Multicultural Considerations in Assessment & Treatment- Reflections from Int'l School Psychologists

By Ali Gribi and Erika Schmitt

At Linden Global Learning, we have the privilege of working with students and families from widely diverse cultural, linguistic, and geographical backgrounds. This unique opportunity of getting to know children from all over the world comes with an important responsibility to actively reflect on how diversity affects our clinical and educational practices. Through our collective years of experience and the international perspective of our team at Linden, we recognize that access to quality assessment and intervention services is critical for positive development and equitable learning opportunities. We’ve pulled together eight considerations for working internationally that we find to be essential for serving multicultural communities as school psychologists.

Educational Practices

Educational practices vary greatly from country to country. Firstly, the school calendar and length of school day children experience can be different. Depending on the country, children start and end school at different ages and education may not be universal or compulsory. Grades are another educational practice to consider, with some countries emphasizing qualitative over quantitative marks. Marks may be based on a letter system, as in the United States or the United Kingdom, a number system, as in Spain or Germany, or some other method. Expectations about behavior management and discipline at school and home are also culturally relevant. Perhaps most important to remember is that the role of the school and the family is often conceptualized differently from culture to culture.

Questions to ask yourself:

• How much schooling has the student received to date and does their academic performance reflect that?

• Does the educational record provide information to shape the current intervention?

• In the student’s home country, who normally provides the services I am providing?

Curriculum

The academic trajectory often varies between countries, and one must not assume that academic or social skill development can be standardized across all school experiences. For example, in the United States literacy development is an early focus, with many students learning letters and letter sounds, along with other phonics and phonemic skills in preschool and kindergarten. This differs from the German education system, which prioritizes social rather than academic skill building in the first years of schooling. Additionally, different countries teach and prioritize different foreign languages and may or may not make them mandatory. For example, studying a second foreign language for at least one year is compulsory in more than 20 European countries, while students in the United States may not have to learn a foreign language until high school, if at all.

Questions to ask yourself:

• Have I gathered enough information from the student’s educational team to understand and assess curricular expectations?

• How is skill development monitored and assessed in the school setting?

• What are considered to be core subjects, and which skill sets are prioritized (e.g. social skills vs. academic skills)?

Mental Health Stigma

Different nations and cultures have vastly different approaches to mental health services and supports. It is important to be aware of the potential stigma that may surround seeking and receiving treatment. According to the World Health Organization, “Many people with mental health problems choose not to engage or maintain contact with mental health services, due to stigma and discrimination. Negative treatment and care experiences are another factor contributing to failure to engage” (2014). Working with families who may be facing societal discrimination requires heightened sensitivity and careful planning through the assessment and treatment process. Certain developmental or background information may be off limits, and treatment options may need to be more discreet.

Questions to ask yourself:

• What do I already know/can I find out about familial views on mental health diagnosis and treatment?

• Is there information the student or the student’s family may feel uncomfortable sharing? If so, will I be able to gather enough information to adequately assess the student and their needs?

• What can I do to combat negative perceptions related to seeking support and initiating services?
  

Ethnocentrism

“Ethnocentrism refers to the natural tendency or inclination among all people to view reality from their own cultural experience and perspective” (Paniagua & Yamada, 2013). Western nations are largely viewed as the dominant culture, and westernized cultural norms are often applied when attempting to evaluate what is typical vs. atypical. As an example, rates in ADHD diagnosis are vastly different across the world, representing discrepant cultural views on behavior and illness (Paniagua & Yamada, 2013). As practitioners, we must try to be as objective as possible and routinely question our assumptions and biases.

Questions to ask yourself:

• What assumptions have I made about the student’s performance or behaviors?

• How might the student’s cultural experience differ from my own?

• What information am I using to judge typicality vs. atypicality?

Acculturative Stress

Acculturative stress commonly results from attempts to integrate into a new culture with differing demands, expectations, and practices. While this stress in and of itself is not always problematic, “if the pressures of migration and acculturation exceed the resources available for coping, then maladaptation and maladjustment may occur” (Paniagua & Yamada, 2013). When working with students with diverse cultural experiences, it is important to investigate whether or not this type of stress may be impacting their current presentation and functioning. Comprehensive development and historical background questionnaires and interviews may help to suss out some challenges with immigration and assimilation.

Questions to ask yourself:

• Has the student recently experienced a move or transition out of a familiar environment? If so, what prompted the move?

• What resources or support systems are available to the student to assist with their transition into a new cultural context?

Multilingualism

Students who come from multilingual homes or participate in multilingual settings require special consideration. When switching between languages, they might confuse vocabulary, grammar, and sometimes pronunciation, but this is not unusual. It is better to wait for students to gain mastery, or at least a firm foundation, in their first and/or second language before introducing another. Additionally, practitioners must remember to keep native languages in mind when testing and choose appropriate assessment tools. It can be challenging to find current, quality instruments in a child’s native language, as many tools are normed on North American, English speaking populations. For example, when administering math assessments that involve currency or non-metric units, students may be missing the vocabulary or culturally-specific knowledge needed to complete certain items. In this event, they may require added explanation, revised visuals, or equivalency charts to adequately assess their skills. Note exceptions like these in reports and interpret results with caution.

Questions to ask yourself:

• Which languages has the student learned/is the student learning and how long have they been speaking these languages?

• Which assessment tools are available?

• Does the student have enough proficiency to test in the best language of the assessor? Does the assessor have enough proficiency to test in the best language of the student?
  

Home-School-Community Partnerships

It is important to build strong bridges between a student’s home, community, and school. These partnerships become even more critical when a student finds him or herself in a new setting. To ensure the highest quality of services, working with interpreters or translators may be necessary. This is especially important when reviewing records and conducting interviews. When creating treatment plans, it is likely that the assessor will not be the one implementing all of the interventions that the child needs. Building rapport with the school, family, and community is important in the assessment process so that when the time comes to deliver results and recommendations, all parties understand the plan and are willing to work together to see it through. Maintaining these relationships over time is equally as important so that the team can come together to monitor progress and make adjustments to the plan as needed.

Questions to ask yourself:

• Has the school been in touch with members of the home? Have multiple school professionals tried to reach out?

• Has the school provided flexible availability options to meet the student’s caregivers?

• Do you have an accurate understanding of where the student is living (e.g., With whom? In which neighborhood?) and what that setting is like (e.g., Is there a place for the student to study? What is the student’s commute to school?)?

Cultural Sensitivity

There exist boundless cultures and subcultures, even within our own communities. Research the student’s environment and listen. Listen to the student and the members of their family and community. Being humble and open-minded is at the core of cultural competence. Even when treating a student from one’s own culture, it is important to consider regional and ethnic differences. Thinking about a student’s background is a good first step in contextualizing their reality. Such differences may be things that they are grappling with in their new setting. Remember, also, that the student and his or her family may still be learning about the culture they currently find themselves in!

Questions to ask yourself:

• What religions are practiced in the student’s home or community?

• What is access to healthcare like?

• Is their diet different?

In sum, multicultural service delivery requires careful attention, thoughtful planning, and sensitivity. As practitioners, we must continue to educate ourselves, challenge our assumptions and biases, and build meaningful partnerships with our students and stakeholders in order to work toward our shared goals.

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References:

Paniagua, F. A., & Yamada, A.-M. (2013). Handbook of multicultural mental health assessment and treatment of diverse populations. San Diego (Calif.): Academic Press.

Pew Research Center (2015). Learning a foreign language a ‘must’ in Europe, not so in

America. Retrieved from https://www.pewresearch.org/ fact-tank/2015/07/13/learning-a-

foreign-language-a-must-in-europe-not-so-in-america/.

World Health Organization (2014). Stigma and discrimination. Retrieved from

http://www.euro.who.int/en/health-topics/noncommunicable-diseases/mental-health/priority-areas/stigma-and-discrimination.