The CFI can be used in the initial assessment of individuals in all clinical settings, regard- less of the cultural background of the individual or of the clinician. Individuals and clini- cians who appear to share the same cultural background may nevertheless differ in ways that are relevant to care. The CFI may be used in its entirety, or components may be incor- porated into a clinical evaluation as needed. The CFI may be especially helpful when there is 0 Difficulty in diagnostic assessment owing to significant differences in the cultural, re- ligious, or socioeconomic backgrounds of clinician and the individual.
Uncertainty about the fit between culturally distinctive symptoms and diagnostic criteria.
Difficulty in judging illness severity or impairment.
Disagreement between the individual and clinician on the course of care.
Limited engagement in and adherence to treatment by the individual.
The CFI emphasizes four domains of assessment: Cultural Definition of the Problem (questions 1-3); Cultural Perceptions of Cause, Context, and Support (questions 4—10); Cul-
Factors Affecting Current Help Seeking (questions 14—16). Both the person-centered process of conducting the CFI and the information it elicits are intended to enhance the cultural va- lidity of diagnostic assessment, facilitate treatment planning, and promote the individual’s engagement and satisfaction. To achieve these goals, the information obtained from the CFI should be integrated with all other available clinical material into a comprehensive clinical and contextual evaluation. An Informant version of the CFI can be used to collect collateral information on the CFI domains from family members or caregivers.
Supplementary modules have been developed that expand on each domain of the CFI and guide clinicians who wish to explore these domains in greater depth. Supplementary modules have also been developed for specific populations, such as children and adoles- cents, elderly individuals, and immigrants and refugees. These supplementary modules are referenced in the CFI under the pertinent subheadings and are available online at www.psychiatry.org / dsm5.
Supplementary modules used to expand each CFI subtopic are noted in parentheses.
GUIDE TO INTERVIEWER ITALICIZED.
Thefollowing questions aim to clarify key aspects of INTRODUCTION FOR THE INDIVIDUAL: the presenting Clinical problem from the point of I would like to understand the problems that view of the individual and other members of the bring you here so that 1 can help you more individual's social network (i.e.,family,friends, or effectively. I want to know about your experi- athers involved in current problem). This includes ence and ideas. 1 will ask some questions the problem’s meaning, potential 50“"55 ofhelp, about what is going on and how you are deal- and expectations for services ing with it. Please remember there are no right or wrong answers.
(Explanatory Model, Level of Functioning)
Elicit the individual’s view of core problems and key 1. What brings you here today?
concerns. IF INDIVIDUAL GIVES FEW DETAILS OR
Focus on the individual’s own way ofunderstand- ONLY MENTIONS SYMPTOMS OR A ing the problem. MEDICAL DIAGNOSIS, PROBE:
Use the term, expression, or briefdescription elicited People often understand their problems in in question 1 to identify the problem in subsequent their own way, which may be similar to or questions (e.g., “your conﬂict with your son"). different from how doctors describe the problem. How would you describe your problem?
Ask how individualframes the problem for members 2. Sometimes people have different ways of of the social network. describing their problem to their family, friends, or others in their community. How would you describe your problem to them?
Focus on the aspects of the problem that matter most 3. What troubles you most about your prob- to the individual. lem?
CULTURAL PERCEPTIONS 0F CAUSE, CONTEXT, AND SUPPORT (Explanatory Model, Social Network, Older Adults)
This question indicates the meaning of the condition 4. Why do you think this is happening to for the individual, which may be relevant for clin— you? What do you think are the causes of ical care. your [PROBLEM]?