12. Working with the first Australians: Culturally Sensitive Assessment Flashcards
What is cultural competence?
It is the ability of practitioners to identify, intervene and treat mental health complaints in ways that recognise the central role that culture plays in un wellness
What does cultural competence involve?
self awareness, knowledge of other cultures and skills
What does ‘aborigines’ mean?
a term for the natives in Australia
What dies indigenous mean?
Aboriginal and Torres Strait Islander people
How long have aborigines and torres strait islander people been here?
60 000 years
Who is an indigenous peoson?
a person who identify with the Indigenous population
Why is the indigenous population so culturally diverse?
Because there are many clans and mobs, different languages, traditions/cultures, different levels of acculturation
What is an important thing to remember when considering indigenous australians?
Not to assume that they are all alike
What is acculturation?
the process of cultural and psychological change that results following meeting between two cultures (majority and minority)
How may an individual or group of people adapt to other cultures?
by borrowing beliefs, traits or behaviours from that other cultures
Who adapts more?
In general, minorities do
What are the levels of acculturation for indigenous people?
Note acculturated - not exposed to the Western cultures or English
Acculturated - exposed to Western culture and proficient in English
What are some past traditions of indigenous people?
- Semi-nomadic life (pre colonisation)
- People & place connection
- Spiritual beliefs
- Sacred sites
- Kinship and family
- Specific roles
- Skin name
- Collectivism
- Gender: men world and a women world
- Sharing: Vital factor in the community.
- Traditional lifestyle: Self sufficient. Give and receive gifts.
- Death : Mourned. Public and private grieving. Personal mutilation as a apart of mourning. The name of the deceased not used for a long time. Important people are mourned for a longer time..
- Hierarchy – elders & lawmen play an important role
How are children rearing practices in indigenous cultures different from anglo-australian culture
- Children are brought up by mother, siblings and other extended family members
- Children taught to be self sufficient –often on their own and may appear to be impulsive
- High emphasis on sharing
How are learning styles different in indigenous cultures than ango-australian cultures?
- Learn by imitation / modelling
- Process information and will perform a task when confident about success
- Practical rather than abstract
- Visual & hands on
- No competition
- Numbers 1,2 or many
- Emphasis on the concept of shame
How is the sense of time different for indigenous cultures than ango-australian cultures?
Time (no past-present-future. A person is in the centre of time circles, Events are placed in a circular pattern of time more important events to the person/community are perceived closer
How do communication styles differ in indigenous cultures?
- No eye contact due to respect for the other person
- No invasion of space
- No direct question (especially when the other person may not know the answer)
- Use titles (not first names)
- Don’t use names. Fred Smith said… Better to say I heard from people.
- Don’t ask people for name. Ask someone else what the name of the person is.
- When asking for people: ask by their formal titles (Chairperson).
- Greet elders first
- Have to be invited in the house / community
- Give the other person time to think reflect
- May say yes.. yes (just to get rid of you).
- Show distress in a non verbal manner
- Men will talk to men about their matters and women to women
- Self disclosure important (before you try to collect information)
- Very uncomfortable when put “on spot”.
- Indirect, open ended questions work better
What is the Ngarlu?
Ngarlu (inner spirit) is located in the stomach, which is the centre for emotions and well being
How do indigneous people see mental health?
Holisitc
What does mental health take into account according to indigenous people?
Mental ill health takes into account entirety of one’s experiences, including spiritual, physical, mental, emotional, social & cultural states (no mind body dichotomy)
When is mental ill health important to resolve?
In the case of conflict
Why do indigenous clients tend to externalise their heath/mental issues?
- Bad luck
- Cultural wrong doing
- Pay back
- Spell
What are some major mental health issues?
- Alcohol and substance abuse
- Domestic violence:
- Aboriginal women & violence
- Child sexual abuse
- Mental Health issues
- Psychosocial issues: Feuds and conflicts
What is the issue of aboriginal women and violence?
assaults from partner, spouse or larger group of relative
What is the issue of child sexual abuse?
Victims abused by non Indigenous institutional staff, foster homes, foster parents, cattle station owners, farmers, and by Indigenous themselves
What are the long term effects of child sexual abuse?
sexual dysfunction, destructive behaviour, low self esteem, depression, dissociation & PTSD.
What is a very sensitive issue for the indigenous population?
Chlild sexual abuse
What are mental health issues?
Depression, suicide & self harm: second most common cause of death among male Ind.
What are psychosocial issues?
Feuds and conflicts: Not a culture of Indigenous population. It is a result if competition for resources.
What is culturally bound syndrome?
