Cultural Formulation Interview Project

About the Cultural Formulation Interview Project

Patients’ cultures and life experiences have a profound impact on their understanding of their symptoms and attitudes toward care. The Outline for Cultural Formulation (OCF) was introduced in DSM-IV as a narrative framework for what an open, empathic and thorough cultural assessment should consist of during a diagnostic interview.  Although professional organizations and government guidelines recommend cultural competence training for providers, until recently the lack of a standardized cultural assessment format hindered research and training.  The DSM-5 Cross-Cultural Issues Subgroup operationalized the OCF into a semi-structured questionnaire, the Cultural Formulation Interview (CFI), to facilitate the implementation of the OCF model in a routine evaluation.

The CFI was tested in an APA-supported field trial led by the NYS Center of Excellence for Cultural Competence at the NYSPI.  The DSM-5 CFI field trial was the largest international collaboration for cultural assessment, involving 321 patients in 11 clinical settings and 6 countries, with the aim of assessing the CFI’s feasibility, acceptability and perceived clinical utility.  To foster person-centered, culturally competent, recovery-oriented treatment planning, an interactive, online training module on the CFI is available to behavioral health providers around the world:  More research is needed on CFI implementation to explore how it is best used in clinical practice and how implementation of the CFI can affect patient satisfaction, symptoms, and quality of life as well as engage providers in lifelong learning about cultural competence.

The APA DSM-5 Cultural Formulation Interview is available at the following links:

Core CFI

CFI Informant Version

CFI Supplementary Modules





Lewis-Fernández R, Aggarwal NK, Hinton L, Hinton DE, Kirmayer LK (eds.): The DSM-5 Handbook on the Cultural Formulation Interview.  Washington, DC: American Psychiatric Publishing, 2016.

Lewis-Fernández R, Aggarwal NK, Lam P, Galfalvy H, Weiss MG,  Kirmayer LJ, Paralikar V, Deshpande S, Diaz E, Nicasio AV, Boiler M, Alarcón RD, Rohlof H, Groen S, van Dijk R, Jadhav S, Sarmukaddam S, Ndetei DM, Scalco M, Bassiri K, Aguilar-Gaxiola S, Ton H, Westermeyer J, Vega-Dienstmaier J: Feasibility, acceptability, and clinical utility of the Cultural Formulation Interview: Mixed-methods results from the DSM-5 international field trial.  British Journal of Psychiatry, 2017, 210:290-297.

Aggarwal, N. K., Lam, P., Jiménez-Solomon, O., Desilva, R., Margolies, P. J., Cleary, K., … & Lewis-Fernández, R. (2018). An Online Training Module on the Cultural Formulation Interview: The Case of New York State. Psychiatric Services69(11), 1135-1137.

DeSilva, R., Aggarwal, N. K., & Lewis-Fernandez, R. (2015). The DSM-5 cultural formulation interview and the evolution of cultural assessment in psychiatry. Psychiatric Times32(6), 10-10.

TRINH, N., SON, M., & CHEN, J. A. (2019). Culture in the DSM-5. Sociocultural Issues in Psychiatry: A Casebook and Curriculum, 37.


Demonstration of Cultural Formulation Interview

Provided by the University of Wisconsin School of Medicine and Public Health

Roberto Lewis-Fernández on the Cultural Formulation Interview

Provided by McGill Transcultural Psychiatry

Roberto Lewis-Fernández on the DSM-5 in Global Mental Health

Dr. Roberto Lewis Fernandez, Professor in the Department of Psychiatry at Columbia University speaks on “Novel Uses of DSM-5 in Global Mental Health” at the 2nd Annual Global Mental Health Forum in May 2013. Provided by the New York Global Mental Health Program.


We invite you to read our Cultural Competence Matters reports on this topic:

You may see all our periodic Cultural Competence Matters reports here: Cultural Competence Matters.

Online Training Module: Using the DSM-5 CFI

The CECC has also partnered with Center for Practice Innovations (CPI) to create an online training program for the CFI that will be available to all providers in the New York State Office of Mental Health (OMH) system.

To download a copy of the CFI

To download your copy of the DSM-5 Cultural Formulation Interview for free, please click here: CFI from the American Psychiatric Association

To view and download the CFI Informant version, click here: CFI-Informant

To view and download supplementary CFI modules, click here: CFI-Supplemental

[The CFI is] Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, (Copyright ©2013). American Psychiatric Association. All Rights Reserved.