Mental health intake tools for First Nation, Inuit and Métis youth

Transcription

1 Evidence In-Sight request summary: Mental health intake tools for First Nation, Inuit and Métis youth Date: March

2 Intake & assessment tools for FNIM youth The following Evidence In-Sight report involved a non-systematic search and summary of the research and grey literature. These findings are intended to inform the requesting organization, in a timely fashion, rather than providing an exhaustive search or systematic review. This report reflects the literature and evidence available at the time of writing. As new evidence emerges, knowledge on evidence-informed practices can evolve. It may be useful to re-examine and update the evidence over time and/or as new findings emerge. Evidence In-Sight primarily presents research findings, along with consultations with experts where feasible and constructive. Since scientific research represents only one type of evidence, we encourage you to combine these findings with the expertise of practitioners and the experiences of children, youth and families to develop the best evidence-informed practices for your setting. While this report may describe best practices or models of evidence-informed programs, Evidence In-Sight does not include direct recommendations or endorsement of a particular practice or program. This report was researched and written to address the following question(s): Are there intake and assessment instruments for Canadian First Nation, Inuit and Métis youth in Ontario that have been developed by and within these communities? We prepared the report given the contextual information provided in our first communications (see Overview of inquiry). We are available at any time to discuss potential next steps. We appreciate your responding to a brief satisfaction survey that the Centre will to you within two weeks. We would also like to schedule a brief phone call to assess your satisfaction with the information provided in the report. Please let us know when you would be available to schedule a 15-minute phone conversation. Thank you for contacting Evidence In-Sight. Please do not hesitate to follow up or contact us at evidenceinsight@cheo.on.ca or by phone at Page 2

3 Intake & assessment tools for FNIM youth 1. Overview of inquiry This request is to identify any intake mental health instruments for children and adolescents that have been developed by a First Nation, Inuit or Métis population for use within their community. The organization asking the question specifically requested that the measure not be an adaptation of an existing measure or an existing measure with a separate set of norms for use with Aboriginal groups. First Nation, Inuit and Métis groups may find existing Western measures are inappropriate for use within their community. 2. Summary of findings There is not presently a Canadian-developed mental health intake questionnaire intended specifically for, and created by, First Nation, Inuit or Métis 1. Measures have been developed from the ground up in Aboriginal communities in Australia. Existing measures have been adapted to be more relevant and applicable to Indigenous groups in Canada, the United States, and Australia. These instruments, however, are received with mixed reviews as they often fail to align with preferred approaches of Aboriginal clients. First Nation, Inuit and Métis communities, as well as Indigenous groups around the world, prefer strengthsbased measures over symptom-based measures. 3. Answer search strategy Preliminary search in Google Scholar using the following terms: Canada > aboriginal > cafas, mental health intake tool aboriginal, Aboriginal > mental health > assessment tool. Website: Social and Emotional Wellbeing and Mental Health Services in Aboriginal Australia List of culturally specific screening tools ( Searched through bibliographies and reference lists of articles and documents for relevance. Found First People s Child & Family Review journal and searched back issues for relevant articles. Databases searched included: PsychInfo, PubMed, Mental Measurements Yearbook, Health and Psychosocial Instruments, Medline. 4. Findings Three broad themes emerge in the literature in regard to mental health measures for use with Indigenous populations: 4.1 Measures developed for use with Indigenous groups from existing measures. These are examined to determine the constructs measured then are edited for wording and to reflect constructs envisioned by Indigenous groups using the measure. Alternatively, measures in this category are not altered in any way but have had separate norms classified for indigenous clients by examining differences between scores of Indigenous and non- Indigenous clients. Examples: Child and Adolescent Functional Assessment Scale (CAFAS) Reasons for Living ( RFL or RFL-A) Patient Health Questionnaire, depression module only (PHQ-9) Lakota Grief Experience Questionnaire Australian Early Development Index (AEDI) Indigenous Adaptation 1 The Centre of Excellence uses First Nation, Inuit and Métis as a term for these communities within Canada. When referring to literature outside of Canada we use the term Indigenous. Additionally, we use the term Aboriginal is used if it was the term used in a specific body of literature. Page 3

