Final Draft

 

 

 

 

 

 

 

 

 

Our names will be in alphabetical order

12/7/2008

 

 

 

 

What impact does ethnicity have on the evaluation process? K.H. Barrett (2005) provides much for the multicultural clinician to ponder as they prepare for conducting competent assessments of individuals from other cultures. Multiculturally competent practices require that we consider knowledge of our own cultural milieu, that we have knowledge of our client's cultural background and his the history and present condition of their cultural background, and that we possess the skills necessary to competently address the needs of a client with a diverse background (Sue, et al., as cited by Sodowsky, Taft, Gutkin & Wise, 1994).

Indeed, the clinician has to take a considerable amount of information into account in order to practice appropriately, and to fulfill their ethical responsibilities of benefice and to ensure that the client is treated in a manner consistent with our professional obligations.

The clinician must learn to recognize how sociodemographic variables such as race, culture, gender, religious affiliation, linguistic background, sexual orientation, age, and disability may influence the life of the client and the life and practice of the evaluator, including subsequent interactions in the evaluation process (Barrett, K.H., 2005, p. 109).

According to Barrett, it is important to understand how culture has influenced the following: the practice of psychotherapy, psychological assessments, diagnostic standards, and concepts of normality. As K.H. Barrett suggests, the practitioner needs to spend significant time preparing for the cross-cultural evaluation. She suggests the following:

Prepare to become culturally competent practitioners

• Read the relevant literature
  
• Make sure you understand the professional ethical standards that are applicable to multicultural competency
  
• The clinician must consider whether he or she is the best person to conduct the evaluation, given the range of differences in background between him- or herself and the client.
  
• The clinician should seek appropriate education and consultation to facilitate work from a multicultural perspective (if there is a lack of availability of professionals that are more qualified by virtue of their professional training and their cultural, racial, or ethnic similarities to the client)
  

Accepting a Referral

• Evaluate level of knowledge
  
• Evaluate level of experience
  
• Evaluate interpersonal comfort in working with a client of a particular racial, ethnic, or cultural background
  

Client I:

 Once we decided to accept the referral, we then needed to determine the purpose for evaluating the client. Barrett advises us to first determine the scope and purpose of the evaluation. Further, we also want to ensure that the client is comfortable with the meeting place and if necessary has an interpreter. Once the client's needs have been taken into consideration, Barrett details the great extent to which we must commit to developing competency with our particular client.

In our evaluation, we were conducting an assessment of an Ethiopian male, Omar. He immigrated to the United States three years ago, and has resided here in a segregated, same race community. In order to practice cross-cultural competence, according to the APA, "multiculturally sensitive and effective therapists are encouraged to examine traditional psychotherapy practice interventions for their cultural appropriateness…" (Bernal & Scharoon-del-Rio, 2001, as cited by the APA, 2002, p. 50).

Without proper consideration of the Omar's culture, we risk committing malfeasance and providing the client with incompetent counsel. As indicated, we need to recognize the central role that a Omar's worldview and cultural perspective have in the his life, as "…it should be clear then that the Worldviews Paradigm lies at the very heart of the analysis and must not be separated from it" (Kambon, K.K., 1998, p. 20).

The following is based directly on the work of K.H. Barrett in her chapter entitled, "Guidelines and Suggestions for Conducting Successful Cross-Cultural Evaluations for the Courts," and many of the questions we ask of ourselves and our client are taken directly from her work, and she should be credited for the vast contribution her work has made to our project.

Preparing for the Evaluation: The Clinician

Take the necessary steps to have knowledge of the culture, the impact that the culture will have on the evaluation process, and the skills needed to conduct a culturally competent evaluation. Clinicians must ask themselves, "have I conducted a literature search in order to gain background information about Ethiopians, particularly since immigrants from Ethiopia are a newer phenomenon and not particularly common to the U.S.?" and "have I consulted appropriately in this regard." Further preparations should include: review of case records, ascertaining the cultural style of communication, acknowledging the stresses inherent in the evaluation and legal process, clarifying the role of the evaluator in the evaluation process

The Initial Interview

The subject of the following questionnaire is an adult male from a minority group who emigrated to the U.S. from Ethiopia and has been in the U.S. for three years. The man lives in a segregated, same-race community. According to the Barrett article, there are certain questions one would want to consider when developing a questionnaire for a person who is not of the dominant culture. The following questions are based on the guidelines from the Barrett article;

1. Omar, what were your reasons for coming to the United States from Ethiopia?
   Do you feel accepted in your community? You live in a community that is predominately-African immigrant; does that help you establish a sense of culture in the United States?
   
2. What ethnic groups do you associate with in the US and in what way do you associate with these groups?
   
3. Do you consider yourself an African American? Do you feel there is a distinction between yourself and American born persons who have African descent?
   What languages do you speak in your household? Do you speak these languages outside your household?
   
4. Have you experienced discrimination in the United States?
   
5. Do you feel connected to your homeland?
   
6. Do you still have family members in Ethiopia?
   
7. Do you feel your cultural background has been challenged in any way since coming to the United States? Is the culture different from the one you came from in major ways?
   
