Overview of Cultural Formulation Interview (CFI)

• The American Psychiatric Association (APA) has developed the Cultural Formulation Interview (CFI) to enhance clinical understanding and decision-making in culturally sensitive contexts.

Cultural Formulation Interview Introduction

• The CFI and its supplementary modules are not intended to be used as the sole basis for clinical diagnosis but as tools to assist in research and clinical evaluation.

• For more information on its application, refer to the DSM-5, Section III, “Cultural Formulation.”

• Feedback regarding the usefulness of these tools can be provided through the APA website at http://www.dsm5.org/Pages/Feedback-Form.aspx.

• Rights Granted: This material can be reproduced without permission by researchers and clinicians for patient use. For other uses, permission must be requested from http://www.appi.org/CustomerService/Pages/Permissions.aspx.

CFI Structure and Purpose

• Supplementary modules are provided for clarity in various subtopics of the CFI.

• Instructions to Interviewer: Italicized text gives guidance to the interviewer.

• The CFI aims to clarify the individual’s clinical problem from their perspective and their social network’s viewpoint (family, friends, etc.).

Interview Introduction

• Objective of Interview: To gather a comprehensive understanding of the client’s issues for effective support.

• Interviewer’s Approach:

  • Emphasize no right or wrong answers,

  • Highlight the importance of the individual’s experience and ideas.

Cultural Definition of the Problem

• Explanatory Model, Level of Functioning: Elicit the individual’s perception of their core problem and concerns.

  • Utilize the terminology the individual uses regarding their problems.

Questions to Elicit Cultural Definitions:

1. What brings you here today?

   • If the individual gives limited information, probe further with:

     • Alternate Approach: People often understand their problems differently than doctors. How do you personally describe your problem?

2. How would you describe your problem to your family, friends, or community?

   • This assesses how the individual frames their issue for their social network.

3. What troubles you the most about your problem?

   • Focus on the individual’s specific concerns.

Cultural Perceptions of Causes

• Explanatory Model, Social Network, Older Adults: Understand the meaning of the condition for the individual, which is crucial for clinical care.

Questions Regarding Cultural Perceptions of Causes:

4. Why do you think this is happening to you? What do you think are the causes of your problem?

   • Expect varied answers based on different aspects of the problem; consider probing for various facets.

5. What do others in your family, friends, or community think is causing your problem?

   • Focus on the perspectives of the social network which may differ from the individual’s views.

Stressors and Supports

• Focus Areas: This section seeks to elicit information about the individual’s life context, including resources, social support, and resilience.

Questions on Stressors and Supports:

6. Are there any kinds of support that make your problem better, such as from family, friends, or others?

7. Are there any kinds of stresses that make your problem worse, such as financial issues or family problems?

Role of Cultural Identity

• Cultural Identity, Psychosocial Stressors, Religion and Spirituality, etc.: Identity aspects can influence the individual’s problems positively or negatively.

Questions on Cultural Identity:

8. What are the most important aspects of your background or identity?

   • Identify aspects that may affect the problem.

9. Are there aspects of your background or identity that make a difference to your problem?

10. Are there aspects of your background or identity that are causing other concerns or difficulties for you?

Cultural Factors Affecting Self-Coping and Past Help-Seeking

• Clarify how the individual copes with their problem.

Questions on Coping and Help-Seeking:

11. What have you done to cope with your problem?

    • Encourage discussion of various coping strategies.

Past Help-Seeking

• Elicit prior sources of help the individual has sought.

Questions on Past Help-Seeking:

12. What kinds of treatment, help, advice, or healing have you sought in the past for your problem?

    • Encourage elaboration on experiences with various help sources.

Barriers to Help-Seeking

• Identify barriers that may hinder the individual from obtaining necessary help.

Questions on Barriers:

13. Has anything prevented you from getting the help you need?

    • Explore factors like finances, commitments, stigma, discrimination, or lack of culturally competent services.

Cultural Factors Affecting Current Help-Seeking Preferences

• Understand the current perceived needs and expectations of help.

Questions on Help-Seeking Preferences:

14. What kinds of help do you think would be most useful for your problem now?

15. Are there other kinds of help that your social network has suggested would be beneficial?

Clinician-Patient Relationship

• Explore any concerns regarding the clinician-patient dynamic that may impact care.

Questions on Clinician-Patient Relationship:

16. Have you been concerned about the clinician-patient relationship?

    • Inquire about any issues such as perceived racism, language barriers, or cultural misunderstandings that could impede communication or care delivery.