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CFI assessment
Cultural Formulation Interview w/Children and Adolescents
| Question | Answer |
|---|---|
| 6 Main Components in Cultural Formulation Interview (CFI): | 1) Chief Complaints, 2) History of Problems, 3) Mental Status, 4) Diagnosis, 5) Biopsychosocial Formulation, 6) Treatment Plan |
| CFI assessments are influenced by 3 sources of information: | 1) Individualistic Factors, 2) Relational Factors, 3) Cultural Factors |
| Individualistic Factors | the specific characteristics of the individual/patient(s) being assessed |
| Relational Factors | the effects of the interpersonal relationship established between patients and therapists (includes influence of clinician on process - bias, level of competence) |
| Cultural Factors | the place and time in which the assessment occurs permeate into what is said (or not) and how it is understood |
| Not knowing cultural factors causes what problem? | It limits our ability to gain accurate understanding of indvidual |
| What is Culture? | a system of knowledge, concepts, rules, and practices transmitted across generations |
| Culture is continually changing who we become. T/F | True |
| Patients make sense of their experiences of illness and distress through culture. T/F | True |
| Culture shapes most aspects of clinical care. T/F | False; every aspect |
| Culture affects when, where, how and to whom patients share their __________________. | experience |
| The tools and model clinicians use to measure, conceptualize, and elicit symptoms from patients are reflective of their ___________ _________. | cultural beliefs |
| When _____________ ___________ are not understood, they are often misconstrued as _____________. | cultural differences; deficits |
| What happens when cultural differences are not understood? | cultural differences misconstrued as deficits; treatment is ineffective; loss of trust with provider; contributes to growing racial/ethnic minority mental health disparities |
| Developmental stages appear at _________ _____ in ____________ ________. | different ages; different cultures |
| Developmental Stages: | 1) Sensorimotor stage, 2) Preoperational stage, 3) Conccrete Operational stage, 4) Formal Operational stage |
| From age 2-8, children tend to be ________ and struggle to see things from the ______________ of others. | egocentric; perspective |
| At what age do children begin developing a sense of identity and autonomy? | 10 years and up |
| At what age does egocentrism start to fade? | Between 7-10 years of age |
| The voices of children are often found in the cultural literature. T/F | False |
| _________ is the main language through which pre-formal operation children (birth to age 10) express themselves. | Play |
| Many researchers believe is is not possible to understand children outside of their __________/____________. | family/contexts |
| The younger children are, the more important it is to understand them within their ___________/____________ contexts. | family/group |
| Play therapy involves helping children feel comfortable expressing themselves through ____________ play. | symbolic |
| Play therapy tools are also shaped _____________. | culturally |
| Play therapy tools can include: | drawings, playdough, puppets, human/animal figures, avatars, doll houses |
| The objective of the CFI is: | to identify cultural and contextual factors relevant to the diagnosis and treatment of different problems by understanding patients’ symptoms and world’s views |
| The CFI has a version for parent/teacher. T/F | True |
| The CFI has a supplementary module for a______________. | adolescents |
| The direct individual CFI version is not very helpful with youth under ______ years of age. | 12 (administering the CFI-informant version with parents/teachers, etc. is more helpful) |
| The 4 areas of the CFI: | 1) Cultural Definition of problem, 2) Cultural Perception of cause of problem, Cultural Factors affecting self-coping and past help-seeking, 4) Cultural Factors affecting help seeking |
| The Cultural Formulation Interview as a Story includes these 4 primary questions: | 1) What is the issue? 2) What caused it (past/history)? 3) How is it being dealt with at this moment? 4) How could it be better (future)? |
| Most Western models default to assessing individuals: | separate from the family/contexts (contrary to other societies) |
| Before starting the CFI assessment, it is important to have an understanding of: | 1) the content of the CFI, 2) an understanding of the child's culture, 3) have an idea of the child's level of development and expected milestones |
| The CFI should be administered in a ________ setting and parents should be informed of the limits of ___________ to parent/child. | structured; confidentiality |
| It is important to establish ___________ before asking the questions in the CFI. | rapport |
| When administering the CFI, it is recommended to start more ________ and work toward making it more __________ (from _______ to more ________). | general; specific (simple;complex) |
| When administering the CFI, clinicians should try to have fun. T/F | TRUE! Being neutral is not very effective. |
| When completing the CFI assessment with a child, start by asking them to _______/_______ someone or identify with a ________ or ______, then gradually add others including their settings and what is happening (continue to follow the CFI). | play/draw; puppet or object |
| To establish effective therapeutic rapport, it is more helpful to follow the flow of a child's __________/_______ rather than ___________ with questions. | dialogue/play; questions |
| When administering the CFI with a child, it is permissible to skip, add or combine questions. T/F | True |
| The CFI can be an excellent tool to establish therapeutic alliance with the family. T/F | True |
| When administering the CFI, clinicians should allow parents/child to express themselves in their own language. T/F | True, then ask them what they were saying (do not interrupt) |
| During the CFI assessment, it is sometimes helpful for clinicians to talk in the ______ _________ and _____________ questions in the tense they use. | third person; rearticulate |
| When using Zoom, it can be helpful to ask the child to ________ you what is ______ to them and what they __________. | show; important; dislike |
| After administering the CFI to a child, it may be helpful to administer the CFI-informant version to _________ or any other _______, or important _________ member. | teachers; family; community member |
| When administering the CFI with adolescents, it is recommended to use: | the supplementary adolescent module |
| Questions to explore the Cultural Definition of the problem using the Explanatory Model (level of functioning): | 1) How come you guys are talking to me today (over What brings you here today), 2) How would you describe the problem to your family, friends? How do your teachers/parents see the issue? 3) What is the worst part of the problem/issue? |
| Questions to explore the Cultural Perceptions of the causes of problems: | Why do you think this is happening to you? What do you think the cause of the problem is? What do others in your family or your friends think is causing the problem? What are teachers saying the issue is? |
| When exploring the Cultural Perception of the causes of problems with children, it is important to focus on the views of the ___________ of the indvidiuals _______ ________. | members; social network (may be diverse/different from child's) |
| When identifying stressors/supports, ask: | Is there anything that your family/friends do that make it better? (elicit information on life context, focusing on resources, social supports, resilience); ask "What makes the issue worse?" |
| When assessing role of Cultural Identity, ask: | What is important about yourself? Are there any aspects of your background/identity that make a difference to your problem? Are these doing something to the issue? Is any part of yourself making the issue happen? |
| Questions to explore how cultural factors affect coping and help seeking: | What have you done to cope with your own problems? What do you do when that happens? In the past, have you ever asked for help? What types of treatments were most useful or not useful? |
| Questions to ask to identify barriers to coping and help seeking: | What has made it hard to ask for help? (Has anything prevented you from getting the help you need?; probe if needed: stigma, family commitments, lack of services?) |
| Questions to identify cultural factors affecting current help: | What kind of help could fix the issue? Are there other kinds of help your family/friends/others have suggested that would be helpful for you now? What do they think should be done to fix the issue? |
| Questions to address cultural factors and the clinician-patient relationship: | Sometimes doctors and patients misunderstand each other because they come from different backgrounds, have you ever been concerned about this? Is there anything we can do to provide you with what you need? What can be done to fix this? |
| T/F: Some children may not be able to answer all questions; clinicians should select and adapt questions to ensure they are developmentally appropriate for the individual | True |
| Transition phrase going to adolescent supplementary module: | Now I would like to know more about how you feel about being ___ years old. |
| During the adolescent supplementary module, much time will be spent exploring feelings of _____ ___________ in different settings. | age appropriateness (e.g., Do you feel you are like other children/youth your age? In what way?) |
| If the child acknowledges feeling different during the supplementary adolescent module, ask: | Does this feeling of being different happen more at home, school, work, or some other place? Do you feel your family is different from other families? In what ways? |
| Risk/resilience questions to ask during the adolescent supplementary module: | Is there something special about you that you like or that you are proud of? What don't you like about being a child/youth at home, school, with friends? Who is there to support you? |
| In the age-related expectations section of the adolescent supplementary module, questions focus on eliciting the ________ _______ of the child/family and how this may differe from other cultural environments. | normative frame (e.g., What do your parents/grandparents expect from a child/youth your age? What do siblings expect?) |
| Questions for adolescents transitioning to adulthood only include: | Are there any important celebrations/events in your community to recognize reaching a certain age? When is a youth ready to become an adult in your community? How do you feel about growing up (good/bad)? |
| Questions to ask in addition to issues directly related to presenting problems: | What is the child's place in the family (e.g., oldest/youngest), Were developmental milestones achieved at expected age? What are your perceptions of age-appropriate behaviors? Importance of spirituality/community? What are child-adult relations like? |
Created by:
hdemerly