12. Working with the first Australians: Culturally Sensitive Assessment Flashcards

1
Q

What is cultural competence?

A

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

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2
Q

What does cultural competence involve?

A

self awareness, knowledge of other cultures and skills

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3
Q

What does ‘aborigines’ mean?

A

a term for the natives in Australia

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4
Q

What dies indigenous mean?

A

Aboriginal and Torres Strait Islander people

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5
Q

How long have aborigines and torres strait islander people been here?

A

60 000 years

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6
Q

Who is an indigenous peoson?

A

a person who identify with the Indigenous population

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7
Q

Why is the indigenous population so culturally diverse?

A

Because there are many clans and mobs, different languages, traditions/cultures, different levels of acculturation

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8
Q

What is an important thing to remember when considering indigenous australians?

A

Not to assume that they are all alike

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9
Q

What is acculturation?

A

the process of cultural and psychological change that results following meeting between two cultures (majority and minority)

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10
Q

How may an individual or group of people adapt to other cultures?

A

by borrowing beliefs, traits or behaviours from that other cultures

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11
Q

Who adapts more?

A

In general, minorities do

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12
Q

What are the levels of acculturation for indigenous people?

A

Note acculturated - not exposed to the Western cultures or English
Acculturated - exposed to Western culture and proficient in English

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13
Q

What are some past traditions of indigenous people?

A
  • 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
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14
Q

How are children rearing practices in indigenous cultures different from anglo-australian culture

A
  • 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
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15
Q

How are learning styles different in indigenous cultures than ango-australian cultures?

A
  • 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
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16
Q

How is the sense of time different for indigenous cultures than ango-australian cultures?

A

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

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17
Q

How do communication styles differ in indigenous cultures?

A
  • 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
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18
Q

What is the Ngarlu?

A

Ngarlu (inner spirit) is located in the stomach, which is the centre for emotions and well being

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19
Q

How do indigneous people see mental health?

A

Holisitc

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20
Q

What does mental health take into account according to indigenous people?

A

Mental ill health takes into account entirety of one’s experiences, including spiritual, physical, mental, emotional, social & cultural states (no mind body dichotomy)

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21
Q

When is mental ill health important to resolve?

A

In the case of conflict

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22
Q

Why do indigenous clients tend to externalise their heath/mental issues?

A
  • Bad luck
  • Cultural wrong doing
  • Pay back
  • Spell
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23
Q

What are some major mental health issues?

A
  • Alcohol and substance abuse
  • Domestic violence:
  • Aboriginal women & violence
  • Child sexual abuse
  • Mental Health issues
  • Psychosocial issues: Feuds and conflicts
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24
Q

What is the issue of aboriginal women and violence?

A

assaults from partner, spouse or larger group of relative

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25
Q

What is the issue of child sexual abuse?

A

Victims abused by non Indigenous institutional staff, foster homes, foster parents, cattle station owners, farmers, and by Indigenous themselves

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26
Q

What are the long term effects of child sexual abuse?

A

sexual dysfunction, destructive behaviour, low self esteem, depression, dissociation & PTSD.

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27
Q

What is a very sensitive issue for the indigenous population?

A

Chlild sexual abuse

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28
Q

What are mental health issues?

A

Depression, suicide & self harm: second most common cause of death among male Ind.

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29
Q

What are psychosocial issues?

A

Feuds and conflicts: Not a culture of Indigenous population. It is a result if competition for resources.

30
Q

What is culturally bound syndrome?

A

Mimic Mental disorders classified by the Western literature

31
Q

What are the causes of barriers in getting health services?

A

o Limited knowledge
o Distance
o Services inconsistent with needs
o Social/ cultural factors

32
Q

What are the problems with psychological services?

A
  • Services are sought as a last resort
  • Referrals are second or third hand
  • Essential to use cultural consultants / interpreters
  • Vouching
33
Q

What are methods of psychological assessment?

A
  • Interview
  • Observation & Mental Status Examination
  • Formal & Informal Assessment
34
Q

What should you be aware of when interviewing children?

