Cultural competence – transforming policy, services, programs and practice

This chapter discusses some of the complex issues surrounding the notion of cultural competence—and the critical need for practitioners to develop knowledge, skills, understandings and attributes to be responsive in diverse cultural settings. The argument for culturally competent mental health practitioners and services is situated within a human rights framework which underpins the principles, standards and practice frameworks intended to facilitate/contribute to the capacity and empowerment of mental health practitioners and clients, families and communities. The National Practice Standards for the Mental Health Workforce 2013 (the practice standards) outline core competencies (including cultural competence) regarded as essential for the mental health workforce: mental health nursing, occupational therapy, psychiatry, psychology and social work. The documented impact of these disciplines/professions on Aboriginal people requires new ways of working that are empowering, respectful and ethical. A case is made for the importance of practitioners providing more culturally inclusive and appropriate care to increase the likelihood that clients and their carers will experience a sense of cultural safety (as well as culturally appropriate services) for Aboriginal clients, their families and communities. The practice standards are complemented by professional guidelines and the National Standards for Mental Health Services 2010 (the service standards). This chapter provides a range of tools and strategies and a Critical Reflection Framework for Analysis to assist students or practitioners to adopt a critical standpoint in order to develop key competencies (knowledge, skills, attitudes and values) to be culturally respectful and effective in their practice in Aboriginal and Torres Strait Islander mental health. Equally important is the need for strategies for self-care and support such as mentoring, journaling, peer support, counselling and engaging in self-reflective, transformative practice.&nbsp

A qualitative exploration of the experiences of young people and their parents regarding the impact of missing school to attend hospital based orthodontic appointments

OBJECTIVE: To explore the experiences of young people and their parents regarding the impact on school performance due to time away from school for orthodontic appointments and to explore their views about a possible extension to the current service. DESIGN: Qualitative study using semi-structured interviews. SETTING: UK district hospitals. PARTICIPANTS: Eleven pairs of interviewees: Young people undergoing fixed appliances and their parents. METHODS: Semi-structured interviews were conducted with young people and their parents. The interviews were audio recorded and transcribed verbatim. A framework approach was used to analyse the data. RESULTS: Thematic analysis of the data identified five main themes which were (i) Expectations of the treatment process and appointments, (ii) Impact of school absences and treatment, (iii) Appointments, (iv) Implications for young people, parents, and others and (v) Satisfaction with treatment. These themes were then further subdivided and analysed. CONCLUSIONS: Thematic analysis of the data identified five main themes which were (i) Expectations of the treatment process and appointments, (ii) Impact of school absences and treatment, (iii) Appointments, (iv) Implications for young people, parents, and others and (v) Satisfaction with treatment. These themes were then further subdivided and analysed

Effective strategies to strengthen the mental health and wellbeing of Aboriginal and Torres Strait Islander people

Introduction: The purpose of this paper is to draw on Aboriginal and Torres Strait Islander (Indigenous) perspectives, theoretical understandings, and available evidence to answer questions about what is required to effectively address Indigenous people’s mental health and social and emotional wellbeing. Social and emotional wellbeing is a multifaceted concept. Although the term is often used to describe issues of ‘mental health’ and ‘mental illness’, it has a broader scope in that Indigenous culture takes a holistic view of health. It recognises the importance of connection to land, culture, spirituality, ancestry, family and community, how these connections have been shaped across generations, and the processes by which they affect individual wellbeing. It is a whole-of-life view, and it includes the interdependent relationships between families, communities, land, sea and spirit and the cyclical concept of life–death–life. Importantly, these concepts and understandings of maintaining and restoring health and social and emotional wellbeing differ markedly to those in many non-Indigenous-specific (or mainstream) programs that tend to emphasise an individual’s behavioural and emotional strengths and ability to adapt and cope with the challenges of life. This paper explores the central question of ‘what are culturally appropriate mental health and social and emotional wellbeing programs and services for Indigenous people, and how are these best delivered?’. It identifies Indigenous perspectives of what is required for service provision and program delivery that align with Indigenous beliefs, values, needs and priorities. It explores the evidence and consensus around the principles of best practice in Indigenous mental health programs and services. It discusses these principles of best practice with examples of programs and research that show how these values and perspectives can be achieved in program design and delivery. This paper seeks to provide an evidence-based, theoretically coherent discussion of the factors that influence the effective development, implementation and outcomes of initiatives to address Indigenous mental health and wellbeing issues. It seeks to assess whether the current investment in Indigenous people’s mental health is aligned with available evidence on what works. To this end, the paper reviews Australian literature and government health, mental health and social and emotional wellbeing policies and programs. The scope of programs and their criteria for inclusion in this paper are informed by the Key Result Area 4, Social and Emotional Wellbeing objectives, within the National Strategic Framework for Aboriginal and Torres Strait Islander Health 2003–13: Australian Government Implementation Plan 2007–2013. This paper acknowledges the holistic nature of health, mental health and wellbeing, and the effects of Australia’s colonial history and legacy on the contemporary state of Indigenous social and emotional wellbeing. It recognises that there is a complex relationship between social and emotional wellbeing, harmful substance misuse, suicide, and a range of social and economic factors. Although this paper encompasses the broad priorities identified within the key Indigenous mental health policies and frameworks, it does not provide a detailed discussion of programs and resources that, although relevant here, are covered in a number of existing Closing the Gap Clearinghouse resource sheets and issues papers (see Appendix 1). These interweavings and overlaps are not surprising given the complexity and interconnectedness of the issues and determinants that are being addressed to strengthen Indigenous mental health and wellbeing