4 Intake & assessment tools for FNIM youth 4.2 Measures developed from the ground up to keep aboriginal context in mind and developed in close collaboration with the Indigenous communities in which the measures are intended to be used. Examples: Here and Now Aboriginal Assessment (HANAA) Westerman Aboriginal Checklist Youth (WASC-Y) Indigenous Risk Impact Screen (IRIS) Strong Souls 4.3 There is ample caution in the literature concerning developing mental health tools for use with Indigenous populations because culturally relevant measures can be inherently flawed even if they are developed, from the ground up, by Indigenous communities. Even though instruments may be created within the context and in terms relevant to the community for which they were developed, they still measure a Western definition of illness (Drew et al, 2010; Kowal, 2007). The definition of a disorder itself may be incongruent with Indigenous beliefs and worldview. Swan and Raphael (1995) stated It is important also to recognize that for Aboriginal people mental health is holistic, bound up in the social, emotional, spiritual and cultural life of people and communities (p.193). Spirituality/religion is mentioned in an appendix in the DSM, suggesting culture is an afterthought. In Indigenous cultures, contrarily, spirituality is a central, principal component of health and wellness (Dingwall et all, 2010). Novins (2004) noted concerns to using mainstream (Western) approaches for measuring mental illness for Alaskan Indian/Alaskan Native communities, with a major weakness to these approaches being the clinical conceptualization of mental health being rooted in problems rather than strengths. In a program evaluation of a mental health program for First Nation youth in Ontario, Dilico Anishinabek found the CAFAS items are not culturally relevant, adjustments due to relocation from remote locations or any questions specific to Anishinabek expressions/practices (Borg et al, 2011). In a study with Indigenous Australian youth, Stathis (2008) cautioned against the use of the Massachusetts Youth Screening Instrument Version 2 (MAYSI-2) as Indigenous young people often seemed confused about the underlying concepts of a number of questions asked, including the nature of the questions, their structure and vocabulary used. Western definitions tend to focus on the individual, while Indigenous cultures are more rooted in community identity (Drew et al, 2010). Page 4

5 Table 1 Summary overview of measures found that have been used, adapted for, or developed for use with Aboriginal communities Measure Name and country Author(s)/ Developer(s ) Date Construct(s) measured Purpose/ Objective(s) Population (s) measured Contact information Method of development Child and Adolescent Functional Assessment Scale with Aboriginal Children and Youth (Canada) Hodges, K. Aboriginal admin manual. Barwick, M. A. Dilico Ojibbway Child and Family Services & Hodges, K Aborigin al admin manual: 2004 School/work, home, and community role performance, behaviour towards others, moods/emotions, self-harmful behaviour, substance use, and thinking problems. Used to assess the degree of functional impairment in children and adolescents with emotional, behavioural, or substance use problems Children and adolescent s ages 5 to 19. Multi-Health Systems Inc Victoria Park Ave. Toronto, Ontario M2H 3M6 Phone: Fax Special Guideline for Rating the CAFAS with First Nations Children and Youth. Developed in collaboration between CAFAS in Ontario and Dilico Ojibway Child and Youth Services. Reasons for Living Adolescent (United States) Osman, Downs, Kopper, Barrios, Besett, Linehan, Baker, & Osman 1998 Future optimism, suicide-related concerns, family alliance, peer acceptance and support, selfacceptance. Develop a selfreport measure that focuses on adaptive factors that are relevant to the assessment of adolescent suicidal behavior. Adolescent s ages Measure: Augustine Osman, University of Texas at San Antonio Phone: (210) Augustine.Osman@ utsa.edu Article: Thomas Crofoot Telephone: tcrofoot@ ewu.edu Measure was not developed for aboriginals. Measure was cited as being useful (Crofoot, 2002) and modifiable to be a bit more specific, but as it exists is a promising tool because of its strengths based, global focus approach. Patient Health Questionnaire Lowe B, Kroenke K, 2004 Depression To determine the likelihood that an Adults Article: Dr Danielle Esler, Four focus groups were held in

