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12 INTER-CULTURAL COMPENTENCY ASSESSING HISPANIC CLERGY USING THE MMPI-2/16PF Raphael Romero, Psy.D. Los Angeles County Department of Mental Health March 7,

13 INTER-CULTURAL COMPETENCY WITH HISPANIC CLERGY - INTRUCTION Development of the MPPI-2 with Hispanics Difference in the MMPI-2 with White and Hispanic Norms Using the MMPI-2 with Hispanic clergy in the United States Uses of the 16PF-5 Brief overview Cultural Consideration Integration of identity models in psychometric assessments

14 INTER-CULTURAL COMPETENCY WITH HISPANIC CLERGY Two perspectives to consider in assessment: 1. Origination of psychiatry, psychology, assessment come from a Eurocentric worldview and culture. 2. Migration to the industrialized nations has led for the need for describe human experience beyond only a particular group or culture Views of Assessment Culture and human behavior have a relationship between culture and psychopathology that leads that personality dimensions/structures are similar across cultures Allocentrism indicates that there are certain characteristics particular to groups and not individuals within Latin American nationalities. Expression of symptoms will be different Butcher, J., Cabiya, J., Lucio, E., & Garido, M.. (2007)

15 INTER-CULTURAL COMPETENCY WITH HISPANIC CLERGY MMPI2 Which MMPI-2 do I use? Test Construction Linguistic Equivalence Will the translation have the same meaning? Construct Equivalence Will the personality concepts be applicable across cultures Psychometric Equivalence Get local norms if the cultures are very different Psychological Equivalence beyond only a particular group or culture Is the psychological meaning the same across the cultures, ie., eye contact Bias in Assessment 1. Lack of culture-specific norms 2. Tests did not originate in the target culture different values 3. Lack of standardized mechanism can t account for acculturation 4. Conducting assessments in a quantitative manner as opposed to the other information, interview and observation 5. Lack of awareness of own ethnic identity Butcher, J., Cabiya, J., Lucio, E., & Garido, M.,(2007)

16 INTER-CULTURAL COMPETENCY WITH HISPANIC CLERGY MMPI2 MMPI-2 in Cuba 50 years with effective use to address mental health problems 1993 Spanish Translation adaptation: Garcia-Azan s MMPI-2 Hispania (Garcia-Peltoniemi & Azan Chaviano, 1993) use this one MMPI-2 in Mexico 1992 Adaption at the National Autonomous University of Mexico (UNAM) G. M. E. Lucio & Reyes-Lagunes, (1996) use this one Literal translation bilingual psychologist Semantic and cultural adaptation bilingual translators External validity 90% agreement Content readjustment Back translation Butcher, J., Cabiya, J., Lucio, E., & Garido, M., (2007)

17 INTER-CULTURAL COMPETENCY WITH HISPANIC CLERGY MMPI2 MMPI-2 in Mexico Equivalence research (813 men and 1,107 women) compared to U.S. college normative sample (Butcher, Graham, Dahlstrom, & Bowman, 1990) Men and women different except on L (Lie) and 8 (Schizophrenia) as in U.S. separate norms needed Significant statistical differences between Mexican and American male university students except on 4 (Psychopathic Deviate). Largest differences in L, 2 (Depression), 6 (Paranoia) Significant differences between Mexican and American female university students, except on F (Infrequency), 1 (Hypochondriasis), and 3 (Hysteria) Largest difference in 5 (Masculinity-Femininity). Confirmed internal consistency, reliability, and discriminant validity Differences did not show elevated pathological indexes as in MMPI Butcher, J., Cabiya, J., Lucio, E., & Garido, M. (2007)

18 INTER-CULTURAL COMPETENCY WITH HISPANIC CLERGY MMPI2 MMPI-2 in Mexico General population study (2001) Norms developed in (see Appendix C) Mexican men/women scored higher than American men/women on same scales Greatest difference in CYN (Cynicism), FRS (Fears), and ASP (Antisocial Personality) FRS due to socioeconomic conditions ASP due to different things are considered antisocial in each culture Other studies results Mexican people score higher on L than Americans More inclined to project a good image collective as opposed to individualistic More traditional than American society Fear of judgment from disclosure strong family loyalty and privacy Have difficulty understanding the double negative Cantinflas Low SES, difficulty with comprehension Butcher, J., Cabiya, J., Lucio, E., & Garido, M., (2007)

