbia
| | - Lisa Andermann
- Psychiatrist, Mount Sinai Hospital, Toronto, Ontario; Associate Professor, Equity, Gender and Populations Division, Department of Psychiatry, University of Toronto, Toronto, Ontario
| | - Kwame McKenzie
- CEO, Wellesley Institute, Toronto, Ontario; Professor of Psychiatry, University of Toronto, Toronto, Ontario; Director, Department of Health Equity, Centre for Addiction and Mental Health, Toronto, Ontario
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Xavier SM, Jarvis GE, Ouellet-Plamondon C, Gagné G, Abdel-Baki A, Iyer SN. Comment les services d’intervention précoce pour la psychose peuvent-ils mieux servir les migrants, les minorités ethniques et les populations autochtones ? SANTE MENTALE AU QUEBEC 2021. [DOI: 10.7202/1088188ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Lewis-Fernández R, Aggarwal NK, Kirmayer LJ. The Cultural Formulation Interview: Progress to date and future directions. Transcult Psychiatry 2020; 57:487-496. [PMID: 32838656 DOI: 10.1177/1363461520938273] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The Cultural Formulation Interview (CFI) developed for DSM-5 provides a way to collect information on patients' illness experience, social and cultural context, help-seeking, and treatment expectations relevant to psychiatric diagnosis and assessment. This thematic issue of Transcultural Psychiatry brings together articles examining the implementation and impact of the CFI in diverse settings. In this editorial introduction we discuss key areas raised by these and other studies, including: (1) the potential of the CFI for transforming current psychiatric assessment models; (2) training and implementation strategies for wider application and scale-up; and (3) refining the CFI by developing new modules and alternative protocols based on further research and clinical experience.
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Affiliation(s)
- Roberto Lewis-Fernández
- Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Neil Krishan Aggarwal
- Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Laurence J Kirmayer
- Division of Social & Transcultural Psychiatry, McGill University & Culture and Mental Health Research Unit, Institute of Community & Family Psychiatry, Jewish General Hospital, Montreal, Quebec, Canada
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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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Jarvis GE, Kirmayer LJ, Gómez-Carrillo A, Aggarwal NK, Lewis-Fernández R. Update on the Cultural Formulation Interview. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2020; 18:40-46. [PMID: 32047396 PMCID: PMC7011218 DOI: 10.1176/appi.focus.20190037] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
This article reviews the clinical and research literature on the Cultural Formulation Interview (CFI) since its publication in DSM-5. The CFI is an interview protocol designed to be used by clinicians in any setting to gather essential data to produce a cultural formulation. The CFI aims to improve culturally sensitive diagnosis and treatment by focusing clinical attention on the patient's perspective and social context. Preliminary evidence indicates that the CFI can improve clinical communication by enhancing clinician-patient rapport, allowing the clinician to obtain new, cultural data in a relatively short period, eliciting patients' perspectives on what caused their symptoms, and helping patients to become aware of their problems in more insightful ways. With practice, the CFI takes approximately 20 minutes to complete. The CFI has been evaluated internationally in the United States, Canada, Kenya, Peru, the Netherlands, India, and Mexico and generally has been found to be clinically acceptable and useful in these varied settings. Clinicians receiving as little as one hour of training on the CFI improved their ability to work with culturally diverse patients. The CFI may be more difficult to conduct with patients who have severe symptoms, including acute psychosis, suicidal behavior, aggression, and cognitive impairment. The CFI provides a simple way to begin the process of cultural assessment, and its systematic use can foster a reflective stance and promote systemic thinking in routine clinical practice about the patient's life and experience.
