Clinician Perceptions of Implementing the Cultural Formulation Interview on a Mixed Forensic Unit

Neil K. Aggarwal; Peter Lam; Samantha Diaz; Amanda G. Cruz; Roberto Lewis-Fernández

doi:10.29158/JAAPL.003914-20

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Table 1

Open-Ended Questions for the Study

Introduction

Hi my name is XXX, and I will be going through this interview with you, where you will be asked for your opinion on the usefulness of the Cultural Formulation Interview (CFI) at your work place. I want to begin by letting you know that we are really interested in making sure that the CFI can be used at your site, and we want to ensure that it is optimally useful to you. All of the information you provide us with here will help us to do that.

Adoption

FOR ALL TIME POINTS

1. Do you plan on using the CFI questions within your practice? If so, how?

2. What would be the barriers to using the CFI questions in your practice?

3. Do you think these barriers would change depending on how frequently you used the CFI? If so, how?

4. What would help to overcome the barriers to using the CFI questions in your practice?

FOR TIME 2 ONLY (AFTER PATIENT 1)

5. After training, how did you first use the CFI with a patient?

FOR TIME 3 ONLY (AFTER PATIENT 3)

6. How did you use the CFI the second time you used it with a patient? Is this different from where you started? What about the third patient?

7. With whom are you using the CFI?

FOR TIME 4 ONLY (AFTER LAST PATIENT)

8. What has influenced your use of the CFI over time?

9. Did the way you work with patients change from before you had the CFI training? If so, what do you do differently now? If not, why not?

Sustainability

FOR ALL TIME POINTS

1. What do you feel you would need to be able to keep using the CFI?

2. What types of policies, procedures, or characteristics of your agency make it easier to use the CFI?

3. What types of policies, procedures, or characteristics of your agency make it harder to use the CFI?

4. Does management support your use of the CFI? If so, how?

5. What else could or should they do to support the use of the CFI?

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Table 2

Sample Characteristics

Age, years	46.31 (8.46)
Gender
Male	3
Female	10
Race/ethnicity
Non-Hispanic white	12
Hispanic/Latino	1
Profession
Psychologist	4
Social worker	9
Years of providing mental health care	19.5 (7.53)
Primary work location
Civil unit	8
Forensic unit	5
Number of hours in cross-cultural training
< 10 hours	2
10–25 hours	5
26–50 hours	2
51–75 hours	1
> 75 hours	2

n = 13 respondents. Data are presented as n or mean (SD).

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Table 3

Clinician EBPAS Mean Scores^{^a}

EBPAS Domain	T0		T1 (n = 14)		T2 (n = 12)		T3 (n = 10)		T4 (n = 13)		Beta (95% CI)^{^b}	P
EBPAS Domain	Mean	SD	Mean	SD	Mean	SD	Mean	SD	Mean	SD	Beta (95% CI)^{^b}	P
Requirements	2.95	1.03	2.88	1.09	2.56	.80	2.57	1.19	2.41	1.36	−.13 (−.27 to .02)	.1970
Appeal	3.11	.72	3.09	.84	2.60	.63	2.80	.98	2.85	.54	−.07 (−.18 to .04)	.0800
Openness	2.96	.92	2.98	.89	3.02	.67	2.55	.94	2.81	.76	−.06 (−.18 to .06)	.3056
Divergence	2.95	.86	3.05	.66	2.02	.67	2.83	.88	2.73	.85	−.07 (−.16 to .02)	.1122
Overall	3.00	.67	3.01	.63	2.66	.49	2.69	.75	2.72	.64	.01 (−.25 to .28)	.9089

↵a EBPAS mean scores range from 0–4.
↵b Based on n = 63 EBPAS scores, mixed-effect model controlling for clinicians administering multiple CFIs.
EBPAS, Evidence-Based Practices Attitudes Scale.

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Table 4

Barriers and Facilitators by Study Period

Domain	Definition	T1 (n = 14)		T2 (n = 12)		T3 (n = 10)		T4 (n = 13)
Domain	Definition	Bar	Fac	Bar	Fac	Bar	Fac	Bar	Fac
Systemic
Environmental context	Physical and structural resources of the context, its processes, and resources	6	7	1	1	0	0	0	0
Culture	System culture, beliefs and behaviors in relation to change and staffing roles	1	9	0	7	0	5	0	1
Communication processes	Processes of conveying information within the system, online, and in-person	0	0	0	0	0	0	0	3
External requirements	Any external pressures or expectations that affect system deliverables	4	5	8	9	2	6	4	6
Staff
Staff commitment and attitudes	Micro-level beliefs, attitudes, and behaviors toward change in general and toward the intervention	5	10	2	3	2	4	4	6
Understanding, awareness	Understanding of the aims and methodology of the intervention	1	6	0	4	0	5	1	9
Role identity	Beliefs and attitudes towards one's work role and responsibilities	3	6	3	2	3	1	1	3
Skills, ability, confidence	Staff's sense of their capacity to carry out the intervention while managing patients and the environment	12	11	11	11	10	7	13	11
Intervention
Ease of integration	How well the intervention “fits” with the system, resources, and needs, and its ability to adapt as needed	7	14	1	9	0	5	0	13
Face validity, evidence base	Whether the intervention is grounded in evidence and how effective it looks to meet its aims	2	3	2	0	3	3	2	0
Safety, legal, and ethics concerns	How well an intervention addresses important concerns of safety and legality to protect staff and patients	0	0	0	0	0	0	4	0
Supportive components	Components of the intervention that work to support and facilitate necessary changes	0	5	0	9	0	3	0	3