19 Butcher, J., Cabiya, J., Lucio, E., & Garido, M. (2007). INTER-CULTURAL COMPETENCY WITH HISPANIC CLERGY MMPI2 MMPI-2 has been translated and adapted in other Latin American Countries Puerto Rico Argentina Chile Peru Spain Castilian High equivalence of the Castilian and U.S. versions in general populations Endorsement percentages for females and for males Provided transcultural evidence

20 INTER-CULTURAL COMPETENCY WITH HISPANIC CLERGY MMPI2 MMPI-2 in the United States with Hispanics English version of MMPI-2 use? Yes Bilingual, live, work, and attend school in the U.S. Read and comprehend English at a 6 th grade level. Code switching Hispanics that are not bilingual but monolingual Spanish use the Garcia- Azan s MMPI-2 Hispania (Garcia-Peltoniemi & Azan Chaviano, 1993) translation Include Puerto Ricans Butcher, J., Cabiya, J., Lucio, E., & Garido, M. (2007).

21 INTER-CULTURAL COMPETENCY WITH HISPANIC CLERGY MMPI2 MMPI-2 in the United States with Hispanics Recent immigrant use a translation from one of the countries closest to the country of origin. English and Spanish have booklet and audiotaped formats Mexican Version of the MMPI-2 booklet, El Manual Moderno Use U.S. norms except when using the Mexican Version or the one for Spain and Chile that have their own norms. There was a normative subset sample of Hispanic individuals No current normative sample for Spanish-speaking American population Avoid interpretation of Psychopathology Five PSY5 Scales and the Restructured Clinical Scales because they have not been researched or validated sufficiently with Hispanics or Latin American populations. Butcher, J., Cabiya, J., Lucio, E., & Garido, M. (2007).

22 INTER-CULTURAL COMPETENCY WITH HISPANIC CLERGY MMPI2 Interpretation guides with Hispanics in the United States F and L scale are slightly higher Lack of acculturation Infrequent responding (F) immigrant stress Scale 5 (Masculinity-Femininity) variable among the Hispanic groups unclear why, traditions, religion, inferiority complex, SES Machismo/Marianismo High HS (Hypochondrisasis) and HES (Health Concerns) - Somatic reporting Determination if they can read English Cannot Say (CNS) Variable (VRIN) and True (TRIN) Infrequency scales (F, Fb, and Fp) True/False percentages evaluates effort, >30% - invalid Butcher, J., Cabiya, J., Lucio, E., & Garido, M. (2007).

23 INTER-CULTURAL COMPETENCY WITH HISPANIC CLERGY MMPI2 Case Sample Pedro is a 21-year-old, single bilingual Hispanic male. Pedro was born in Orange, California, however. His heritage is from South America. Both of his parents were born in Bolivia. He had a normal birth and developmental milestones within normal limits. He described himself as an Evangelical Christian but rejected by his Catholic family. Pedro s MMPI-2 results are valid indicators of his personality functioning. However, his profile should be interpreted with extreme caution (MMPI-2: L=65) Pedro responded to all of the items on the test (MMPI-2: CANNOT SAY=0). He responded to similar items consistently (MMPI-2: VRIN=40). He did not respond randomly to the test items but was able to discriminate (MMPI-2: TRIN=50). He denied experiencing any significant pathology (MMPI-2: F=42). However, in the second part of the test, Pedro endorsed items that are relevant to one area of difficulty (MMPI-2: Fb=55). Pedro s approach to the test was defensive and presented him in a favorable light (MMPI-2: L=65).

24 INTER-CULTURAL COMPETENCY WITH HISPANIC CLERGY MMPI2 Case Sample Pedro presented himself in a very positive manner that seemed unrealistic (MMPI-2: Ma=74). He expressed that his idea of right and wrong was better than that of other people. He felt that he was unfairly mistreated by the lack of support from his mother after he changed his faith and that others that are not of his faith mistreated him (MMPI-2: Ma4=69). Pedro indicated that he was not a person that trusted others and seemed concerned that other people were not honest about their lifestyles (MMPI-2: CYN=68, RC6=65). Pedro appeared to be a person that was very focused with details and perfection. Such as, he expressed that he was a very organized person and that if, there was something that was not organized then, he would organize it because it would bother him (MMPI-2: AGGR=69, Ho=66).

