Chapter 8: Morrissey & Reddy (2015) Flashcards
In psychology what does “diversity” often describe?
ethnic differences among individuals whose experiences are different from those of a dominant cultural group.
This model can be described as deficit model because one group becomes standard or norm, and other groups that are different are deviant or atypical
Also refers differences in gender, age, disability, socio-economic status, sexuality.
What does culture refer to?
Shared belief systems and value orientations that influence customs, norms, practices, and social intuitions, including psychological processes such as language and educational systems.
What is cultural deficit theory?
- Origins lay in social Darwinism
- argues that membership of certain social and cultural grouping places limitations on an individuals ability to succeed educationally, vocationally an economically.
How is intra-individual variation often suppressed in psych practice and research?
Labelling and then grouping individuals according to their apparent cultural background has the tendency to suppress importance of situational contextual factors that influence people to behave differently - underplay the differences between individuals from the same culture
- within group differences often not examined in research
What is a cultrual identity?
A reference group or social entity with whom we identify and to whom we look for standards of behaviour
- May also involve language, country of origin, gender, age, class, religious beliefs, and sexual orientations
Australians come from how many countries?
more than 200 countries
Australians speak how many languages at home?
over 300 languages
What percentage of the population speak a language other than English?
16%
In Australia:
- Increasing numbers of same sex partnerships
- Increasing numbers of lone parent households
- Skilled migration will bring more people into Australia who are highly educated and from Asian countries
What are the implications of this for psychologists?
We will be working with an increasingly culturally diverse population in our practice
What is cultural competence in the context of psychological care?
having the capacity to function effectively as an individual and an organisation within the
cultural beliefs, behaviours, and needs presented by
consumers and their communities
What is an example of cultural differences in health risk factors?
- ATSI peoples, 12 years less life expectancy than other Australians
- Smoking and alcohol use are determinants of health for Indigenous populations.
- Type 2 diabetes more frequent for those born in Asia as well as Indigenous groups.
Why are migrants to Australia in good health?
Strict health requirements associated with migration
- However, this “health advantage” of migrants becomes smaller with age.
How may cultural diversity affect the management of an illness?
- Lower SES in terms of income, education, and occupation has been linked
to mental health problems. - ATSI people suffer a higher burden of ill
health and have a shorter life expectancy - ATSI people are hospitalised at a higher
rate for mental and behavioural disorders - The death rate associated with mental disorders among Indigenous males
is over three times the rate for non-Indigenous males - The death rate from suicide for Indigenous males and females is approximately twice that of non-Indigenous persons
How can cultural identity affect the management of an illness?
- distinct patterns of beliefs and behaviours associated with willingness to seek, and respond to health services
- barriers to help seeking may be exacerbated by cultural differences that exist between health professionals and consumers
- Participation in health care is a family concern rather than an individual responsibility in many cultures
- Communication/language barriers - lack of interpreters and bilingual service providers
What is provider-patient communication linked to?
- Patient satisfaction and adherence
- Subsequent health outcomes
What does being a culturally competent practitioner mean?
- understanding the importance of social and cultural influences on
patients’ health beliefs and behaviours - Devising appropriate
interventions that take social and cultural influences on health beliefs and behaviours into account - Culturally competent health care systems are seen as having the potential
to reduce ethnic disparities in health care
How can we achieve culturally competence health care systems?
- Culturally diverse staff that reflect the communities served
- Providers or translators who speak the clients’ language(s)
- Training about the culture and language of the people they serve
- Signage and instructional literature in the clients’ language(s) and
consistent with their cultural norms - Culturally specific health care settings
Code of ethics conveys sensitivity to cultural diversity including:
- As psychologists we are asked to recognise the impact of culture, and related constructs, in our professional practice
- We are also asked not to engage in, or condone, discrimination towards any client or group of
clients
The APA has published two useful documents focusing on diversity issues. One of these offers a comprehensive framework for psychologists providing services to culturally diverse individuals and groups. 2 important points include:
- The role of our cultural attitudes and beliefs on the perception of and interactions with individuals who are ethnically and racially different
- Psychologists should strive to apply culturally appropriate skills in clinical
and other applied psychological practices
How is the ethical principle of competence relevant in the context of working with a culturally diverse population?