8. Have your family members been sick mentally or physically after the immigration to the United States? Did they receive treatment for illnesses? Is treatment easy to obtain in your community?
   
9. On a scale of 1 to 10, with 1 being the lowest and 10 being the highest, how would you rate your financial security at this time? Do you think that will change in the future?
   
10. On a scale of 1 to 10, with 1 being lowest and 10 the highest, how would you rate your chances of being socially comfortable in the United States?
    
11. What does it mean to be Ethiopian?
    
12. What does it mean to be African?
    
13. Have there been any problems with legal residency status or difficulty with citizenship applications?
    
14. Do you engage in any hobbies, sports or positive leisure activities?
    
15. How do you cope with stress?
    
16. What outlets do you have to release the pressures that result from your current legal situation?
    
17. What steps do you take to problem-solve? Please describe.
    
18. What are your goals for the future?
    
19. What have been the losses and disappointments as a result of moving here?
    
20. What traditions, either ethnic or religious, do you celebrate?
    
21. Do you understand the U.S. judicial system?
    
22. Have you and your family found a religious community here that fits with your background?
    
23. Have you ever felt ridiculed, criticized, or excluded because of your skin color, facial features, accent, or ethnic background?
    
24. What is the highest level of education you have completed? Have there been any difficulties in your education? Describe.
    
25. Have you ever rejected your Ethiopian identity, values or traditions?
    
26. Does Ethiopian culture provide spiritual explanations for mental illness, such as angry spirits, spirit voices, and possession by evil spirits?
    
27. What values are most important to you at this time in your life?
    
28. Are there any particular cultural or ethnic traditions or customs that you practice on a regular basis?
    
29. Have you been able to learn about community agencies and services such as health care, social services, counseling, youth activities, and the like?
    
30. Have you ever received a mental health diagnosis?
    
31. Have you ever had a history of drug or alcohol abuse?
    
32. Do you participate in any community organizations specific to your Ethiopian background?
    
33. What percentages of your friends are from your ethnic group?
    
34. What have been the gains and benefits of moving to the United States?
    

Content of the Next Meeting

Determine whether the client needs to divulge difficult questions, assessment of symptoms, and discussions of traumatic material for the second meeting, unless it seems as though the client is comfortable and at ease in the first meeting.

• Begin with an in-depth developmental history
  
• Make sure that the client feels comfort and trust, and doesn't sense disrespect, intimidation, impatience, racism, or disregard for his or her cultural background. This will facilitate the sharing of information.
  

 Assessment of Symptoms

• Determine whether structured interviews or questionnaires are appropriate by determining whether their language or descriptions of symptoms fit with the linguistic and cultural framework of the client's worldview or representational systems.
  
• Determine background information on how mental health symptoms are expressed in the culture of my client.
  
• Use culturally appropriate language on assessments
  

Debriefing

• Conduct a short debriefing, inquiring as to whether my client feels as though there is any information that they wish to add.
  
• Ask the client if they have any questions or feedback about the process or content of the evaluation.
  
• Offer long-term treatment recommendations that appear in reports as relevant.
  
• Re-clarify the purpose of the assessment at each meeting
  
• Ask for questions and comments
  
• Arrange an appointment to review the final results, conclusions, recommendations, report and testimony that will be presented, as this will be very important to the client and may not be shared by the attorney, and to do this prior to my court appearance.
  
• Explain diagnostic conclusions and psychological terminology to the client, so they better connect my conclusions to their experiences and perceptions of their problems, which is vital if the client will be asked about them in court.
  

Client II:

Prior to conducting a questionnaire it is essential that the clinician prepare for the client as well as himself/herself for the meeting. The clinician should spend time reflecting on their own racial and cultural identity, and how their values, experiences, and culture bias may influence their role in this evaluation. The clinician should determine what purpose this evaluation is going to serve, and if their own history would sway the outcome of the assessment.

Once the clinician determines they will be able to evaluate their client without bias, they should prepare the client for the evaluation; make sure the client understands the purpose of this evaluation, how long the evaluation will be, make sure the client knows correct directions, and offer empathy for their situation in case they had reservations about coming for this evaluation. In this particular case the clinician would make sure the 7 year old girls aunt or uncle knew all of the information normally told to the client. I would also ask them to come with any medical/family history information that might be useful.

Sasha is seven years old. Sasha, and her brother and sister moved to America from Russia three years ago (when Sasha was four years old) and lived with their aunt. One year ago their parents moved to America from Russia. In accordance with the APA Code of Ethics, Section 9:3, "(a) Psychologists obtain informed consent for assessments, evaluations, or diagnostic services, as described in Standard 3.10 …..". In this case we would obtain consent from the minor's Aunt and Uncle.

