INHE 4009 Week 10 Position Paper Example

Retire the Fact Sheets: A Position Paper Arguing That an Integrative Health Certificate Program Should Replace Its Cultural Fact Sheet Module With a Person-Directed Interview Modeled on the Cultural Formulation Interview

Student Name

Walden University

INHE 4009: Cultural Humility and Diversity

Instructor Name

Month Day, Year

Retire the Fact Sheets: A Position Paper Arguing That an Integrative Health Certificate Program Should Replace Its Cultural Fact Sheet Module With a Person-Directed Interview Modeled on the Cultural Formulation Interview

The Position

A certificate program in integrative health, the composite program this paper addresses, teaches a module called "Cultural Considerations" built around one-page fact sheets on twelve ethnic and religious groups: their food customs, views on illness, family roles in decisions and attitudes toward complementary therapies. This paper argues that the program should retire the fact sheets and teach in their place a person-directed interview, modeled on the Cultural Formulation Interview, which first appeared in the fifth edition of the psychiatric diagnostic manual (American Psychiatric Association [APA], 2013). The change is narrow: one module, one teaching method.

What the Fact Sheets Do

The fact sheets were written with good intentions. They aim to prepare practitioners for clients whose backgrounds differ from theirs and to prevent obvious mistakes. In a busy training program, a page per group is efficient to teach and easy to test.

But fact sheets teach practitioners to start with the group and infer the person. The week 4 case in this course showed what that produces: a nutrition counselor who read a surname and built a meal plan for a cuisine the client did not eat. Kleinman and Benson (2006) argued that cultural competence taught as lists of traits encourages stereotyping and distracts from what actually matters to the patient in front of the practitioner. Fact sheets also age poorly. A 1995 survey found that many older Korean American adults in Los Angeles favored family decision-making, but about half of the same group believed patients should be told a cancer diagnosis (Blackhall et al., 1995). A fact sheet line that says "Korean families make decisions together" erases that variation and freezes a finding from one place and time.

What the Interview Does Instead

The Cultural Formulation Interview is a brief set of questions that asks a person how they understand their problem, what they believe causes it, what kinds of help they have tried or would accept, what role family and community play, and how their background affects their situation. It was developed for psychiatric assessment, but its approach transfers to integrative practice: the practitioner asks, and the client supplies the culture that matters. An adapted version for integrative health could ask what the client calls the problem, what they think would help, who should be involved in decisions and which practices from their own background they use or would like to use.

The Leading Objection

Its most serious critics argue that practitioners need some background knowledge, or they will not recognize what they hear. A practitioner who has never heard of Ayurveda, or of fasting during Ramadan, may miss the significance of a client's answer or fail to ask a useful follow-up. Fact sheets, the objection says, supply that background efficiently, and an interview without background risks becoming a list of questions asked without understanding.

The Answer

The objection is right that knowledge matters and wrong about where it should sit in training. Background knowledge is most useful as a source of better questions, not as a source of conclusions about a person. The program can keep teaching about traditions and practices, Ayurveda, traditional Chinese medicine, curanderismo and religious observances, as topics in their own right, linked to the interview: here is a practice some clients use, and here is how to ask about it. What it should retire is the organization of that knowledge by ethnic group, which invites practitioners to apply it to anyone with the right surname. Cultural humility does not reject knowledge; it rejects treating the practitioner's knowledge as more authoritative than the client's account of their own life (Tervalon & Murray-García, 1998).

What Students Would Practice Saying

The difference shows most clearly in what students say in the room. Under the fact sheet module, a student meeting a client who mentions Ayurveda might say, "I understand Ayurvedic patients often prefer natural remedies." Under the interview module, the same student would ask, "How do you use Ayurveda in your own health care, and is there anything from it you would like us to work around or include?" The first sentence tells the client who they are. The second asks. A second example: a client who mentions a large extended family. A fact sheet might lead a student to involve relatives in decisions; the interview leads the student to ask, "Who, if anyone, would you like involved in decisions about your care?" Practicing these questions until they are habitual is the skill the module would teach.

Evidence That the Approach Works

The Cultural Formulation Interview was field-tested across several countries while DSM-5 was being developed, and clinicians and patients in that international field trial generally rated it feasible, acceptable and clinically useful (Lewis-Fernández et al., 2017). Its developers designed it to be brief enough for routine use, which matters for integrative practitioners with limited visit time. Adapting it for integrative health would require its own evaluation, and the program should measure whether graduates who learn the interview make fewer assumption-based errors in supervised practice than graduates of the fact sheet module did.

How the Change Would Work

The module would keep its six hours. Two would teach the interview and its adaptation for integrative practice. Two would cover traditions and practices as topics, each linked to interview questions. Two would be supervised practice with standardized clients, in which students conduct the interview and are assessed on whether they let the client define what matters. Assessment would shift from recalling facts about groups to demonstrating the interview, which is harder to test but closer to the skill practitioners need.

Conclusion

The fact sheets were a reasonable first attempt at preparing practitioners for diverse clients. They now teach the habit the course has worked to undo: starting with a group and inferring the person. Replacing them with a person-directed interview, supported by knowledge organized around practices rather than groups, would teach practitioners to ask first.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Publishing.

Blackhall, L. J., Murphy, S. T., Frank, G., Michel, V., & Azen, S. (1995). Ethnicity and attitudes toward patient autonomy. JAMA, 274(10), 820-825. https://doi.org/10.1001/jama.1995.03530100060035

Kleinman, A., & Benson, P. (2006). Anthropology in the clinic: The problem of cultural competency and how to fix it. PLoS Medicine, 3(10), Article e294. https://doi.org/10.1371/journal.pmed.0030294

Lewis-Fernández, R., Aggarwal, N. K., Lam, P. C., Galfalvy, H., Weiss, M. G., Kirmayer, L. J., Paralikar, V., Deshpande, S. N., Díaz, E., Nicasio, A. V., Boiler, M., Alarcón, R. D., Rohlof, H., Groen, S., van Dijk, R. C. J., Jadhav, S., Sarmukaddam, S., Ndetei, D., Scalco, M. Z., . . . Vega-Dienstmaier, J. M. (2017). Feasibility, acceptability and clinical utility of the Cultural Formulation Interview: Mixed-methods results from the DSM-5 international field trial. The British Journal of Psychiatry, 210(4), 290-297. https://doi.org/10.1192/bjp.bp.116.193862

Tervalon, M., & Murray-García, J. (1998). Cultural humility versus cultural competence: A critical distinction in defining physician training outcomes in multicultural education. Journal of Health Care for the Poor and Underserved, 9(2), 117-125. https://doi.org/10.1353/hpu.2010.0233