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Week3 - Week$3$$ Assessment$con-nued$and$Cultural$...

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Unformatted text preview: Week$3$$ Assessment$con-nued$and$Cultural$ Formula-on$ EXAM 1: 4/21 1 hour, 32 M/C, 3 Essay Questions Ethnic$Iden-ty$development$ •  Ethnic$iden-ty$diffusion$(Lack$of$clear$iden-ty)$ •  Foreclosure$(commitment$without$ explora-on)$ •  Moratorium$(Period$of$exploring)$ •  Achievement$(commitment$based$on$ explora-on)$ making opinions on your background, whether you like or dislike it, the importance it may have on your life Impact$of$Ethnic$Iden-ty$ •  Discrimina-on$associated$with$greater$odds$of$serious$ psychological$distress$regardless$of$aHribu-on$(racial/nonJ racial)$ –  $High$racial$group$iden-fica-on$buffered$the$nega-ve$effect$of$ moderate$levels$discrimina-on$$$(Chae$et$al.,$2011)$$ •  Asian$Americans$who$reported$unfair$treatment$had$higher$odds$of$ alcohol$abuse/dependence.$$$ –  Low$Ethnic$iden-ty$and$racial$discrimina-on$associated$with$alcohol$ use$(Chae$et$al,.,$2008)$ –  MetaJanalysisJSeveral$outcomes$were$strongly$related$to$ethnic$iden-ty$ like$selfJesteem,$quality$of$life,$social$connectedness,$sa-sfac-on$with$life$ (r"=$.21,$Z$=$8.58),$and$selfJefficacy$ Standardized$tests$ •  Examples$ •  What’s$the$problem?$ Problems$with$Standardized$tes-ng$ there is concern because the normative sample is not diversified, so we do not know if results can be generalized or externally valid across cultures or racial groups •  Who$is$the$norma-ve$sample$ •  Research$sugges-ng$bias$on$some$measures$ –  Lacking$cross$cultural$equivalence$$ •  Tests$based$on$western$constructs$ Consider$case$of$Intellectual$Abili-es$$ •  Difference$between$academic$and$prac-cal$ intelligence$(increase$with$tacit$knowledge/ common$sense)$ –  Tacit$knowledge$is$ac-on$oriented,$prac-cal,$ acquired$without$help$of$others$$ –  Is$one$more$important$than$the$other?$ An$ideographic$approach$$ •  Skills$and$knowledge$used$to$assess$a$client’s$ func-oning$are$those$considered$important$ for$that$person$and$his/her$environment$ •  Is$this$enough?$$ Culture and upbringing may influence the development of various skill sets and acquired knowledge based on various tasks Formal$ways$to$decreasing$bias$ •  Restandardiza-onJnew$norms$based$on$ more$representa-ve$samples$ •  Create$new$tests$from$boHom$up$ •  Use$an$index$of$correc-on$for$culture;$the$ greater$the$accultura-on$difference$ between$person$and$standardiza-on$ sample,$greater$the$correc-on$ •  Add$strategies$to$supplement$exis-ng$ standardized$tests;$“tes-ng$the$limits”$$$ Pros: More representative measure of various disorders and diagnosis across cultures and individuals Cons: more socio-cultural factors to measure, standardization is lost Mini$Mental$Status$Examina-on$$ •  Do$you$have$any$concerns$about$fairness$of$ any$of$the$ques-ons$for$different$ethnic$ groups.$$ Ways$to$address$MMSE$bias$ •  Involve$a$cultural$consultant$ •  Understand$individuals$sociocultural$upbringing$ •  Verbal$abili-es$such$as$naming,$word$genera-on$ and$verbal$memory$may$not$represent$func-onal$ abili-es;$may$be$beHer$to$ask$about$rou-nes$ •  Choose$significant$events$in$person’s$life$rather$ than$dates$ •  Test$the$limits$ Test$the$limits$ •  Tes-ng$the$limits$–go$beyond$standardiza-on$ to$test$possible$reasons$for$poor$performance$$ –  Can$explore$why$item$was$missed$ –  Assess$impact$of$-me$pressure$ –  Give$them$correct$answer$and$see$if$they$ understand$explana-on$$ –  