QUESTIONNAIRE

Family and Developmental History

1. Hi Sasha, I am going to ask you a few questions, okay?
   
2. Can you tell me a little bit about your family?
   
3. Who do you live with right now?
   
4. Is it fun living with your aunt and your parents?
   
5. Do you know how long your aunt has lived here?
   
6. Do you miss Russia?
   
7. Do you think that your brother and sister miss Russia?
   
8. Did you live by a lot of family in Russia?
   
9. Tell me what your family and home was like before.
   
10. Tell me about how you celebrated birthdays in Russia.
    
11. When is your birthday?
    
12. Did you grow up around a lot of other kids?
    
13. What kind of things did you do for fun?
    
14. Is school in America a lot a like school in Russia, or is it very different?
    
15. What is your favorite part about school in America, and what was your favorite part about school in Russia?
    

Current Family Life

1. Who do you live with here?
   
2. Do you like your new home?
   
3. Is living here a lot different from living in Russia?
   
4. Do you share a bedroom with anyone? (Who?)
   
5. Who do you spend the most time with in your family?
   
6. What happens when you are very helpful, or do a good job with schoolwork?
   
7. What happens if you and your brother or sister gets into an argument?
   
8. Does your mommy and daddy will like where you live? And where you go to school?
   
9. If you needed help with homework when you were in Russia, who would have helped you?
   
10. Who helps you with your homework now?
    

Immigration and Acculturation

1. Do you know why you and your family decided to move to America?
   
2. Do you remember how long ago you moved here?
   
3. How did you move from Russia to America, did you fly or take a boat?
   
4. When did your parents move here?
   
5. Was moving here hard for you, and your brother and sister?
   
6. Were the kids in your class nice to you when you first moved here?
   
7. Are kids in your class/school nice to you now?
   
8. Who are your best friends at school?
   
9. What do you think the toughest part of coming to America was? (probe: leaving friends at home, learning English, etc)
   
10. Was it difficult to come to America without your mom and dad?
    
11. Do you think your mom and dad are happy your family moved here?
    

Experience with Racism and Ethnic, Cultural and Racial Identity

1. Does anyone ever say anything not nice to you because you are from Russia?
   
2. What kinds of things do they say to you?
   
3. How often do they say these things?
   
4. How does it make you feel when someone says something mean to you?
   
5. What do you do when someone says something about Russia, or you being from Russia?
   
6. Are most of your friends from Russia too?
   
7. Do you have friends that are American, or from other groups?
   
8. Sasha, do your Aunt and Uncle like to visit your school? Are they friends with other parents and relatives at school?
   
9. Can you tell me what language you speak at home with your Aunt and Uncle and your brothers and sisters?
   
10. Can you describe to me some of the traditions you brought from Russia and do here in America?
    
11. Do you do any of the American traditions in your Aunt and Uncles home with your sisters and brothers? Is this OK with your Aunt and Uncle?
    
12. Do you feel any different about your Aunt and Uncle than older people in Russia?
    

 

 

Client/Family Health and Mental History

1. Sasha, have you and your brothers and sisters been healthy since you moved here to your Aunt and Uncles house in America?
   
2. Do you get along with your brothers and sisters the same way you did before you moved here?
   
3. Does anyone in your family go to a counselor?
   
4. Sasha, do you know where to go in your neighborhood if you needed help or wanted to talk to someone other than your family?
   
5. Is it very hard to be here waiting for your parents to come to America or do your aunt and Uncle make it easier?
   
6. Do you belong to any clubs at school or in the neighborhood?
   
7. Educational and Employment History
   
8. Did you and your brothers and sisters go to school before you moved here? What was it like?
   
9. Do you like your school here? What is your favorite class?
   
10. Did you have good food to eat and nice clothes to wear in Russia? Can you tell me about them?
    
11. Can you tell me about your home?
    
12. Does your father have a job in Russia? Did you and your brothers and sisters have a job before you moved here? Were the people nice that your family worked for?
    
13. What kinds of jobs do your Aunt and Uncle have?
    
14. Presenting Concerns, Stresses, and Current Status
    
15. Do you like the people that you see when you go shopping? Are they nice to you and your brothers and sisters?
    
16. Do you feel that America is your home now? Do you feel like you are part of America?
    
17. Sasha, if there were anything you could change right now, what would those things be?
    
18. On a scale of 1 to 5 Sasha, 1 being not very happy to 5 meaning very very happy…how happy do you feel?
     
    

     
     

 

 

REFERENCES

American Psychological Association (2002). Guidelines on Multicultural Education,
    Training, Research, Practice, and Organizational Change for Psychologists. Retrieved     December 06, 2008 from http://www.apa.org/pi/multiculturalguidelines.pdf

Barrett, K.H. (2005). Guidelines and suggestions for conducting successful cross cultural     evaluations for the courts. In K.H. Barrett & W. H. George (Eds.), Race,     culture, psychology & law (pp.107-123). Thousand Oaks, CA: Sage.

Kambon, K. K. (1998) The Worldviews Paradigm: On the Legitimacy of Cultural     Differences     in Psychological Analysis. The African Personality in America: An African-Centered     framework. Tallahassee, FL: Nubian Nation Publications

Sodowsky, G. R., Taffe, R. C., Gutkin, T. B., & Wise, S. L. (1994). Development of the     multicultural counseling inventory: A self-report measure of multicultural competencies.     Journal of Counseling Psychology, 41(2), 137-148.