- Psychologists are expected to gauge their level of knowledge and skills relative to the cultural characteristics of their clients, and work within areas in which they are competent
- Psychologists should not provide psychological services to individuals or
groups when they lack appropriate knowledge and skills
It is not uncommon to administer English-language tests with people from non-English speaking backgrounds - True or False?
True - sometimes this is unavoidable.
- We need to be able to take this into consideration when interpreting results
- Test scores may hold important implications for interventions, therefore our testing needs to be conducted competently
- Culturally appropriate assessment measures should be used if available
- We also need to maintain a flexible approach to intervention in order to match our expertise with the needs and abilities of the client
When assessing people from cultural backgrounds different from our own, what areas need to be considered to ensure ethical standards of care?
*LANGUAGE PROFICIENCY: Needs to be sufficient to:
- establish rapport
- motivate and support the client and clarify treatment expectations
- obtain informed consent
- we need to consider the dangers of using untrained interpreters such as family members of
bilingual staff. The use of untrained interpreters may involve ethical problems and risks to both
the client and the health professional.
- ACCULTURATION: Understanding the client’s journey from one culture and language to another is important. Consider:
- what are the client’s experiences of dealing with the mainstream or host culture?
- how did the client end up in Australia?
- experiences prior to and after moving to Australia?
- this will help you develop an understanding re: the client’s strengths and ability to adapt to changing circumstances and environments
- CULTURAL SENSITIVITY: Knowledge and mutual respect is imperative:
- Some literature provide detailed knowledge of specific cultures. Do not make any assumptions!!! There is the potential for stereotyping. Most people have mixed cultural identities and experiences, and individuals within any culture will vary considerably.
- People may either reject their culture and family of origin or take pride in their family and culture of origin. You need to find these things out!! They may want you to include the family in consultations for example.
- EXPLANATORY MODELS:
- encounters with belief systems that clash with our own may be challenging (e.g., religious views)
- religion may be more important to the client than it is to you, and the client may want a religious leader to have a role in decision-making about health and treatment. How would you manage this?
- Explanatory models help explain why something has happened to a particular person. They also present ideas about the cause and course of problems and illness, and the effectiveness of treatments. These ideas may be significantly different from the models that have been part of our education and training
- Recognizing the client’s explanatory models will provide useful information about cultural health beliefs and possibilities for intervention (and possible barriers)
- SOCIAL ACTIVISM:
- As psychologists, we need to be active on social justice matters
- We recognize that discrimination, prejudice, and institutional oppression affects the health of individuals and groups and entire societies
- The APS Code is mainly silent on psychologists social responsibilities
Indigenous Australians are generally most disadvantaged in terms of quality of life and access to mental health services. Who are a second vulnerable population?
Asylum seekers, refugees and other mobile populations.
- Checklists of what to consider and do when interpreters are used to assists with provision of health services for refugees - checklists developed by Davidson and colleagues AND Procter AND Victorian Transcultural Psychiatry Unit
What was included in Procter’s (2005) checklist to assist emergency mental health nurses in building trust with refugee clients? (This checklist lends itself to adaption by psychologists).
- engagement of a suitable interpreter
- clarification of the client’s expectations
- the presenting problem
- the mental health worker’s role
- the services that will be provided
- outcomes that might be reasonable expected
- role of and support available for, associated parties such as family members
Working with these vulnerable populations often presents practitioners with extremely difficult dilemmas including.. ?
- there may multiple clients with competing interests
- duties of beneficence and non-maleficence towards clients conflict with their duties to employers, other professionals and law
- professional boundaries may be blurred by a sense of moral obligation personal and professionally to advocate for clients
What should practitioners do when working with vulnerable populations and extremely difficult dilemmas ?
- develop skills for self-monitoring
- examine their own personal values
- build and maintain a supportive network of collegiate relationships
- may need to seek personal therapy
- an ethical decision making framework that helps them weigh up their competing ethical responsibilities to clients, others and themselves
Cultural competence programs tend to incorporate at least 3 dimensions of cultural competence:
a) . awareness of ones own attitudes and beliefs
b) . knowledge about cultural differences
c) . skills in working with diverse groups
Research suggests what about cultural competence training?
- some evidence that it could improve patient/client outcomes, but objective evidence rare
Whats the mission of the APA Diversity Implementation Plan?
To ensure that diversity is an integral part of the APA structure and functions
- culture change is needed - at individuals as well as organisational levels
