1. Objectifs

Intentions :
This article aims to document the impact of a series of interdisciplinary case discussion seminars (ICDSs) on the case formulation process. ICDSs are a modality to train clinicians to use the recently developed Cultural Formulation Interview (CFI) in child mental health. «The specific objectives are to describe the impact of the ICDS on[:] information collection (nature of information, age-related specificity)[;] changes in case formulation (from initial to final formulation) in terms of degree of complexity (relative inclusion of sociocultural aspects) and in shifts in formulation; and […] treatment plan development (confirmation of intuitions/actions, questioning of proposed interventions, opening of alternative avenues).» (p. 582-583)

2. Méthode

Échantillon/Matériau :
«The study took place in Montreal, at public community health and social services centers providing general medical and mental health care for inner city neighborhoods with very diverse populations. [From 2013 to 2015], three different groups held monthly ICDSs for a total of 45 sessions […]. Focus groups were held with a sub-sample of participants at the end of each ICDS year. […] In total, 154 different professionals participated in the ICDSs, since 46 participated in both years. ICDS participants included 130 practicing clinicians (84.4%) and 24 still in training (15.6%). Among the ICDS participants, 58 also participated in a focus group, either at the end of year 1 (n=21), at the end of year 2 (n=31), or, for some participants, in both years (n=6) […]. Therefore, a total of 42 cases were documented and analysed for the study […]. Most families had lived in Canada for more than 10 years (20) or had one parent who was Canadian-born (8), while 14 families had immigrated to Canada less than 10 years previously. Cases were presented with a balanced representation in terms of children’s age categories, with a higher representation of girls (35 girls and 22 boys).» (p. 583-584)

Instruments :
Guide d’entretien de groupe

Type de traitement des données :
Analyse de contenu

3. Résumé

«The group discussion analysis showed that ICDSs encouraged clinicians to widen the scope of their information collection, which is the main objective of the CFI, in order to better capture the complexity of the cultural and social experiences of patients and families. Moving away from simple or monolithic assignments of identity, the ICDS discussions supported inquiry into structural dimensions linked to social and economic factors associated with migration experiences.» (p. 590) Moreover, in «this case, the discussion transformed the participants’ and the presenting clinicians’ vision of the case. The turning point was the shift from the perception of a Rwandan family with intra-familial conflicts, to a Hutu–Tutsi family reenacting unresolved and unspoken trauma linked to the genocide. After attending ICDSs, new participants presented their cases with increasing complexity. With time, the genograms that case presenters drew to display the family’s relationships evolved from a schematic nuclear family representation to a more complex representation encompassing three (and sometimes four) generations. Participants also learned to unpack simple identity categories. For example, in cases of ‘‘Muslim’’ families, they would further inquire to find out if they were Shia, Sunni, or belonged to another group, and would ask questions to get a sense of the relative importance of religion in terms of the family’s social network, gender and familial roles, and of the role of religion in terms of individual family members’ spiritual support.» (p. 585)