Question
What are some recommendations for clinicians who make culturally competent assessments of behavioral health patients?
Answer
Creating a culturally competent assessment for a behavioral health patient involves a thoughtful and comprehensive approach. Listed and broken down below are five major elements to consider when assessing patients to ensure a culturally competent assessment.
- DSM and Cultural Formulation Interview:
- Cultural Formulation Interview: Use tools like the Cultural Formulation Interview to gather information related to culture. This interview helps in understanding cultural factors influencing the patient's mental health without assuming homogeneity.
- DSM Integration: Incorporate cultural considerations into the Diagnostic and Statistical Manual of Mental Disorders (DSM) assessment. This includes recognizing how symptoms may be linked to issues like racism, socioeconomic challenges, mass incarceration, and police violence.
- Frameworks for Culturally Competent Assessment:
- Use these acronym frameworks to guide your assessment, ensuring a comprehensive exploration of various cultural factors.
- RESPECTFUL Framework:
- R - Religious/Spiritual identity
- E - Economic class background
- S - Sexual identity
- P - Level of psychological maturity
- E - Ethnic/Racial identity
- C - Chronological/Developmental challenges
- T - Threats to well-being and trauma
- F - Family background and history
- U - Unique physical characteristics
- L - Location of residence and language differences
- ADDRESSING Framework:
- A - Age/generation
- D - Disability status (developmental)
- D - Disability status (acquired)
- R - Religion/spiritual orientation
- E - Ethnicity
- S - Socioeconomic status
- S - Sexual orientation
- I - Indigenous heritage
- N - National origin
- G - Gender
- Use of Other Scales and Tools:
- Utilize additional tools such as the Trauma Symptoms of Discrimination Scale, Everyday Discrimination Scale, UConn Racial/Ethnic Stress and Trauma Survey, and the Cultural Formulation Interview. These tools help in understanding discrimination, trauma, and the broader social environment's impact on mental health.
- Communication:
- Ask clients to describe their identity rather than making assumptions.
- Explore ideas, experiences, and beliefs to understand cultural and historical factors influencing mental health.
- Be aware of the historical context of therapy and its associations, considering cultural and familial pressures.
- Note in-group differences to avoid inaccurate assessments and racial bias.
- Resisting Avoidance and Discomfort:
- Resist avoiding gathering information due to discomfort. Move through discomfort to build meaningful connections.
- Consider using more structured interviews when discomfort is present to provide a starting point for gathering information.
By integrating these approaches, behavioral health professionals can conduct culturally competent assessments that consider the individual and collective factors influencing a patient's mental health, fostering a more effective and culturally sensitive therapeutic relationship.
This Ask the Expert is an excerpt from the course, Cultural Competency in Behavioral Health, presented by Sophie Nathenson, PhD.
