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

The use of the Cultural Formulation Interview (CFI), a 16-item, semistructured, patient cultural assessment, in a forensic mental health setting has not been examined. Using a mixed-methods approach, we performed a pilot test of the CFI in an inpatient service that treats both forensic and nonforensic adult patients. Clinicians' attitudes toward adoption of the CFI was assessed quantitatively with the Evidence-Based Practices Attitudes Scale, which is used to measure provider attitudes toward adopting new treatments, and qualitatively with a semistructured interview. Assessments occurred up to five times to analyze changes with increasing CFI use. In the quantitative measures we observed a general openness to implementing the CFI throughout the implementation period. Compared with clinicians on civil units, forensic clinicians indicated they were less likely to implement the CFI over time if it were required rather than voluntary. Interviews with clinicians revealed concerns about the skills, ability, and confidence needed to implement the CFI, external requirements, and the ease of integrating the CFI into their practice. Based on our findings, forensic units could encourage CFI use after the clinician has determined that the patient is clinically stable, rather than at admission. Units could also incorporate information obtained from the CFI into current documentation to reduce administrative burden.