Role-Playing Practice: Using the CFI to Individualize Anxiety Care

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Role-Playing Practice: Using the CFI to Individualize Anxiety Care

Social workers need to be able to identify cultural conceptions of illness and mental illness. Because studies show that anxiety and depression differ from culture to culture and within cultures, it is important to build skill using the Cultural Formulation Interview (CFI) to elicit how an individual has actually incorporated their cultural beliefs. While the core interview is a set of 16 questions, more detailed versions expand on each area. In this Assignment, you sensitively apply the CFI to your case collaboration partner as well as research how to address and individualize anxiety resources for your partner’s culture and needs.

To prepare:

  • Read the Diaz (2017) article (ATTACHED) and take note of their experience using the CFI and the advantages they found in the process. Also note the minority stress concerns that arise in those working with anxiety issues in different cultures.
  • Review the CFI questions (ATTACHED) and readings in the DSM-5 *ATTACHED) on cultural variations, syndromes, and idioms.
  • Meet your collaboration partner and take turns administering the CFI questions (and any needed subsections) to each other. Your partner will role-play an anxiety issue but otherwise be as true to their own situation as possible.
  • Observe how the CFI administration process goes and take any notes needed. Based on what you learn about your partner’s needs and culture, you may need to do further research in the suggested readings and library before submitting your Assignment.

Submit a 4-page paper in which you do the following:

  • 1. Describe the skills or techniques you used to engage your partner during the CFI.
  • 2. Explain which aspects of the CFI were the most helpful in learning about your partner’s personal view of the problem and situation.
  • 3. Identify which relevant subsections of the CFI you used. Explain why you did (or did not) use a subsection as part of your assessment.
  • 4. Analyze how you, as a social work treatment provider, might adjust interventions for the client, their individualized circumstances, and culture of origin.
  • 5. Describe culturally appropriate evidence-based treatment recommendations for intervention. Support these recommendations with evidence from scholarly resources.
  • 6. Recommend a specific evidence-based measurement instrument to validate the diagnosis and assess outcomes of treatment. Explain any cultural considerations you made when determining an appropriate instrument.

Role-Playing Practice: Using the CFI to Individualize Anxiety Care

The APA is offering the Cultural Formulation Interview (including the Informant Version) and the Supplementary Modules to the Core Cultural Formulation Interview for further research and clinical evaluation. They should be used in research and clinical settings as potentially useful tools to enhance clinical understanding and decision-making and not as the sole basis for making a clinical diagnosis. Additional information can be found in DSM-5 in the Section III chapter “Cultural Formulation.” The APA requests that clinicians and researchers provide further data on the usefulness of these cultural formulation interviews at http://www.dsm5.org/Pages/Feedback-Form.aspx. Measure: Cultural Formulation Interview (CFI) Rights granted: This material can be reproduced without permission by researchers and by clinicians for use with their patients. Rights holder: American Psychiatric Association To request permission for any other use beyond what is stipulated above, contact: http://www.appi.org/CustomerService/Pages/Permissions.aspx

Page 1 of 3 Copyright © 2013 American Psychiatric Association. All Rights Reserved.

This material can be reproduced without permission by researchers and by clinicians for use with their patients.

Cultural Formulation Interview (CFI)

Supplementary modules used to expand each CFI subtopic are noted in parentheses.

GUIDE TO INTERVIEWER INSTRUCTIONS TO THE INTERVIEWER ARE ITALICIZED.

The following questions aim to clarify key aspects of the presenting clinical problem from the point of view of the individual and other members of the individual’s social network (i.e., family, friends, or others involved in current problem). This includes the problem’s meaning, potential sources of help, and expectations for services. Role-Playing Practice: Using the CFI to Individualize Anxiety Care

INTRODUCTION FOR THE INDIVIDUAL:

I would like to understand the problems that bring you here so that I can help you more effectively. I want to know about your experience and ideas. I will ask some questions about what is going on and how you are dealing with it. Please remember there are no right or wrong an- swers.

CULTURAL DEFINITION OF THE PROBLEM

CULTURAL DEFINITION OF THE PROBLEM

(Explanatory Model, Level of Functioning)

Elicit the individual’s view of core problems and key concerns.

Focus on the individual’s own way of understanding the problem.

Use the term, expression, or brief description elicited in question 1 to identify the problem in subsequent questions (e.g., “your conflict with your son”).

1. What brings you here today?

IF INDIVIDUAL GIVES FEW DETAILS OR ONLY MENTIONS SYMPTOMS OR A MEDICAL DIAGNOSIS, PROBE:

People often understand their problems in their own way, which may be similar to or different from how doctors describe the problem. How would you describe your problem?

Ask how individual frames the problem for members of the social network.

2. Sometimes people have different ways of 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 to the individual.

3. What troubles you most about your problem?

CULTURAL PERCEPTIONS OF CAUSE, CONTEXT, AND SUPPORT

CAUSES

(Explanatory Model, Social Network, Older Adults)

This question indicates the meaning of the condition for the individual, which may be relevant for clinical care.

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

Note that individuals may identify multiple causes, de- pending on the facet of the problem they are consid- ering.

PROMPT FURTHER IF REQUIRED:

Some people may explain their problem as the result of bad things that happen in their life, problems with others, a physical illness, a spiritual reason, or many other causes.

