. Psychosocial stressors and cultural features of vulnerability and resilience: Identify key stressors and supports in the individual’s social environment (which may include both local and distant events) and the role of religion, family, and other social networks (e.g., friends, neighbors, coworkers) in providing emotional, instrumental, and infor- mational support. Social stressors and social supports vary with cultural interpreta- tions of events, family structure, developmental tasks, and social context. Levels of functioning, disability, and resilience should be assessed in light of the individual’s cul- tural reference groups.
0 Cultural features of the relationship between the individual and the clinician: Iden- tify differences in culture, language, and social status between an individual and clini- treatment. Experiences of racism and discrimination in the larger society may impede establishing trust and safety in the clinical diagnostic encounter. Effects may include problems eliciting symptoms, misunderstanding of the cultural and clinical signifi- cance of symptoms and behaviors, and difficulty establishing or maintaining the rap- port needed for an effective clinical alliance.
0 Overall cultural assessment: Summarize the implications of the components of the cul- tural formulation identified in earlier sections of the Outline for diagnosis and other clinically relevant issues or problems as well as appropriate management and treat- ment intervention.
The Cultural Formulation Interview (CFI) is a set of 16 questions that clinicians may use to obtain information during a mental health assessment about the impact of culture on key aspects of an individual’s clinical presentation and care. In the CPI, culture refers to 0 The values, orientations, knowledge, and practices that individuals derive from mem- bership in diverse social groups (e.g., ethnic groups, faith communities, occupational groups, veterans groups).
0 Aspects of an individual’s background, developmental experiences, and current social contexts that may affect his or her perspective, such as geographical origin, migration, language, religion, sexual orientation, or race/ethnicity.
0 The inﬂuence of family, friends, and other community members (the individual’s social network) on the individual’s illness experience.
The CFI is a brief semistructured interview for systematically assessing cultural factors in the clinical eneounter that may be used with any individual. The CFI focuses on the in- dividual’s experience and the social contexts of the clinical problem. The CFI follows a per- son-centered approach to cultural assessment by eliciting information from the individual about his or her own views and those of others in his or her social network. This approach is designed to avoid stereotyping, in that each individual’s cultural knowledge affects how he or she interprets illness experience and guides how he or she seeks help. Because the
CFI concerns the individual’s personal views, there are no right or wrong answers to these questions. The interview follows and is available online at www.psychiatry.org/dsm5.
The CFI is formatted as two text columns. The left-hand column contains the instruc- tions for administering the CFI and describes the goals for each interview domain. The questions in the right-hand column illustrate how to explore these domains, but they are not meant to be exhaustive. Follow-up questions may be needed to clarify individuals’ an- swers. Questions may be rephrased as needed. The CFI is intended as a guide to cultural as- sessment and should be used ﬂexibly to maintain a natural ﬂow of the interview and rapport with the individual.
The CFI is best used in conjunction with demographic information obtained prior to the interview in order to tailor the CPI questions to address the individual’s background and current situation. Specific demographic domains to be explored with the CFI will vary across individuals and settings. A comprehensive assessment may include place of birth, age, gender, racial/ethnic origin, marital status, family composition, education, language ﬂuencies, sexual orientation, religious or spiritual affiliation, occupation, employment, in- come, and migration history.