cultural formulation interview a DSM-5 tool for cultural competence

Transcription

1 cultural formulation interview a DSM-5 tool for cultural competence

2 Agenda 1. Health disparities 2. Cultural competency 3. CFI 4. Video of CFI 5. Initial benefits of CFI 6. Activity

3 The impact of culture on clinical encounters Compared to White clients, racial and ethnic minorities are : 50% less likely to initiate treatment compared to White clients 40-80% more likely to prematurely end treatment 80% less likely to receive guideline or evidence-based care Clients from racial and ethnic minorities are seven times more likely than whites to end treatment when the are unconvinced that their clinician understands their cultural view.

4 Civil Rights and Healthcare Since the 1960s, helping professions have tried to keep pace with the rest of society by addressing the unique needs of historically disadvantaged or marginalized populations.

5 Cultural Competence the recognition and appreciation that a person s cultural background influences experiences with the healthcare process. Informs clinical practice (diagnosis, assessment, conceptualization) Aids in creation of culturally-appropriate treatments.

6 How do educators sensitize clinicians to a client s cultural world? Old model of CC: grouplevel model that focused on race and ethnicity > here s the treatment for this group New model of CC: contextual model that recognized multiple identities > what identity matters most to the client

7 There are compelling ethical arguments in favor of cultural competence. However, aside from short-term knowledge gains by clinicians and higher satisfaction rates from clients, there is minimal evidence that cultural competence impacts clinical outcomes.

8 Why? CC models do not lend themselves to true experimental testing, field studies, or outcome comparisons.

9 How do we get that evidence? Rich body of literature on how to test training Train counselors in a technique, ensure that they do it faithfully, and then see if clients have responded in ways that are meaningful. This is what the APA is attempting to do with the Cultural Formulation Interview in the DSM-5. (See... the DSM-5 is doing something right!)

10 What is the Cultural Formulation Interview (CFI)? When clinicians know what matters most to the client, they can tailor treatment recommendations Structured interview with 16 open-ended questions Appropriate for use with ALL clients Intended to precede the diagnostic interview

11 Overview of the CFI Revised from the DSM-IV s Outline for Cultural Formation... which was a disaster! Recognizes four clinical domains that are influenced by culture: 1. cultural identity of the individual 2. cultural explanations of illness 3. cultural levels of psychosocial support and functioning 4. cultural elements of the client-counselor relationship

12 Watch the CFI in action.

13 Client benefits In initial field studies of the CFI, clients report that they: feel the clinician is listening to them more respond positively to the open-ended questions of the CFI Feel satisfaction just from the use of the CFI, irrespective of the clinician

14 Clinician benefits In initial field studies, clinicians report: The CFI improves on the lengthy family and social histories by asking clients questions like who in your family has helped improve this problem? who in your family who has made this worse in direct ways? CFI reveals rich clinical information that wouldn t come out otherwise CFI illuminated many of the psychosocial stressors clients face

15 Other benefits of the CFI helps if there are questions about diagnosis trouble with medication, or treatment adherence. reveals other cultural knowledge that might be relevant Improves communication between patients and clients And... the initial success in training/fidelity could potentially provide an empirical basis on which we can measure the clinical impact of cultural competency.

16 To get a copy of the CFI, go to: