1. TEACHING CULTURAL SENSITIVITY IN THE PATIENT - CLINICIAN RELATIONSHIP: Cultural Formulation

2. Goals Learn how to elicit and obtain information to understand the patient’s culture Teach the elements of a cultural formulation

3. Objectives The interviewer will be able to: Elicit information to evaluate the socio- cultural context of the patient Build a cultural formulation useful for diagnosis and treatment Become aware that being culturally sensitive is an ongoing life process

4. Cultural Formulation The cultural formulation (DSM IV-TR) asks clinicians to operationalize a more thorough evaluation of the socio-cultural context in which illness experience is embedded. Without this systematic contextual assessment the meaning of illness might elude a busy clinician Lewis-Fernandez, R. The Cultural Formulation, Transcultural Psychiatry 2009, Vol 46: 379.

5. Five Elements of the Cultural Formulation 1.Identity 2.Explanatory model or cultural explanation of illness 3.Cultural factors related to psychosocial environment and levels of functioning (family and social support) 4.Cultural elements of the clinician patient relationship 5.Overall impact of culture on diagnosis and care (DSM IV TR)

6. Identity The goal is to describe a person as a cultural being identified with particular values traditions and orientations (Mezzich). Useful questions to elicit information: How long have you lived in this city? Do you have a partner? Whom do you live with? Do you have children? Where were they born? How far did you go to school? Where? Degrees? Job? How old are you? Are you spiritual, religious? Mezzich, J. Caracci, G, Fabrega, H. Kirmayer, L Cultural Formulation Guidelines Transcultural Psychiatry, 2009, Vol 46 (3) 383- 405)

7. Identity Questions to Elicit Information from Immigrants: What is your country of origin? Your parents? How old were you when you came to this country? How comfortable do you feel speaking English? What other languages do you speak? Are most of your friends from your country? What do you miss the most about your country of origin? Relatives? Food? Music?

8. Explanation of Illness Explanations of symptoms are unique for each person. The following questions can be used: What is your problem? –What words does the patient use to describe it? –Be attentive for idioms of distress What do you think causes it? What have you done to seek help?

9. Cultural Factors Related to Psychosocial Environment or Functioning Influence of illness on family, work, community and the impact of the local community on the patient’s illness: What events have played a role in your illness? Who do you trust? Are any community groups helpful? Family? How are your symptoms affecting your functioning?

10. Cultural Elements of the Relationship Individual-Clinician It is critical to recognize the difference in cultural backgrounds (patient-clinician): Are you (clinician) aware of any cultural mediated reactions? Is the patient aware of any? How is your (clinician’s) cultural and social identity similar or different to that of the patient's? How do intercultural similarities or differences influence communication and rapport with the patient?

11. Overall Impact of Culture on Diagnosis and Care Summary of salient themes useful to enhance care and health promotion

12. VIDEO CLIPS