functioning, disability, and resilience should be  assessed in light of the individual’s cul-
tural reference groups.
•Cultural features of the relationship between the individual and the clinician:  Iden-
tify differences in culture, language, and social status between an individual and clini-
cian that may cause difficulties in communication and may influence diagnosis and
treatment. Experiences of racism and discri mination in the larger society may impede
establishing trust and safety in the clinical  diagnostic encounter. Effects may include
problems eliciting symptoms, misunderstanding of the cultural and clinical signifi-
cance of symptoms and behaviors, and diffi culty establishing or maintaining the rap-
port needed for an effe ctive clinical alliance.
•Overall cultural assessment:  Summarize the implications of the components of the cul-
tural formulation identified in  earlier sections of the Ou tline for diagnosis and other
clinically relevant issues or problems as well as appropriate management and treat-
ment intervention.
Cultural Formulation Interview (CFI)
The Cultural Formulation Interview (CFI) is a set of 16 questions that clinicians may use to
obtain information during a me ntal health assessment about the impact of culture on key
aspects of an individual’s clinical presentation and care. In the CFI, culture  refers to
• The values, orientations, kn owledge, and practices that individuals derive from mem-
bership in diverse social groups (e.g., et hnic groups, faith communities, occupational
groups, veterans groups).
• Aspects of an individual’s background, de velopmental experiences, and current social
contexts that may affect his or her perspe ctive, such as geographical origin, migration,
language, religion, sexual orie ntation, or race/ethnicity.