Review of Screening and Assessment Tools

Several recent articles listed below have reviewed tools that have been culturally validated, or adapted for use with Aboriginal and Torres Strait Islander people and tools being used without specific adaptation. These screening and assessment tools include structured or semi structured diagnostic interviews, survey and self-report questionnaires, measures of treatment outcome, and qualitative approaches.

References

Adams, Y., Drew, N., & Walker, R. (2014).  Principles of Practice in Mental Health Assessment with Aboriginal Australians. In P. Dudgeon, H. Milroy & R. Walker (Eds). Working together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice (2nd ed.),(Ch. 16) (pp. 271-288). Canberra, ACT: Commonwealth of Australia.

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.

Black, E. B., Toombs, M. R., & Kisely, S. (2018). The cultural validity of diagnostic psychiatric measures for Indigenous Australians. Australian Psychologist53(5), 383–393. https://doi.org/10.1111/ap.12335

Objective: There is limited research available regarding the prevalence rates of psychiatric illness in Indigenous Australians, and the available literature varies widely in terms of methods and findings. Culturally valid and appropriate tools are needed to ensure accurate outcomes. The purpose of this review is to examine the methods used to diagnose psychiatric disorders in Indigenous Australians and identify whether these are culturally appropriate or valid. Method: A systematic search of available literature was undertaken in electronic databases (PubMed, Scopus, PsycInfo, PsycArticles, Web of Science, Medline, and Informit Health Indigenous Australians Peoples Collections). Narrative synthesis was used to analyse the data obtained, with a quantitative evaluations of study quality and cultural validity. Results: Twelve articles were included for review. Six studies were of diagnostic tools and none had been validated for use with Indigenous Australians. Another six used practitioner assessment. Some studies indirectly referenced cultural competence on behalf of the practitioner, but again on the whole this was lacking. Conclusions: Further validation of the use of diagnostic instruments in Indigenous Australians is needed so that the prevalence of psychiatric disorders in this population can be accurately determined. In addition, practitioners working with Indigenous Australians should have some training in cultural awareness or competence, and consider the cultural appropriateness of diagnostic tools when applied to this population.

Kotz, J., & Robinson, M. (2018).‘Baby Coming – You Ready?’ An audacious innovation to perinatal social and emotional wellbeing assessment screening and supportive management for vulnerable parents-to-be. Women and Birth, Volume 31, Supplement 1, (Page S3)
Introduction: ‘Baby Coming – You Ready?’ is an audacious innovation to perinatal social and emotional wellbeing assessment screening and supportive management for vulnerable parents-to-be. This digitalised screening rubric, called ‘Baby Coming-You Ready?’, uses touch screen images to provide an engaging culturally safe solution to the many barriers to effective screening and primary prevention currently faced by both non-Indigenous service providers and Indigenous women. It has been developed through a strong collaboration between Aboriginal Australians, midwives, child health nurses and researchers through the participatory action research (PAR) called Kalyakool Moort- Always Family. Indigenous Australians are historically cautious, acute observers and frequently over-ridden in research and health care processes. Embarking on PAR and adopting an Aboriginal world view in the research process has seen a curious interface of cultures that is both complex and challenging. However, it has been critical to its success. Aim: This paper describes this process which resulted in a solid effective research structure, a commitment to working from the Aboriginal world view and a strong research translational pathway. It will explain the significance of strong community commitment and the extensive organisational and community collaboration. Method: A desire based approach to narrative inquiry through an Indigenous lens is a key feature of this process. Through analysis of the current context of perinatal mental health screening among Indigenous mothers and fathers, the perspectives of three separate target groups has been included: that of Indigenous women, Indigenous fathers and health professionals involved in routine perinatal care. Data triangulation of results included a state-wide online questionnaires and thematic analysis of semi-structured interviews with health professionals, ‘yarning’ sessions with Indigenous women and fathers, extensive analysis of current screening surveillance data through a cultural lens and metasynthesis of current literature. Findings: Emergent from this process is the touch screen image driven screening and assessment ‘rubric’ called ‘Baby Coming-You Ready?’. It embodies four key elements: good engagement, a sense of safety, a trusting relationship, and the capacity to embrace the strengths in the Aboriginal and Torres Strait peoples cultural viewpoint which is central to family/community centred-care. This goes far beyond current woman/family-centred care. Culture is fluid, traditional roles/expectations are changing and many Indigenous Australian fathers are becoming increasingly vulnerable as a result. Therefore developing a parallel version of the ‘Baby Coming-You Ready? rubric for fathers was considered vital. Conclusion: Widespread community acceptance to this innovative approach to perinatal mental health screening and primary prevention is now possible as the ‘Baby Coming-You Ready?’ rubric is being piloted across the health care sector.