6 (depression module only) (Australia) Herzog W, Grafe K (measure) Article: Esler, Johnson, Thomas 2007 individual has a danielleelser@ diagnosable Intake & assessment tools for hotmail.com FNIM youth disorder. an urban, Aboriginal communitycontrolled health service. Explored participants attitudes to screening for depression and the specific components of PHQ-9. Lakota Grief Experience Questionnaire (United States) Yellow Horse Brave Heart, M Sadness, Grief, Pride, Anger, Hopelessness, Shame, Helplessness, Joy, Guilt Designed for measuring various components of grief, including somatic reactions, general grief reactions, search for explanation, loss of social support, stigmatization, guilt, responsibility, shame, rejection, self-destructive behavior, and reactions to a unique form of death. Adults Maria Yellow Horse Brave Heart Research Associate Professor University of New Mexico mbraveheart@salud.un m.edu Measure adapted to better suit native needs. No information provided on modifications (e.g. what modifications were made or how what needed to change was determined) Australian Early Developmenta Silburn, S., Brinkman, S., Ferguson Physical health and wellbeing, social A holistic measure covering five developmental Children in their first year of Professor Sven Silburn Head, Developmental Health and Education Qualitative investigation involved focus Page 6

7 l Index Indigenous Adaptation (Australia) Here and Now Aboriginal Assessment (Australia) Westerman Aboriginal Symptom Checklist- Youth (Australia) Hill, S., Styles, I., Walker, R. and Shepherd, C. competence, emotional maturity, language and cognitive development, and communication skills and general knowledge Lyons, Z General wellbeing, physical health, anxiety, depression, suicide risk, substance use, psychotic experiences, functioning, contextual issues and resilience. Westerman, T.G 2003 Depression, suicidal behaviours, drug and alcohol use, impulsivity, anxiety and cultural resilience domains: physical school. Research health and Intake & assessment tools for Menzies FNIM youth School of wellbeing, social Health Research competence, PO Box emotional maturity, Casuarina NT 0810 language and cognitive skills, and du.au communication skills Telephone: (08) 8922 and general 7897 knowledge Fax: (08) The screening tool assesses the social and emotional wellbeing of Aboriginal people, focusing on the mental and physical health of the respondent. To determine relevant population level risk and protective factors known to increase and moderate the risk of suicidal behaviours, Age not specified Australian Aboriginal Youth ages Adult version available for those Zaza Lyons Assistant Professor Telephone: Aleksandar Janca Telephone: edu.au Indigenous Psychological Services groups and interviews with over 50 Western Australian Indigenous teachers and other Indigenous school personnel such as Aboriginal and Islander Education Officers and Aboriginal Teacher Assistants. Developed in close consultation with Aboriginal people. First culturally and scientifically validated psychological test that has been developed specifically for use with Aboriginal Page 7

8 Indigenous Risk Impact Screen (Australia) Strong Souls Schlesinger, C.M., Ober, C., McCarthy, M.M., Watson, J.D., & Seinen, A. Thomas, A., Cairney, S., 2007 Drug and alcohol use and mental health 2010 Social and emotional well- depression, anxiety, 18+ Australian youth alcohol and Intake drug & use assessment tools for FNIM youth in Aboriginal people. and is the first such measure for Indigenous youth worldwide (Canadian Health, 2009). Developed to screen for both alcohol and drug and mental health issues, with the broad aim of (i) case finding at risk individuals, (ii) providing timely advice to clients about the potential risk and (iii) enabling Aboriginal and Torres Strait Islander and mainstream substance misuse and health agencies to better respond to client needs and provide appropriate and timely referrals. Designed to assess social and emotional Aboriginal adults who were able to speak English multilingua l with Carla M. Schlesinger Carla_Schlesinger@ health.qld.gov.au qld.gov.au/atod/ prevention/iris.asp Sheree Cairney, Menzies School of Health Developed specifically for use with aboriginal population. Ober is an Islander by birth with kinship ties in the Aboriginal communities of Cherbourg, Palm Island, the Torres Strait Islander community of Saibai and Vanuatu in the Pacific Islands. Developed for young Indigenous Page 8

9 (Australia) Gunthorpe, W., Paradies, Y. and Sayers, S. being for problems related to depression, anxiety, suicide risk and levels of resilience. wellbeing in English as Research, Institute of Indigenous Intake & assessment a non- tools for Advanced FNIM youth adolescents. The four factors relate to anxiety, resilience, depression and suicide risk. primary language and they generally had poor English literacy. Australian aboriginal youth ages Studies, Charles Darwin University, PO Box 41096, Casuarina, NT 0811, Australia; sheree.cairney@ menzies.edu.au Territorians with the help of these young people themselves Page 9

10

11 Intake & assessment tools for FNIM youth 5. Next steps and other resources Knowing what works and receiving training on an evidence-informed practice or program is not sufficient to actually achieve the outcomes that previous evaluations indicate are possible. A program that has been shown to improve mental health outcomes for children and youth but that is poorly implemented will not achieve successful outcomes (Fixsen et al, 2005). In order for a program to be evidence-informed, it needs to be applied with fidelity to the design and it needs to be implemented using supportive drivers related to staff competency, organizational leadership and organizational capacity. These drivers include assessing and monitoring the outcomes of your practice using evaluation or performance measurement frameworks, which are particularly important when there is insufficient evidence in the literature to guide clinical decisions. Choosing a practice is an initial step toward implementation, but the implementation drivers are essential to ensure that the program reaches appropriate clients, that outcomes are successful and that clinical staff members are successful in their work. The Ontario Centre of Excellence for Child and Youth Mental Health has a number of resources and services available to support agencies with implementation, evaluation, knowledge mobilization, youth engagement and family engagement. For more information, visit: or check out the Centre s resource hub at For general mental health information, including links to resources for families: Page 11

12 Intake & assessment tools for FNIM youth References Ackerson, L. M., Dick, R. W., Manson, S. M., & Baron, A. E. (1990). Properties of the Inventory to Diagnose Depression in American Indian Adolescents. Journal of the American Academy of Child & Adolescent Psychiatry, 29(4), Barrett, T. W., & Scott, T. B. (1989). Development of the Grief Experience Questionnaire. Suicide and Life-Threatening Behavior, 19(2), Barwick, M. A. Dilico Ojibbway Child and Family Services & Hodges, K (2004). Culturally competent evaluation: Clinical considerations for rating the Child and Adolescent Functional Assessment Scale (CAFAS ) with Aboriginal children and youth. Toronto, ON: The Hospital for Sick Children. Borg, D., Bennett, T., & Pittis, R. (2011). Assessment and Brief Treatment Residential Services: Examining best practices in residential programs and developing a method of evaluating outcomes through the analysis of empirical evidence pertaining Assessment and Brief Treatment Residential Services at Dilico Anishinabek Family Care. Thunder Bay, ON: Dilico Anishinabek Family Care. Retrieved from: _Final_Outcomes_Report.pdf Crofoot Graham, T. L. (2002). Using reasons for living to connect to American Indian healing traditions. Journal of Sociology and Social Welfare, 29(1), Dingwall, K. M., & Cairney, S. (2010). Psychological and cognitive assessment of Indigenous Australians. Australian & New Zealand Journal of Psychiatry, 44(1), Drew, N., Adams, Y., & Walker, R. (2010). Issues in mental health assessment with indigenous Australians. In N. Prudie, P. Dudgeon, & R. Walker (Eds.), Working together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice (pp ). Canberra, ACT: Department of Health and Ageing. Eley, D., Hunter, K., Young, L., Baker, P., Hunter, E., & Hannah, D. (2006). Tools and methodologies for investigating the mental health needs of Indigenous patients: it's about communication. Australasian Psychiatry, 14(1), Esler, D., Johnston, F., Thomas, D., & Davis, B. (2008). The validity of a depression screening tool modified for use with Aboriginal and Torres Strait Islander people. Australian and New Zealand Journal of Public Health, 32(4), Esler, D. M., Johnston, F., & Thomas, D. (2007). The acceptability of a depression screening tool in an urban, Aboriginal community-controlled health service. Australian and New Zealand Journal of Public Health, 31(3), Jonk, L. B. (2009). Using a Western-based survey to assess cultural perspectives of Dene mothers in northern Manitoba. First Peoples Child & Family Review, 4(2), Page 12

13 Intake & assessment tools for FNIM youth Kowal, E., Gunthorpe, W., & Bailie, R. S. (2007). Measuring emotional and social wellbeing in Aboriginal and Torres Strait Islander populations: an analysis of a Negative Life Events Scale. Internationl Journal for Equity in Health, 6(1), Linehan, M. M., Goodstein, J. L., Nielsen, S. L., & Chiles, J. A. (1983). Reasons for staying alive when you are thinking of killing yourself: the reasons for living inventory. Journal of Consulting and Clinical Psychology, 51(2), Lowe, B., Kroenke, K., Herzog, W., & Grafe, K. (2004). Measuring depression outcome with a brief self-report instrument: sensitivity to change of the Patient Health Questionnaire (PHQ-9). Journal of Affective Disorders, 81(1), Mitchell, C. M., O'Nell, T. D., Beals, J., Dick, R. W., Keane, E., & Manson, S. M. (1996). Dimensionality of Alcohol Use Among American Indian Adolescents: Latent Structure, Construct Validity, and Implications for Developmental Research. Journal of Research on Adolescence, 6(2), Osman, A., Downs, W. R., Kopper, B. A., Barrios, F. X., Baker, M. T., Osman, J. R. et al. (1998). The reasons for living inventory for adolescents (RFL-A): Development and psychometric properties. Journal of Clinical Psychology, 54(8), Overmars, D. (2010). Diagnosis as a naming ceremony: Caution warranted in use of the DSM-IV with Canadian Aboriginal Peoples. First Peoples Child & Family Review, 5(1), Schilesinger, C. M., Ober, C., McCarthy, M. M., Watson, J. D., & Seinen, A. S. (2007). The development and validation of the Indigenous Risk Impact Screen (IRIS): a 13-item screening instrument for alcohol and drug and mental health risk. Drug and Alcohol Review, 26(2), Silverburn, S., Brinkman, S., Ferguson-Hill, S., Styles, I., Walker, R., & Shepherd, C. (2009). The Australian Early Development Index (AEDI) Indigenous adaptation study Perth: Curtin University of Technology and Telethon Institute for Child Health Research. Stathis, S., Letters, P., Doolan, I., Fleming, R., Heath, K., Arnett, A., & Cory, S. (2008). Use of the Massachusetts Youth Screening Instrument to assess mental health problems in young people within an Australian youth detention centre. Journal of Paediatrics and Child Health, 44(7-8), Stathis, S. L., Doolan, I., Letters, P., Arnett, A., Cory, S., & Quinlan, L. (2012). Use of the Westerman Aboriginal Symptoms Checklist--Youth (WASC-Y) to screen for mental health problems in Indigenous youth in custody. Advances in Mental Health, 10(3), 235. Sullivan, L. (2012). Creating a culturally appropriate "basket of tools". FNHMA National Conference, Vancouver, BC. Swan, P., & Raphael, B. (1995). Ways Forward: National Aboriginal and Torres Strait Islander Mental Health Policy. National Consultancy Report. Canberra: AGPS. Page 13

14 Intake & assessment tools for FNIM youth Tagalik, S., Joyce, M., Brackenbury, J., Centre of Excellence for Children & Adolescents with Special Needs., Nunavut Task Force on Mental Health., & Gibson Library Connections, I. (2006). The feasibility and applicability of the Australian (WASC-Y) model of suicide prevention/intervention for use in Nunavut. Thunder Bay, ON: Centre of Excellence for Children & Adolescents with Special Needs. Thomas, A., Cairney, S., Gunthorpe, W., Paradies, Y., & Sayers, S. (2010). Strong Souls: development and validation of a culturally appropriate tool for assessment of social and emotional well-being in Indigenous youth. Australian & New Zealand Journal of Psychiatry, 44(1), Westerman, T. (2010). Engaging Australian Aboriginal youth in mental health services. Australian Psychologist, 45(3), Yellow Horse Brave Heart, M. (1998). The return to the sacred path: Healing the historical trauma and historical unresolved grief response among the Lakota through a psychoeducational group intervention. Smith College Studies in Social Work, 68(3), Page 14