Mimic Mental disorders classified by the Western literature
What are the causes of barriers in getting health services?
o Limited knowledge
o Distance
o Services inconsistent with needs
o Social/ cultural factors
What are the problems with psychological services?
- Services are sought as a last resort
- Referrals are second or third hand
- Essential to use cultural consultants / interpreters
- Vouching
What are methods of psychological assessment?
- Interview
- Observation & Mental Status Examination
- Formal & Informal Assessment
What should you be aware of when interviewing children?
Children and cultural differences
What do you need to do in an interview with children?
- Become familiar with the child (interact / play before working).
- Change work station. Sit side by side.
- Give child time to reply.
- Gains child attention- can show them pictures (animal/ birds) and ask if the bird is in their district.
When interviewing an adult, how should you be communicating?
In an indirect way as it could be considered cut and dry
What is involved in effective listening when interviewing an adult?
Talk simply and clearly. Be comfortable with silences
Who should interpreters be nominated by?
The communities
What questions should be avoided?
avoid negative questions. “You don’t want to go to the town”.
What should be considered when interviewing adults with regards to “thanks”?
Indigenous people do not thank like the western people. They do not have a word for it. They do things for the other person.
How should you dress when interviewing indigenous adults?
modest & conservative
What shouldn’t be used when interviewing?
Using names and asking them for names
e.g. Fred Smith said…
Better to say I heard from people
How do you present respect when interviewing adults?
use formal titles, when asking for people, ask by their formal titles (Chairperson).
How should you address time when interviewing adults?
Do not do things by the clock. Use other markers of time – when school start / finish, sun finishes, two moon past.
How should you address dates/calendars when interviewing adults?
go with seasons- rain, hot time.
How do you greet indigenous people?
Greet them with loose hand shake. Hand should not be withdrawn too quickly. Greet elders first.
Where should you conduct the interview?
may have to interview where Indigenous person is comfortable
What should you do when interviewing in their home?
ask where would they like to sit. Do not invade their space.
How should you introduce yourself?
at length
How much eye contract should you use?
limited, but show you are attentive
Should you cover confidentiality issues?
Yes, they are very important
How do you arrange seating in interviews?
Men & women sit separately. Women sit at a distance from men. Sit side by side.
How do you ask questions in interviews?
Hinting statements with silence.
• “I’m am wondering about… It seems as if… Maybe…
How should sexuality and marital problems be addressed?
Should be asked by the interviewer, who has the same gender as the client.
In mental status examination, how does one assess appearance?
self care. Self mutilation
What is needed if the mental status examination is not based on grief?
probing
What are common behaviours in mental status examination?
Shyness is common, except children, who are boisterous.
What is a concern with regards to affect in mental status examination?
Flat affect in the one to one interview can give a wrong impression. If it exists when with family or in the camp then it is a concern.
What moods should be examined in mental status examination?
weak spirit- depressed
What should be examined with regards to speech and thought form in mental status examination?
Can be detected if the person has good English. Or checked via interpreter.
How should perception be examined in mental status examination?
check if hallucination or cultural way (seeing spirit) Auditory Hallucinations are signs of mental illness.
How should cognition be examined in mental status examination?
For general knowledge, information –ask about local knowledge for ones part of the country.
How does one diagnose and conduct formulation in mental status examination?
Careful history taking and MSE. Sort out the difference between psychotic phenomenon, real precipitants, retrospective attributions and culturally accepted explanations of mental disorder.
What are things to consider in psychological tests with the indigenous community?
- Caution: be aware of the limitations
- Load heavily on Western cultures
- Load heavily on English language
- Validity – not developed for
- Norms - not standardised on Indigenous
- Items / content- not appropriate
What are the main issues in psychological testing with indigenous people?
language and cultural barriers
If it essential to test mainstream and nonverbal tests, what should be used?
use non-verbal & culturally fair tests or subtests
What do mainstream and nonverbal tests assess?
intelligence and cognitive abilities
what are some adaptive mainstream screening and assessment tools?
- Kimberly Indigenous Cognitive Assessment (KICA)
- Patient Health Questionnaire (PHQ-9)
- Negative Life event scale
What are some culturally specific screening tools?
- Indigenous Risk Impact Screen and Brief Intervention (IRIS)
- Westerman Aboriginal Symptom Checklist - Youth (WASC-Y)
- Strong Souls: development and validation of a culturally appropriate tool for assessment of social and emotional wellbeing in Indigenous youth
what is involved in interventions?
- Intervention is short termed, practical & involves family (often community/ elders) and in in line with the culture.
- Intervention
- Incorporate traditional method of healing
- Narrative
- Solution focussed
- Cognitive behaviour therapy (teaching practical skills via modelling) in group format