Principles of practice in mental health assessment with Aboriginal Australians

In this chapter, concepts and history of assessment and testing in the context of Aboriginal and Torres Strait Islander social and emotional wellbeing and mental health are discussed. Importantly, recently revised diagnostic guidelines and the National Practice Standards for the Mental Health Workforce 20131 and their appropriateness for meeting the distinctive needs of Aboriginal people are reviewed. Various assessment tools and measures that have been validated or proved appropriate for use with particular Aboriginal populations, i.e. youth, women and older people, are described. We conclude that practitioners need to be critically reflective in their role in assessment, and position themselves to play an important transformative role in conducting assessment. This extends to acknowledging and enacting culturally responsive principles, procedures and practices to ensure that Aboriginal people have access to effective, culturally secure mental health care

Facilitating empowerment and self-determination through participatory action research:Findings from the national empowerment project

The National Empowerment Project (NEP) is an innovative Aboriginal-led community-based project. Since 2012, it has been working with communities in 11 sites across Australia to develop a culturally appropriate health promotion and primary prevention intervention strategy to reduce the high rates of psychological distress and suicide among Aboriginal and Torres Strait Islander peoples. The NEP is built around the use of localized participatory action research (PAR) processes to support communities to identify key factors negatively impacting on their lives as well as strategies for promoting well-being and building resilience. This article details the application of the PAR approach by the NEP Aboriginal community-based researchers. It provides some unique insights into how PAR facilitated communities to have a voice and the ways in which it supported important change processes at both an individual and a community level

Early Vocabulary Development of Australian Indigenous Children: Identifying Strengths

The current study sought to increase our understanding of the factors involved in the early vocabulary development of Australian Indigenous children. Data from the Longitudinal Study of Indigenous Children were available for 573 Indigenous children (291 boys) who spoke English ( = 37.0 months, = 5.4 months, at wave 3). Data were also available for 86 children (51 boys) who spoke an Indigenous language ( = 37.1 months, = 6.0 months, at wave 3). As hypothesised, higher levels of parent-child book reading and having more children’s books in the home were associated with better English vocabulary development. Oral storytelling in Indigenous language was a significant predictor of the size of children’s Indigenous vocabular

Social determinants of Aboriginal and Torres Strait islander social and emotional wellbeing

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Assessing The Validity Of A Culturally Modified Drinking Motives Questionnaire For Use In Aboriginal Communities

Alcohol related harms disproportionately affect Aboriginal people in Australia. Motives to drink have been identified as the most proximal factor to alcohol consumption.The aim of this study is to assess the validity of a culturally modified Drinking Motives Questionnaire-Revised (DMQ-R) (Cooper, 1994) with Aboriginal participants. The study was cross sectional, utilising data collected via face-to-face surveys with a sample of adult Aboriginal participants. A convenience sample of 135 Aboriginal men (n=41) and women (n=94) from the Pilbara Region of Western Australia, who had consumed alcohol in the preceding 12 months. The Culturally modified DMQ-R (CDMQ-R) developed in consultation with Aboriginal community researchers and a local Aboriginal Community Reference Group was the primary outcome measure for this study. Confirmatory Factor Analysis indicated the four-factor model of drinking motives as measured by a culturally modified DMQ-R was valid for use with Aboriginal people of the Pilbara region. While most items loaded on the factor solution as hypothesised, there were some minor discrepancies which suggest further modification may be needed. In addition, the reduction of the original five-point scale to a three-point scale created statistical challenges. Future research might seek to further refine the DMQ-R for this population and determine an appropriate method for expanding the response scale incorporating advice from Aboriginal people

An Evaluation of the National Empowerment Project Cultural, Social, and Emotional Wellbeing Program

 An array of cumulative risk and stress factors, and social inequities, have contributed to high suicides and family and community dysfunction, in two communities in Queensland. An independent, post-program evaluation of the National Empowerment Project (NEP) Cultural, Social and Emotional Wellbeing (CSEWB) Program specifically developed to address these issues was conducted in Kuranda and Cherbourg communities, Queensland in early 2017. Summaries of 153 stories of most significant change (SMSC) and 30 interviews undertaken with participants who completed the CSEWB program informed the evaluation. The evaluation assessed if, and how, the CSEWB program contributed to strengthening the cultural, social, and emotional wellbeing of participants, their families and communities. Participant’s interviews describe how the CSEWB Program significantly changed their lives and their families’ lives in various constructive and affirming ways to bring about positive outcomes. The extent of significant changes reported are compelling, and they highlight the need for greater government commitment to services and programs which address the social determinants influencing social and emotional wellbeing (SEWB) within Indigenous communities around Australia

Psychosocial Risk Factors in Disordered Gambling: A Descriptive Systematic Overview of Vulnerable Populations

Background: Gambling is a behaviour engaged in by millions of people worldwide; for some, gambling can become a severely maladaptive behaviour, and previous research has identified a wide range of psychosocial risk factors that can be considered important for the development and maintenance of disordered gambling. Although risk factors have been identified, the homogeneity of risk factors across specific groups thought to be vulnerable to disordered gambling is to date, unexplored. Methods: To address this, the current review sought to conduct a systematic overview of literature relating to seven vulnerable groups: young people and adolescents, older adults, women, veterans, indigenous peoples, prisoners, and low socio-economic/income groups. Results: Multiple risk factors associated with disordered gambling were identified; some appeared consistently across most groups, including being male, co-morbid mental and physical health conditions, substance use disorders, accessibility and availability of gambling, form and mode of gambling, and experience of trauma. Further risk factors were identified that were specific to each vulnerable group. Conclusion: Within the general population, certain groups are more vulnerable to disordered gambling. Although some risk factors are consistent across groups, some risk factors appear to be group specific. It is clear that there is no homogenous pathway in to disordered gambling, and that social, developmental, environmental and demographic characteristics can all interact to influence an individual’s relationship with gambling