Cultural considerations in psychological assessment PDF

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Psychological Assessment Week 12 Pre-readings Cultural Considerations in Psychological Assessment Why cultural competence? -Awareness, knowledge, skills for engaging with and supporting diverse clients -The boundaries between normality and pathology, and tolerance thresholds for specific symptoms vary across cultures, social settings and families. -The judgement that a behaviour/experience is normal and requires clinical attention depends on cultural norms awareness of this can help avoid mistakes (inappropriate pathologizing) -culture can contribute to the vulnerability, suffering and stigma and/or provide support, coping strategies and facilitate help-seeking Where and why? -formal psychological assessment of people from culturally diverse backgrounds: variety of reasons (e.g. address educational, personal, mental health needs) different contexts (e.g. school, community services, private practice) Psychopathology -distress or clinical symptoms in the form of a diagnostic assessment -how client is settling into their new environment -maladaptive behaviours -acculturation difficulties -daily functioning -interpersonal concerns Education assessment/cognitive functioning -

Questions re. cognitive ability may be due to injury/trauma (e.g. TBI) -Intellectual disability, specific learning disability, attention and memory, information processing, executive functioning

Organisational psychology -

Career counselling and job selection recruitment

self monitor and engage in reflective practice regarding cultural competence What’s different? -difficulty collecting information

-language -lack of appropriate tests -testing environment (time constraint, strange process, conscious, different types of questions and scales, examiner could be an authority figure and client may be uncomfortable) -lack of understanding of the test processes -response to authority figures -interpreters (note impact it has on client performance) -relies on factual/historical information like school and clients may not eb able to provide these information Informed consent and interviews-simple language to explain informed consent -explain the goals of the assessment and how the information gathered will be used -Clarify that the client has understood.  Verbal informed consent can be obtained and documented (if written consent not an option).  Information may be gathered in an adhoc manner over several sessions.  May be essential to interview family members or carers to obtain more information. Important to explain the rationale for this. Cultural Factors & DSM-5  DSM-5 is more sensitive to and inclusive of cultural differences than previous editions.  Updated criteria reflect cross-cultural variations in presentations (including Culture-Related Diagnostic Issues sections).  Separate Glossary of Cultural Concepts of Distress providing detailed and structured information.  Includes a clinical interview tool to facilitate comprehensive, person centered assessments. Updated Criteria & Culture-Related Diagnostic Issues Sections  “The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing: will lead to rejection or offend others).” (pg. 202)  “Intellectual disability occurs in all races and cultures. Cultural sensitivity and knowledge are needed during assessment, and the individual's ethnic, cultural, and linguistic background, available experiences, and adaptive functioning within his or her community and cultural setting must be taken into account.” (pg. 39)  “This decision inevitably requires the exercise of clinical judgment based on the individual’s history and the cultural norms for the expression of distress in the context of loss.” (pg. 161)

Glossary of Cultural Concepts of Distress (pg. 833)  Details 9 culture-specific conceptualisations of distress (explains these syndromes/experiences).  Cluster of symptoms occurring within a specific group, community, or context which may/may not been viewed as an illness.  Intended to assist clinicians in recognizing and understanding how different cultures think and talk about psychological problems. Cultural Formulation Interview (CFI)  Designed to assist clinicians in assessing cultural factors which influence patients’ perspectives of their symptoms and treatment options.  Provides a foundation for formulation, diagnosis, and treatment.  Questions about culture, race, ethnicity, religion or geographical origin.  Provides clients an opportunity to define their distress in their own words and then relate this to how others perceive their problems. Cultural Awareness Tool  Series of 9 questions produced by the Queensland Health Department; aimed at providing practitioners with general guidance re: how to manage clients with mental illness in a more culturally-aware manner.  Designed to enhance your understanding of the patient’s perception of their problem.  Goal= reach a mutually interpretable explanation for client’s presenting problem(s). STAR-MH  9 item screening tool for PTSD and MDD in adult asylum-seekers and refugees, recently developed by Australian researchers.  Items derived from gold standard instruments for measuring symptoms of depression, anxiety and PTSD in individuals of refugee-like background.  Initial testing suggests it is quick (6 minutes median administration) with sound psychometric properties. Additional testing of external validity required. Common Cognitive Assessments  Raven’s Matrices.  Naglieri Nonverbal Ability Test.  Test of Nonverbal Intelligence [TONI].  Comprehensive Test of Nonverbal intelligence [CTONI].  Leiter or Universal Nonverbal Intelligence Test [UNIT]).  Address the issues associated with language, but results should be interpreted with caution as cultural appropriateness has not been examined in a rigorous manner.

Adaptive Functioning  Can use tools such as the ABAS and Vineland.  Focus should be on universal behaviours (e.g., removing dirt off one’s body), as many items are specific to Western culture (e.g., using cutlery).  Consider the characteristics and culture of the country of origin and select relevant subtests. Interpret results cautiously and in collaboration with information from other sources. Potential Ethical Challenges  May feel pressure from a third party to assess a person from a culturally diverse background but may feel that they do not have the level of competence to do so. Further, he/she may not have the adequate support and supervision.  Timeline of assessment can also pose issues.  Ethical reasoning and decision-making in line with the APS Code of Ethics and a range of APS ethical guidelines. Key Takeaways  Skills for engaging clients remain the same.  Clinical judgement is key in assessing culturally diverse clients.  Primary goal is always to assist the client.  The way assessment results are used may be different (e.g. hypotheses/formulation vs definitive answer).  Always work within your scope of competence....