25 INTER-CULTURAL COMPETENCY WITH HISPANIC CLERGY MMPI2 Case Sample Pedro s internal conflict seemed to surface in his interactions with others. He did not trust people and thought that they were selfish and uncaring but his faith required that he serve others (MMPI-2: Ma4=69, CYN2=66, Ho=66). This was evident in his inability to form any intimate relationships during his growing years and love his love above their rejection of him. There appeared to be a strong resentment toward his mother for not standing up for him when he felt persecuted by his family (MMPI-2: Ho=66). His strong devotion to his faith has led him to have higher expectations from others even when they are in authority over him (MMPI-2: Ma=74, CYN=68). For instance, Pedro stated that he did not want to be like his father but wanted his father to accept his faith. Also, he refused to attend the church connected to the Christian school he attended because it was not like the church he had grown up in. He also expressed a strong sense of confidence in his leadership with directing his younger siblings toward his faith. He said that as the older brother they would do whatever he did.

26 INTER-CULTURAL COMPETENCY WITH HISPANIC CLERGY MMPI2 Case Sample Pedro felt very committed to his faith and it appeared that it was a large source of his emotional stability. However, his internal conflict demonstrated that it is possible that Pedro felt apprehension because he had to honor his parents and do what was right but he could express his feelings toward his parents. It seemed that he withheld a lot of aggression and has done so through most of his life (MMPI-2: Ho=66). For instance, Pedro reported that when someone upset him, he would not confront the individual but waited until he became frustrated. Overall, it appeared that Pedro felt better than others because of his near death events and his faith.

27 INTER-CULTURAL COMPETENCY WITH HISPANIC CLERGY 16PF Sixteen Personality Factors Questionnaire (16PF-5) Translated into 35 languages Can be taken in several languages on their website. Developed mostly in a homogenous group - Caucasians No norms for Hispanics in the United States Many concerns with inter-cultural competency because of its development Global Scales Extraversion (A+, F+, H+, N, Q2 ) Anxiety (Goldberg s Emotional Stability reflected) (C, L+, O+, Q4+) Tough-Mindedness (Goldberg s Openness reflected) (A, I, M, Q1) Independence (Goldberg s Agreeableness reflected) (E+, H+, L+, Q1+) Self-Control (Goldberg s Conscientiousness) (G+, F, M, Q3+)

28 INTER-CULTURAL COMPETENCY WITH HISPANIC CLERGY 16PF Sixteen Personality Factors Questionnaire (16PF-5) Whitworth, R and Perry, S. (1990). Administered the 16PF to three separate groups: White Americans tested in English, Hispanics tested in English and Hispanics tested in Spanish. Greatest differences among Anglos who took it in English and Hispanics who took it in Spanish Second difference among the Hispanics tested in English and Hispanics tested in Spanish. Smallest difference among White Americans and Hispanics tested in English Gender Elevations Male scored high on scales M and QI Females scored high on scales I, L, and O

29 INTER-CULTURAL COMPETENCY WITH HISPANIC CLERGY 16PF Scale Num. of Items Anglo-E Mex-A-E Mex-A-Sp Faking Good + Faking Bad + A Warmth 11 B Reasoning 15 + C Emotional Stability 10 E Dominance 10 + F Liveliness 10 G Rule-Consciousness 11 H Social Boldness 10 +

30 INTER-CULTURAL COMPETENCY WITH HISPANIC CLERGY 16PF Scale Num. of Items Anglo-E Mex-A-E Mex-A-Sp I Sensitivity 11 + L Vigilance 10 + M Abstractedness 11 + N Privateness 10 + O Apprehension 10 + Q1 Openness to Change 14 Q2 Self-Reliance 10 + Q3 Perfectionism 10 Q4 Tension 10 + IM Impression 12 Management Whitworth, R and Perry, S. (1990).