Culturally Responsive Assessment

Person-Centered Culturally Responsive Assessment

Click here for a PDF of the Person-Centered Culturally Responsive Assessment Guide

Goals:

Assess mental health concerns from the perspective of youth and caregivers.  
Understand influences of family culture and context on mental health concerns. 
Foster an environment that allows clients and caregivers to feel safe, supported, understood, and empowered. 
Integrate symptom-based concerns and cultural and contextual understanding to inform case conceptualization and treatment planning.

Assessment starts from initial contact and continues throughout treatment. Initial contact consists of concentrated assessment to determine the appropriate course of treatment. Formal and informal ongoing assessment is used to monitor treatment progress, refine treatment course, and deepen engagement and rapport with the family.  

Youth anxiety and obsessive-compulsive disorders are notoriously hard to detect for several reasons: 

In many instances, whether anxiety is “disordered” (i.e., warrants treatment focus) or not is difficult to determine. Families can vary widely in the types of anxious behaviors that they view as normative and acceptable.   
The stereotypes of the anxious child (e.g., one who is hiding behind their parent’s leg or repeatedly washing their hands) represent only a small fraction of the ways anxiety can present in youth. Youth with anxiety can also present with behavioral dysregulation and have varying insight into their own emotional triggers, making it difficult to determine whether anxious feelings are a primary driver of youth behavioral disturbances or not.  
Given the often taboo or stigmatizing topics of OCD obsessions, many clients with OCD can experience high levels of shame about their thoughts and may even be worried that they will be institutionalized or go to jail if they disclose the content of their intrusive thoughts, leading them to conceal their symptoms.

Clients with OCD and anxiety who have had prior mental health treatment may also come into the treatment process with negative experiences.

In many cases, this may be because their anxious symptoms were not accurately detected by prior providers. Minoritized clients are at particularly high risk for being misdiagnosed (e.g., being diagnosed with externalizing or psychotic disorders instead of OCD). Therefore, it is important to create a safe environment for minoritized youth through considering cultural and contextual factors that influence expression and experiences of mental health diagnoses like anxiety and OCD.  

Conducting Person-Centered Culturally Responsive Assessment

We recommend conducting a person-centered culturally responsive assessment alongside standard structured assessment tools for anxiety and OCD.  

A person-centered culturally responsive assessment allows individuals to name their sources of identity, while avoiding stereotyping or minimizing culture to only one aspect of identity. The goal of this type of assessment is to understand the context in which mental health difficulties exist, and to make appropriate diagnoses and treatment plans that are responsive to the client’s needs and life context.  

Asking brief questions about culture and context from the beginning demonstrates that therapy is a safe place to have those conversations.  
Assessing the client and families’ cultural norms, values, beliefs, and life context is critical for avoiding making assumptions or stereotyping. This gives the clinician context for the client's experience, helps improve treatment planning, and helps the client feel understood.

Process Tips for Conducting Person-Centered Culturally Responsive Assessment

The assessment process should be flexible and follow the client’s lead. The goal is not to “get all the answers”, but to better understand your client and to create a space of safety and openness and one in which conversations about identity, cultural values and life context are normal and valued. Clients will not always feel comfortable answering questions about their culture and life context. This may relate to cultural values of privacy, fear of bad consequences, shame, or mental rehearsal or rituals, among others. Here are recommendations for responding to a client/ who is having difficulty with the assessment questions or begins to shut down:

 Pause, slow down, leave room for silences, and avoid repeated questioning (unless the client asks for clarification) as the client may see it as disrespectful. It takes time to build trust, especially for clients who have had negative experiences with mental health care in the past. In future sessions, you can come back to topics that were not previously discussed.
Normalize the challenges with sharing personal information with someone new.
- Sample Language: "It can be hard to open up about uncomfortable feeling/thoughts/ behaviors, especially to a new person. Many families struggle with this question/this experience."
Empower the client/youth by offering them options on how to proceed.
- Sample Language: "We can either skip this for now and come back to it OR I can give you more time to think. You have permission to choose either option."

The assessment can be done with the caregiver and client together or separately. Doing the assessment separately may allow both the caregiver and the client to feel more comfortable and be more open about their perspectives.