Lavrencic, L., et al. (2019). Cognitive test norms and comparison between healthy ageing, mild cognitive impairment, and dementia: A population‐based study of older Aboriginal Australians.  Australian Journal of Psychology – Wiley Online Library
The prevalence of dementia and cognitive impairment is higher in Aboriginal Australians compared to the national population, increasing the need to understand cognitive impairment in this at‐risk population. This article reports normative data for a range of commonly used cognitive tests, in a population‐based small normative sample of older Aboriginal Australians living in urban/regional New South Wales.

Le Grande, M., Ski, C.F., Thompson, D.R., Scuffham, P., Kularatna, S., Jackson, A.C. &  Brown, A. (2017). Social and emotional wellbeing assessment instruments for use with Indigenous Australians: A critical review, Social Science & Medicine, 187, 164-173. Doi: 10.1016/j.socscimed. 2017.06.046

Rationale: There is growing recognition that in addition to universally recognised domains and indicators of wellbeing (such as population health and life expectancy), additional frameworks are required to fully explain and measure Indigenous wellbeing. In particular, Indigenous Australian wellbeing is largely determined by colonisation, historical trauma, grief, loss, and ongoing social marginalisation. Dominant mainstream indicators of wellbeing based on the biomedical model may therefore be inadequate and not entirely relevant in the Indigenous context. It is possible that “standard” wellbeing instruments fail to adequately assess indicators of health and wellbeing within societies that have a more holistic view of health. Objective: The aim of this critical review was to identify, document, and evaluate the use of social and emotional wellbeing measures within the Australian Indigenous community. Method: The instruments were systematically described regarding their intrinsic properties (e.g., generic v. disease-specific, domains assessed, extent of cross-cultural adaptation and psychometric characteristics) and their purpose of utilisation in studies (e.g., study setting, intervention, clinical purpose or survey). We included 33 studies, in which 22 distinct instruments were used. Results: Three major categories of social and emotional wellbeing instruments were identified: unmodified standard instruments (10), cross-culturally adapted standard instruments (6), and Indigenous developed measures (6). Recommendations are made for researchers and practitioners who assess social and emotional wellbeing in Indigenous Australians, which may also be applicable to other minority groups where a more holistic framework of wellbeing is applied. Conclusion: It is advised that standard instruments only be used if they have been subject to a formal cross-cultural adaptation process, and Indigenous developed measures continue to be developed, refined, and validated within a diverse range of research and clinical settings

Marley, J. V., Kotz, J., Engelke, C., Williams, M., Stephen, D., Coutinho, S., & Trust, S. K. (2017). Validity and acceptability of Kimberley mum’s mood scale to screen for perinatal anxiety and depression in remote aboriginal health care settings.

Newton, D. , Day, A. , Gillies, C. and Fernandez, E. (2015). The assessment of social and emotional well‐being in Indigenous patients. Australian Psychologist, 50, 40-50. doi:10.1111/ap.12064

Addressing low levels of social and emotional well‐being (SEWB) in Indigenous communities has been a national strategic priority for over 10 years and yet progress in assessing the impact of interventions has been slow. One of the key factors limiting the development of evidence‐based practice has been the lack of well‐validated instruments to assess SEWB and how it changes over time as a result of intervention. This article systematically reviews available measures, classifying them in terms of the evidence base that exists to support their use. It is concluded that there is an ongoing need to develop psychometrically sound, comprehensive, culturally appropriate measures to operationalise Indigenous SEWB at a population health, programme evaluation, and clinical level. It is suggested that seven pathways be followed to achieve this goal, including the need to recognise that the gold standard status for Indigenous measurement tools cannot be ascribed based on evidence‐based assessment criteria alone.

Stephens, A., Bohanna, I., & Graham, D. (2017). Expert Consensus to Examine the Cross-Cultural Utility of Substance Use and Mental Health Assessment Instruments for Use with Indigenous Clients. Evaluation Journal of Australasia, 17(3), 14-22. https://doi.org/10.1177/1035719X1701700303

Evaluation of minority-culture specific treatment centres for substance use and mental health is challenging. The challenge is compounded by a paucity of validated instruments for assessing substance use and mental ill health. In the field of Australian Indigenous alcohol and other drug service provision there are few guidelines to determine which instruments should be targets for validation for use with Indigenous clients. As such, reliable, validated, evaluable data on the client population is limited, posing multifaceted concerns for clinicians and service providers as well as evaluators. The aim of this study was to pilot the use of a participatory expert consensus approach to evaluate, rate and select suitable majority-culture substance use and mental health assessment instruments for use with their clients. Eight practitioners of an Indigenous-specific substance misuse residential treatment centre participated. The findings reinforce the value of consensus approaches for stakeholder engagement and to provide a sense of ownership of the results. In this setting, consensus on the implementation of an agreed set of Indigenous-specific and non-Indigenous specific instruments improved the ownership of the instruments by clinicians allowing for the use of valid and/or reliable instruments that also had good face validity. This makes it more probable that reliable client wellbeing data will be collected. This is crucial to program evaluation at a later point in time. This study was a novel approach to generating evidence to inform practice in the absence of normative practice guidelines.