Other$reasons,$anxiety,$fa-gue,$disinterest,$pain$ –  Test$in$both$languages$$ –  ADDRESSING$influences$ Patient care can falter if the incorrect language interpreters or assistance is used. This miscommunication can lead to drastic issues in diagnosis and understanding. Projec-ve$tests$ •  Thema-c$ Appercep-on$tests$ •  Rorschach$$$ psychoanalytic treatment that looks at the subjective, unconscious experience of a patient TEMASJTell$me$a$story$ •  Projec-ve$test$for$culturally$and$ linguis-cally$diverse$children$ and$adolescentsJJJcultural$ iden-ty$of$characters$makes$a$ difference$in$client’s$responses$ Consider$symptoms$and$scores$in$their$ ….context$ •  •  •  •  •  •  •  Bio$ Psycho$ Social$ Cultural$ Historical$ Poli-cal$ Linguis-c$$ Complex interaction to evaluate in order to produce most applicable and efficient treatment for patients Recommenda-ons$for$crossJcultural$ standardized$assessments$ •  Tes-ng$environment$is$culturally$sensi-ve$ •  Conduct$clinical$interview$in$conjunc-on$with$ standardized$tes-ng$$ •  Transla-ons$should$have$validity$and$ reliability$ •  WriHen$report$should$include$informa-on$on$ poten-al$cultural$biases$in$the$test$and$tester,$ and$in$tester’s$interpreta-ons$ Implica-ons$for$Clinical$Prac-ce$ Infuse$cultural$competence$into$assessment$ Evaluate$ones $cultural$competence.$ Infuse$cultural$issues$into$intake$interviews.$ Do$not$stereotype$clients$or$overgeneralize$based$ on$the$informa-on$presented$in$the$text.$ •  Clients$must$be$viewed$in$their$totality,$as$unique$ individuals.$ •  •  •  •  DSM$AND$CULTURAL$ FORMULATION$INTERVIEW$ DSM$ •  Historically$diagnoses$have$been$EuroJcentric$ and$based$on$western$norms$$ •  Previously$has$used$the$appendix$to$list$50$or$ so$“culture$bound$syndromes”$ –  Somewhat$rare$and$exo-c$$ •  Limited$guidance$about$how$to$interpret$ devia-ons$in$symptoms$ –  Biopsychosocial$model$ instead of culture-bound syndromes, DSM institutes cultural concepts of distress because these symptoms appear in some other cultures as well Cultural$Psychiatry$(Jacob,$2014)$$ •  Proposes$that$universal$categories$presented$ by$the$DSM$are$inappropriate$and$cannot$be$ understood$unless$one’s$culture$and$context$is$ also$understood$$$ •  There$is$much$heterogeneity$within$diagnos-c$ categories$$ •  More$focus$on$personJcentered,$ biopsychosocial$model$is$necessary$ •  Requires$a$shared$collabora-ve$approach$ Cultural$Formula-on$Interview$$ •  For$ALL$pa-ents$with$ALL$disorders$ •  Semi$structured$interview$ •  PersonJcentered$because$it$tries$to$get$ informa-on$from$individual$about$their$views$ and$the$views$of$others$in$their$social$network$ •  Intended$to$be$used$as$an$adjunct$to$a$diagnos-c$ interview$and$in$conjunc-on$with$demographic$ ques-onnaire$$$ •  Supplementary$modules$are$available$for$the$ elderly,$children,$refugees,$immigrants$etc.$$ - There are many aspects of culture beyond ethnicity, and these events have an effect on psychopathology. - This interview gives supplementary information that should be evaluated in addition to diagnostic and demographic criteria CFIJFour$Domains$ –  1)$Cultural$defini-on$of$the$problem$$ –  2)$Cultural$Percep-ons$of$Cause,$Context,$and$Support$ (causes,$stressors,$supports,$role$of$cultural$iden-ty)$$ –  3)$Cultural$factors$affec-ng$selfJcoping$and$past$help$ seeking$(also$barriers)$ –  4)$Cultural$factors$affec-ng$current$helpJseeking$$ (preferences$for$treatment,$clinicianJpa-ent$ rela-onship)$ •  Ques-ons$extend$to$religion$and$spirituality,$and$ other$cultural$groups$ Explanatory$models$of$illness$$ •  Kleinman$1980$ –  Ideas$about$onset,$causes,$mechanisms,$course,$ and$treatment$expecta-ons$ –  Explanatory$model$interview$catalogue$–$a$ research$tool$to$assess$these$narra-ves$ CFIJGoals$ •  Helps$to$avoid$reducing$pa-ent’s$history$to$ symptoms$by$developing$illness$narra-ves$$ •  To$avoid$misdiagnosis$$ Patient have a story behind every diagnosis that demonstrate their current state of being •  Improve$validity$of$assessment,$inform$ treatment$planning,$and$promote$sa-sfac-on$ and$engagement$ •  Decrease$bias$and$stereotyping$ $ Results$from$Feasibility$Trials$ N$=$321$pa-ents$across$5$sites$in$US,$Peru,$Canada,$Netherlands,$ Kenya,$India$ •  15J20$minutes,$followed$by$standard$evalua-on$$ Results$ •  Some$data$to$suggest$that$this$CFI$has$resulted$in$low$rates$of$ misdiagnosis$of$psycho-c$disorders$in$immigrants$(Adeponle,$etal$ 2012)$ •  Improves$interrater$reliability$(Zandi$et$al.,$2008)$ •  Barriers:$$ –  Similar$to$other$intake$procedures,$too$much$discussion$of$past,$and$ unclear$wording$of$ques-ons$ –  Logis-cs$of$delivery,$extra$-me,$length$and$training,$redundancy$ Cultural$Formula-on$interview$ DSM$Cultural$Concepts$of$Distress$ Ways$that$people$understand$and$experience$their$illness$as$well$as$ communicate$their$symptoms$ •  Cultural$Syndromes:$clusters$of$symptoms$that$tend$to$coJoccur$in$ a$specific$cultural$group$and$are$recognized$as$a$coherent$paHern$ of$experience$ •  Cultural$Idioms$of$Distress:$ways$of$expressing$distress$that$may$ not$involve$specific$symptoms$or$syndromes$but$provide$a$ collec-ve,$shared$ways$of$experiencing$or$talking$about$personal$ concerns$“I’m$depressed”$“I’m$stressed$out”$“I’m$having$trouble$ with$my$nerves”$ •  Cultural$ExplanaCons:$indicate$culturally$recognized$meaning$or$ e-ology$for$symptoms,$illness$or$distress$ CULTURE$BOUND$SYNDROMES$HAVE$BEEN$REPLACED$ Cultural$Concepts$of$Distress:$ Syndromes$ •  Khyal$or$“wind$aHacks”$–Symptoms$include$panic$aHacks,$ anxiety,$-nnitus,$neck$soreness,$catastrophic$cogni-ons$that$ khyal$may$rise$in$the$body,$along$with$blood$and$cause$serious$ effects$(compress$lungs$to$cause$shortness$of$breath,$enter$ cranium$to$cause$-nnitus,$dizziness,$blurry$vision).$$Thought$to$ be$triggered$by$worrisome$thoughts,$standing$up$too$quickly,$ odors,$agoraphobic$cues.$$$ –  Cultural$Syndrome$among$Cambodians$ Idioms$of$distress$ •  NerviosM$general$state$of$vulnerability$to$stressful$life$ experience$and$to$difficulty$life$circumstances.$$Includes$a$ range$of$symptoms$of$distress$like$headaches,$neck$pain,$ irritability,$stomach$problems,$sleep$problems,$nervousness,$ trembling,$dizziness$etc.$ –  Idiom$of$distress$among$La-n$Americans$ Cultural$Explana-on$ •  Kufungisisa—thinking$too$much$among$the$Shona$of$ Zimbabwe.$$Causes$anxiety,$depression$and$soma-c$ problems.$$Usually$individual$interpersonal$and$social$ problems.$$$ –  Brain$fag$in$Nigeria$(studying$too$much)$ •  Maladi$moun$(“sent$sickness”)JHai-.$$Interpersonal$envy$and$ malice$cause$people$to$harm$their$enemies$by$sending$ illnesses$such$as$psychosis$and$depression.$$People$who$are$ aHrac-ve,$intelligent$or$wealthy$are$perceived$as$very$ vulnerable.$ Key$features$of$concepts$of$distress$$ •  They$do$not$have$a$1:1$correspondence$with$a$ DSM$disorder$ –  But$osen$share$features$in$common$with$many$ disorders$ –  E.g.$nervios$ •  There$is$a$wide$range$of$severity;$some$that$ would$not$be$considered$“clinical”$$ •  Cultural$concepts$change$over$-me$$ ...
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