A

Children and cultural differences

35
Q

What do you need to do in an interview with children?

A
  • 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.
36
Q

When interviewing an adult, how should you be communicating?

A

In an indirect way as it could be considered cut and dry

37
Q

What is involved in effective listening when interviewing an adult?

A

Talk simply and clearly. Be comfortable with silences

38
Q

Who should interpreters be nominated by?

A

The communities

39
Q

What questions should be avoided?

A

avoid negative questions. “You don’t want to go to the town”.

40
Q

What should be considered when interviewing adults with regards to “thanks”?

A

Indigenous people do not thank like the western people. They do not have a word for it. They do things for the other person.

41
Q

How should you dress when interviewing indigenous adults?

A

modest & conservative

42
Q

What shouldn’t be used when interviewing?

A

Using names and asking them for names
e.g. Fred Smith said…
Better to say I heard from people

43
Q

How do you present respect when interviewing adults?

A

use formal titles, when asking for people, ask by their formal titles (Chairperson).

44
Q

How should you address time when interviewing adults?

A

Do not do things by the clock. Use other markers of time – when school start / finish, sun finishes, two moon past.

45
Q

How should you address dates/calendars when interviewing adults?

A

go with seasons- rain, hot time.

46
Q

How do you greet indigenous people?

A

Greet them with loose hand shake. Hand should not be withdrawn too quickly. Greet elders first.

47
Q

Where should you conduct the interview?

A

may have to interview where Indigenous person is comfortable

48
Q

What should you do when interviewing in their home?

A

ask where would they like to sit. Do not invade their space.

49
Q

How should you introduce yourself?

A

at length

50
Q

How much eye contract should you use?

A

limited, but show you are attentive

51
Q

Should you cover confidentiality issues?

A

Yes, they are very important

52
Q

How do you arrange seating in interviews?

A

Men & women sit separately. Women sit at a distance from men. Sit side by side.

53
Q

How do you ask questions in interviews?

A

Hinting statements with silence.

• “I’m am wondering about… It seems as if… Maybe…

54
Q

How should sexuality and marital problems be addressed?

A

Should be asked by the interviewer, who has the same gender as the client.

55
Q

In mental status examination, how does one assess appearance?

A

self care. Self mutilation

56
Q

What is needed if the mental status examination is not based on grief?

A

probing

57
Q

What are common behaviours in mental status examination?

A

Shyness is common, except children, who are boisterous.

58
Q

What is a concern with regards to affect in mental status examination?

A

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.

59
Q

What moods should be examined in mental status examination?

A

weak spirit- depressed

60
Q

What should be examined with regards to speech and thought form in mental status examination?

A

Can be detected if the person has good English. Or checked via interpreter.

61
Q

How should perception be examined in mental status examination?

A

check if hallucination or cultural way (seeing spirit) Auditory Hallucinations are signs of mental illness.

62
Q

How should cognition be examined in mental status examination?

A

For general knowledge, information –ask about local knowledge for ones part of the country.

63
Q

How does one diagnose and conduct formulation in mental status examination?

A

Careful history taking and MSE. Sort out the difference between psychotic phenomenon, real precipitants, retrospective attributions and culturally accepted explanations of mental disorder.

64
Q

What are things to consider in psychological tests with the indigenous community?

A
  • 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
65
Q

What are the main issues in psychological testing with indigenous people?

A

language and cultural barriers

66
Q

If it essential to test mainstream and nonverbal tests, what should be used?

A

use non-verbal & culturally fair tests or subtests

67
Q

What do mainstream and nonverbal tests assess?

A

intelligence and cognitive abilities

68
Q

what are some adaptive mainstream screening and assessment tools?

A
  • Kimberly Indigenous Cognitive Assessment (KICA)
  • Patient Health Questionnaire (PHQ-9)
  • Negative Life event scale
69
Q

What are some culturally specific screening tools?

A
  • 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
70
Q

what is involved in interventions?

A
  • 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