Recent reviews of standard SEWB instruments (Black et al. 2018; LeGrande, et al., 2017, Newton, et al. 2015) identified few SEWB measures specifically developed for use with Indigenous people and emphasised the need for a formal cross-cultural adaptation process when using existing tools. Even tools developed for and by Indigenous people may require further research and refinement to ensure they are validated for Aboriginal and Torres Strait Islander diverse consumers, needs, settings and regions.
The following tools have been culturally validated.
Gee, G., Boldero, J., Dwyer, J., Egan, J., Holmes, L., Hulbert, C., Mobourne, A., Paradies, Y., & Kennedy, H. (2019). Understanding resilience and recovery from trauma in an urban Aboriginal Australian community: Development of the Aboriginal Resilience and Recovery Questionnaire. (in preparation). For more information, please contact Dr Gee on 0416 827 467 or firstname.lastname@example.org.
Aboriginal and Islander Mental Health Initiative (AIMhi) NT
Indigenous people with mental illness are subject to a range of complex and interrelated issues which can contribute to their social disconnection. The Aboriginal and Islander Mental health initiative (AIMhi)was conducted by the Menzies School of Health Research and the Remote Alcohol and Other Drugs Workforce Program with Aboriginal people to address these complex needs. It has developed resources including mental health assessment and brief wellbeing screening tools and training to support a culturally adapted strengths-based approach to assessment and early intervention which are used in mental health, alcohol and other drug and chronic disease settings.
The following assessment tools have all been evaluated for use with Aboriginal people in the Northern Territory.
The Brief Wellbeing Screener was developed to be used with Aboriginal and Torres Strait Islander peoples. There are 10 items that allow self-report of various worries in relation to SEWB issues. They include feelings of sadness and anxiety, alcohol and other drug use, energy levels, strange thoughts, hearing voices and seeing things, violent or strange behaviours, and suicide and self-harm. The tool is not designed for use in diagnosing mental illnesses. However, it can facilitate the help-seeking process if a person is worried about any of the SEWB measures and shows where a person is at risk.
AIMhi mental health assessment form is a more detailed assessment form for use by general practitioners to obtain a previous medical history as well as the other factors that may contribute to an individual’s current mental health situation.
The e‐mental health resource (the Australian Integrated Mental Health Initiative [AIMhi] Stay Strong App). The App is designed for service providers working with Aboriginal and Torres Strait Islander people in the Northern Territory. A study by Dingwall and colleagues in 2015 showed there is strong support among service providers for the acceptability, feasibility and appropriateness of this e mental resource. Clients experience an interactive visual representation of the areas in their life where they are strong and not so strong, leading to identification of personal behavioural goals that are broken down into manageable steps. A pictorial summary of the individual’s story is provided and a copy can be emailed and printed to keep a record of the session for clients and health providers. The process is assisted and supported by the health provider, and the Stay Strong App provides help text and audio instructions for each step (Dingwall et al., 2015).
Service providers found the AIMhi Stay Strong App: 1) helped in building relationships and engaging with Aboriginal and Torres Strait Islander clients; 2) was broadly applicable across a range of clients, services, and settings; 3) as having potential as an initial screening assessment tool.
The Here and Now Aboriginal Assessment (HANAA) was developed as a culturally appropriate screening tool for social and emotional wellbeing (SEWB) and mental health issues in Indigenous adults. The HANAA is a semi-structured interview addressing 10 domains of SEWB: physical health, sleep, mood, suicide risk and self-harm, substance use, memory, unusual experiences, functioning, life stressors, and resilience. The interview focuses specifically on issues in the ‘here and now’. The tool is a screening instrument and not designed to diagnose mental health problems. However, the tool and accompanying guidelines can be used by health practitioners and Indigenous clients to assess whether a referral to more specialised services needs to be made.
A recent study of users of the HANAA demonstrated positive experiences of the tool, especially the semi-structured, narrative style of administration and simple rating system. The HANAA assessment domains showed a high level of utility and cultural applicability. Users recommended to include a domain addressing personality and to develop a child and adolescent version.
Strong Souls: Social and Emotional Wellbeing Assessment Tool
Strong Souls is a 25-item screening and research tool of social and emotional wellbeing (SEWB), specifically problems related to depression, anxiety, suicide risk and levels of resilience. There is also an 8-item version.
The tool has been used and validated in an Aboriginal Birth Cohort Study and research in substance misuse rehabilitation and prison settings and includes Factor analysis of the 25-item version found support for a four-factor model which demonstrated sound construct validity and reliability. Factor structure was consistent with the epidemiological literature, identifying constructs of anxiety, resilience, depression and suicide risk. While these align with observations in mainstream populations, different relationships between distinct factors, and differences in symptomatology were found in this population. For example, two key findings were: feelings of sadness and low mood were linked with anxiety and not depression; and the expression of anger was verified as a unique symptom of depression for Indigenous people. Strong Souls demonstrated validity, reliability and cultural appropriateness as a tool for screening for SEWB among Indigenous young people in the Northern Territory (Thomas et al. 2010).
Strong Souls is currently recommended only for research or screening purposes as the tool has not yet been validated in a clinical setting and there are currently no guidelines or manual available for its use or scoring
The Strong Souls assessment can be downloaded here.
The Ngaanyatjarra Pitjantjatjara Yankunytjatjara (NPY) Women’s Council have developed a culturally sensitive guide developed to help Aboriginal children and young people talk about mental health. The Words for Feelings Map depicts characters experiencing a range of adverse feelings and links English and Aboriginal words to express them. The Words for Feelings Map has been developed in both Ngaanyatjarra and Pitjantjatjara languages. This guide is intended to encourage children and young people to talk about their feelings and seek help when they need to. The ‘words for feelings map’ is an illustrated poster (A2 size), that is designed to help people find the right words to express different feelings, and is available for $20.