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Affiliation(s)
- G Eric Jarvis
- Division of Social and Transcultural Psychiatry, McGill University, and Culture and Mental Health Research Unit, Institute of Community and Family Psychiatry, Jewish General Hospital, Montreal, Quebec (Jarvis, Kirmayer, Gómez-Carrillo); Department of Psychiatry, Columbia University, New York (Aggarwal, Lewis-Fernández); New York State Center of Excellence for Cultural Competence (Aggarwal, Lewis-Fernández), Anxiety Disorders Clinic (Lewis-Fernández), and Hispanic Treatment Program (Lewis-Fernández), New York State Psychiatric Institute, New York
| | - Laurence J Kirmayer
- Division of Social and Transcultural Psychiatry, McGill University, and Culture and Mental Health Research Unit, Institute of Community and Family Psychiatry, Jewish General Hospital, Montreal, Quebec (Jarvis, Kirmayer, Gómez-Carrillo); Department of Psychiatry, Columbia University, New York (Aggarwal, Lewis-Fernández); New York State Center of Excellence for Cultural Competence (Aggarwal, Lewis-Fernández), Anxiety Disorders Clinic (Lewis-Fernández), and Hispanic Treatment Program (Lewis-Fernández), New York State Psychiatric Institute, New York
| | - Ana Gómez-Carrillo
- Division of Social and Transcultural Psychiatry, McGill University, and Culture and Mental Health Research Unit, Institute of Community and Family Psychiatry, Jewish General Hospital, Montreal, Quebec (Jarvis, Kirmayer, Gómez-Carrillo); Department of Psychiatry, Columbia University, New York (Aggarwal, Lewis-Fernández); New York State Center of Excellence for Cultural Competence (Aggarwal, Lewis-Fernández), Anxiety Disorders Clinic (Lewis-Fernández), and Hispanic Treatment Program (Lewis-Fernández), New York State Psychiatric Institute, New York
| | - Neil Krishan Aggarwal
- Division of Social and Transcultural Psychiatry, McGill University, and Culture and Mental Health Research Unit, Institute of Community and Family Psychiatry, Jewish General Hospital, Montreal, Quebec (Jarvis, Kirmayer, Gómez-Carrillo); Department of Psychiatry, Columbia University, New York (Aggarwal, Lewis-Fernández); New York State Center of Excellence for Cultural Competence (Aggarwal, Lewis-Fernández), Anxiety Disorders Clinic (Lewis-Fernández), and Hispanic Treatment Program (Lewis-Fernández), New York State Psychiatric Institute, New York
| | - Roberto Lewis-Fernández
- Division of Social and Transcultural Psychiatry, McGill University, and Culture and Mental Health Research Unit, Institute of Community and Family Psychiatry, Jewish General Hospital, Montreal, Quebec (Jarvis, Kirmayer, Gómez-Carrillo); Department of Psychiatry, Columbia University, New York (Aggarwal, Lewis-Fernández); New York State Center of Excellence for Cultural Competence (Aggarwal, Lewis-Fernández), Anxiety Disorders Clinic (Lewis-Fernández), and Hispanic Treatment Program (Lewis-Fernández), New York State Psychiatric Institute, New York
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Johnson-Lafleur J, Papazian-Zohrabian G, Rousseau C. Learning from partnership tensions in transcultural interdisciplinary case discussion seminars: A qualitative study of collaborative youth mental health care informed by game theory. Soc Sci Med 2019; 237:112443. [PMID: 31387010 DOI: 10.1016/j.socscimed.2019.112443] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 07/22/2019] [Accepted: 07/23/2019] [Indexed: 11/30/2022]
Abstract
Although collaborative care was adopted in several countries, including Canada, to improve the health and social services system, partnerships are often experienced as challenging. In many cases, transformative partnership remains a political rhetoric rather than a practical reality. This article presents an analysis of partnership relationships in youth mental health (YMH) using insights from game theory and a qualitative analysis of interactions during transcultural interinstitutional and interdisciplinary case discussion seminars (TIICDSs). Drawing on the analysis of 40 seminar sessions and six focus groups with seminar participants conducted in Montréal (Canada) between October 2013 and April 2015, this article interrogates the conditions and processes present in TIICDSs that contribute to building and strengthening YMH partnerships, examining how tensions among TIICDS participants are attended to. Research results indicate that TIICDSs can be seen as a game operating under different rules than real-life clinical work. They are characterized by the establishment of a climate of trust and respect, a high value placed on diversity and creativity, a concern for affects and power dynamics, a process of inclusive dialogue and negotiation, and a consideration for continuity. The game rules allow participants to safely apprehend a situation from a different perspective, a key competence in intercultural and collaborative YMH care. Results also indicate that participants complexify their representations by playing with divergent perceptions of people and situations and that enhanced case formulations are collective game outcomes. In light of our findings, tensions in collaborations can be seen as constituting both obstacles that can be counterproductive if not attended to, as well as powerful and useful learning tools that, under certain conditions, can support the clinical process and contribute to partnership building. Some clinical and partnership impasses may be overcome through clinical case discussions that allow partners to address these tensions and negotiate power relationships.
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Affiliation(s)
- Janique Johnson-Lafleur
- Division of Social and Transcultural Psychiatry, McGill University, Montréal, Québec, Canada; SHERPA Research center, CLSC Parc-Extension, Montréal, Québec, Canada.
| | - Garine Papazian-Zohrabian
- Département de psychopédagogie et d'andragogie, Université de Montréal, Montréal, Québec, Canada; SHERPA Research center, CLSC Parc-Extension, Montréal, Québec, Canada
| | - Cécile Rousseau
- Division of Social and Transcultural Psychiatry, McGill University, Montréal, Québec, Canada; SHERPA Research center, CLSC Parc-Extension, Montréal, Québec, Canada
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