Focus on the views of members of the individual’s social network. These may be diverse and vary from the indi- vidual’s.

5. What do others in your family, your friends, or others in your com- munity think is causing your [PROBLEM]?

Cultural Formulation Interview (CFI)

Page 2 of 3 Copyright © 2013 American Psychiatric Association. All Rights Reserved.

This material can be reproduced without permission by researchers and by clinicians for use with their patients.

STRESSORS AND SUPPORTS

(Social Network, Caregivers, Psychosocial Stressors, Religion and Spirituality, Immigrants and Refugees, Cultural Identity, Older Adults, Coping and Help Seeking)

Elicit information on the individual’s life context, focusing on resources, social supports, and resilience. May also probe other supports (e.g., from co-workers, from participation in religion or spirituality).

6. Are there any kinds of support that make your [PROBLEM] better, such as support from family, friends, or others? Role-Playing Practice: Using the CFI to Individualize Anxiety Care

Focus on stressful aspects of the individual’s environ- ment. Can also probe, e.g., relationship problems, difficulties at work or school, or discrimination.

7. Are there any kinds of stresses that make your [PROBLEM] worse, such as difficulties with money, or family problems?

ROLE OF CULTURAL IDENTITY

(Cultural Identity, Psychosocial Stressors, Religion and Spirituality, Immigrants and Refugees, Older Adults, Children and Adoles- cents)

Sometimes, aspects of people’s background or identity can make their [PROBLEM] better or worse. By background or identity, I mean, for example, the communities you belong to, the languages you speak, where you or your family are from, your race or ethnic background, your gender or sexual orientation, or your faith or reli- gion.

Ask the individual to reflect on the most salient elements of his or her cultural identity. Use this information to tailor questions 9–10 as needed.

8. For you, what are the most important aspects of your background or identity?

Elicit aspects of identity that make the problem better or worse.

Probe as needed (e.g., clinical worsening as a result of discrimination due to migration status, race/ethnicity, or sexual orientation).

9. Are there any aspects of your background or identity that make a difference to your [PROBLEM]?

Probe as needed (e.g., migration-related problems; conflict across generations or due to gender roles).

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

CULTURAL FACTORS AFFECTING SELF-COPING AND PAST HELP SEEKING

SELF-COPING

(Coping and Help Seeking, Religion and Spirituality, Older Adults, Caregivers, Psychosocial Stressors)

Clarify self-coping for the problem. 11. Sometimes people have various ways of dealing with problems like [PROBLEM]. What have you done on your own to cope with your [PROBLEM]?

Cultural Formulation Interview (CFI)

Page 3 of 3 Copyright © 2013 American Psychiatric Association. All Rights Reserved.

This material can be reproduced without permission by researchers and by clinicians for use with their patients.

PAST HELP SEEKING

(Coping and Help Seeking, Religion and Spirituality, Older Adults, Caregivers, Psychosocial Stressors, Immigrants and Refugees, Social Network, Clinician-Patient Relationship)

Elicit various sources of help (e.g., medical care, mental health treatment, support groups, work-based coun- seling, folk healing, religious or spiritual counseling, other forms of traditional or alternative healing).

Probe as needed (e.g., “What other sources of help have you used?”).

Clarify the individual’s experience and regard for pre- vious help.

12. Often, people look for help from many different sources, including different kinds of doctors, helpers, or healers. In the past, what kinds of treatment, help, advice, or healing have you sought for your [PROBLEM]?

PROBE IF DOES NOT DESCRIBE USEFULNESS OF HELP RE- CEIVED:

What types of help or treatment were most useful? Not useful?

BARRIERS

(Coping and Help Seeking, Religion and Spirituality, Older Adults, Psychosocial Stressors, Immigrants and Refugees, Social Net- work, Clinician-Patient Relationship)

Clarify the role of social barriers to help seeking, access to care, and problems engaging in previous treatment.

Probe details as needed (e.g., “What got in the way?”).

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

PROBE AS NEEDED:

For example, money, work or family commitments, stigma or dis- crimination, or lack of services that understand your language or background?

CULTURAL FACTORS AFFECTING CURRENT HELP SEEKING

PREFERENCES

(Social Network, Caregivers, Religion and Spirituality, Older Adults, Coping and Help Seeking)

Clarify individual’s current perceived needs and ex- pectations of help, broadly defined.

Probe if individual lists only one source of help (e.g., “What other kinds of help would be useful to you at this time?”).

Now let’s talk some more about the help you need.

14. What kinds of help do you think would be most useful to you at this time for your [PROBLEM]?

Focus on the views of the social network regarding help seeking.

15. Are there other kinds of help that your family, friends, or other people have suggested would be helpful for you now?

CLINICIAN-PATIENT RELATIONSHIP

(Clinician-Patient Relationship, Older Adults)

Elicit possible concerns about the clinic or the clini- cian-patient relationship, including perceived racism, language barriers, or cultural differences that may undermine goodwill, communication, or care delivery.

Probe details as needed (e.g., “In what way?”).

Address possible barriers to care or concerns about the clinic and the clinician-patient relationship raised pre- viously.

Sometimes doctors and patients misunderstand each other because they come from different backgrounds or have different expectations.

16. Have you been concerned about this and is there anything that we can do to provide you with the care you need? Role-Playing Practice: Using the CFI to Individualize Anxiety Care

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